Breast augmentation is a surgical technique that enlarges or changes the shape of the breasts using implants or fat grafts (fat that is taken from another part of the body and transferred to the breast). Breast augmentation surgery can be done for both cosmetic and reconstructive purposes.
There are numerous options for breast augmentation that can help you achieve the outcome you want, but it is important to find a skilled plastic surgeon who can help you decide what kind of augmentation is best for you.
The following is a list of what makes a good candidate for breast augmentation surgery:
- You are in good overall health
- You do not have any major medical problems (however, breast augmentation may be done for breast reconstruction after mastectomy)
- You are 18+ years old for saline implants or 22+ years old for silicone implants
- You are informed about the risks and benefits associated with the procedure
- You have realistic expectations
Not everyone is a good candidate for breast augmentation surgery. You may not be a good candidate if:
- You have serious or ongoing medical issues
- Your breasts haven’t fully developed (women under the age of 22)
- You have unrealistic expectations
- You are getting the surgery to please or impress someone else, not for yourself
If you want to learn whether you are a good candidate for breast augmentation, schedule a consultation with a board-certified plastic surgeon.
According to the American Society of Plastic Surgeons, breast augmentation is the most popular cosmetic surgical procedure in the US, with more than 300,000 women undergoing the procedure every year. In addition, more than 100,000 women have reconstructive breast surgery every year.
Data have consistently shown that the majority of women who undergo breast augmentation surgery under the care of a skilled surgeon enjoy increased self-confidence and quality of life after the surgery. However, breast augmentation is not without risk and there are patients who are dissatisfied after their surgery, underscoring the importance of being fully informed and having realistic expectations.
Here are some common things women who have had breast augmentation wish they knew before having the operation:
- Implants may not last a lifetime. Many plastic surgeons recommend that your implants be replaced every 10-15 years.
- Breast implant removal may affect your breasts. Although uncommon, breast implant removal may cause pain, asymmetry, scar tissue development, and other complications.
- Improperly sized implants or poorly performed surgery can give your breasts a “fake” appearance. The best way to avoid these issues is to work with a board-certified plastic surgeon who has consistently demonstrated outstanding results.
- Implants require monitoring. Ruptured implants require prompt treatment.
- The surgery will leave small scars. Plastic surgeons do their best to minimize scarring, but they cannot eliminate them.
- Pregnancy, menopause, and weight loss may affect implant appearance.
- Your body type can influence how your surgery is performed. Incision placement may be determined by your body type.
- When in doubt, opt for the smaller implant. You can always increase the size later.
- Implants do not feel like real breasts. Although modern implants can feel very similar to natural breast tissue, they have different weights and densities than natural breast tissue.
- You can’t go from small to large immediately. Petite women in particular may need to gradually increase the implant size over a period of time.
- Augmentation may affect your ability to breastfeed. Although it is rare that women with implants are unable to breastfeed, they may reduce the amount of milk that is produced.
- Nipple sensation may be reduced or lost after breast augmentation.
- Your posture might be affected. Large breasts may be heavy, which can affect your posture and may cause back or neck pain.
- Mammograms can be tricky. Saline and silicone implants may obscure mammogram images.
- Aging may affect your implants. Aging is associated with loss of tissue elasticity and sagging skin that may affect the appearance of your implants.
There are many options for breast augmentation and understanding how to choose the right type for you can be overwhelming. Working with an experienced plastic surgeon is the best way to make sure that you get the results you want with the most appropriate implants for your body.
Among the considerations you and your doctor should discuss are:
- Implant type (saline, silicone)
- Implant size
- Implant texture (smooth, textured)
- Implant shape (round, teardrop)
- Implant placement (over or under the muscle)
- Incision type
- Your desired breast profile
- Whether to have a breast lift
Each of these will be discussed in detail below.
Most breast implants will be saline or silicone, each of which have advantages and disadvantages. Your surgeon may recommend one type over the other based on your circumstances.
|Length of Incision||Approx. 2.5 cm||Approx. 3.5 to 4 cm|
|Implant Surface||Both textured and smooth surfaces are available||Both textured and smooth surfaces are available|
|Feel||Soft particularly in patients that are not very thin. In thinner patients, they may feel firmer and ripple more than silicone implants.||Soft and more natural feeling than with saline implants. The consistency more like breast tissue.|
|Risk of “rippling”||More common than with silicone implants especially in thin patients.||Less likely than with saline implants.|
|Rupture||Easy to detect||More difficult to detect|
|Average Lifespan||Implants are made to last a lifetime and are warrantied by the manufacture for life. Patients are told there is a .5% chance per year of having an implant-related issue.||Implants are made to last a lifetime and are warrantied by the manufacture for life. Patients are told there is a .5% chance per year of having an implant-related issue.|
|Cost||Cost less than silicone||Cost slightly more than saline implants|
Cohesive gel implants, sometimes referred to as “Gummy bear” implants, are another option available for breast augmentation patients. They have a silicone shell that encases a firmer composition of silicone. If they were cut in half, the gel would still hold its shape due to the cohesiveness of the gel. Unlike traditional silicone-based breast implants, gummy bear implants retain their shape even if their shells are broken.
- They hold their shape longer
- They’re less likely to fold or ripple
- They’re less likely to leak
- They offer a more natural look
- They may lower the risk of capsular contracture (excessive scar tissue development)
- They could move out of place
- They’re relatively new so we are still learning about their long-term performance
- They may be associated with serious health complications
- They cause more prominent scarring
- They’re more expensive
Most women think of breast size in terms of cup size. Unfortunately, bra cup sizes are not standardized (meaning that a 34C bra from two brands may be very different sizes). Breast implants are measured by volume, which is a very accurate sizing method. The unit that is used to measure implants is the cubic centimeter (cc), and the more cc’s an implant has, the bigger it will be.
A recent study found that an increase of 130-150 cc is roughly equivalent to going up one cup size, but this generalization should never be used to determine the size of implant that you want.
It is very important that you work with a plastic surgeon who understands sizing challenges associated with breast implants. During your initial consultation, describe your ideal outcome for breast augmentation and he or she can help you decide the most appropriate implant size.
Many women have asymmetric breasts, and it is very common for a surgeon to recommend two different sizes of implant.
An experienced surgeon will also be able to help you understand how different implant sizes will affect cleavage. A woman with a broad chest will have less cleavage than a woman with a narrower chest even if they got the same size implant.
The choice of smooth or textured implants is one that requires input from an experienced plastic surgeon. In most cases, there is no obvious aesthetic difference between smooth or textured implants, but textured implants may reduce the chance that an implant rotates or develops capsular contracture (hardened scar tissue that may be painful or distort breast shape). Textured implants may be more likely to ripple than smooth implants. In women with poor soft tissue coverage, smooth implants may be a more appropriate choice than textured.
Implants come in round or teardrop (also called contoured or anatomical) shapes. Teardrop shaped implants are designed to provide more natural looking contours, but many patients and surgeons prefer round implants, which provide a fuller look. Your surgeon may recommend one shape over the other based on your body type.
A breast implant profile refers to how far an implant projects from the chest wall when you are standing. There are three grades of implant profile: moderate, moderate plus, and high profile. The greater the size and/or profile of the implant, the more attention you will attract.
Your personality, body type, and desired outcome will influence which breast implant profile you choose. Your surgeon will help you decide on the most appropriate profile for you based on your body type and your desired outcome.
A moderate breast implant profile has a rounded, natural look, and projects less than the moderate plus and high implants. If you have a broad chest, your doctor may suggest this option. If you have a narrow build, the low-profile implant may be too wide for your body.
A moderate plus breast implant profile is also called normal, regular or standard. You can expect more projection, but less width compared to a moderate profile. However, if you have a narrow build, the moderate breast implant profile may still be too wide for your body.
A high breast implant profile allows for the most projection of the breasts. You’ll have a lot of fullness in the upper part of the breast, which may or may not look natural. With this option, the implant won’t push into the underarm area because it has the least width of the three. If you have a narrow build, the high breast implant profile may be your best option.
The next thing to consider is what type of incision is going to be made. Plastic surgeons try to make the smallest incision possible, but some implants require a larger incision than others. Ultimately, the decision for the incision type belongs to your surgeon, but it’s important to express your concerns and your preferred selection to him or her. The placement of the incision will dictate what kind of scarring, if any, you may have.
There are four different types of incisions options that could be used during the breast augmentation procedure:
- Transaxillary – This incision is made in the armpit, so a scar may be visible when you lift up your arms. Some implant manufacturers don’t recommend this type of incision because of potential damage to the implants.
- Periareolar – This incision is made right under the nipple. Women with small nipples or who need large incisions are not candidates for a periareolar incision. In addition, this incision may increase the risk of overly firm implants and may affect your ability to breastfeed in the future.
- Inframammary – This incision is made in the crease where your breast meets the chest. Many surgeons prefer this incision because it heals well and is not associated with significant risks or complications.
- Transumbilical / TUBA – This is an incision made at the bellybutton, and the implant is pushed up to the location where it will rest. This incision is not favored by most surgeons, and it leaves a scar that is not covered by a bikini.
Breast implant incisions range from one to three inches long. Scars generally fade over six months to a year and return to the color of the surrounding skin.
Based on your body type, your goals for the procedure, and your lifestyle, your surgeon will decide whether your implants should be placed over (subglandular) or under the pectoral muscle (submuscular).
Subglandular placement is done behind the mammary gland but in front of the pectoral muscle. This placement is best for silicone implants and for women with large amounts of breast tissue. Flexing your chest muscles will not distort the implant, but the implant may be more visible and more easily felt. Subglandular placement heals more quickly than submuscular.
Submuscular placement is done partially or completely behind the pectoral muscle. This placement is usually recommended for saline implants and for women who have small amounts of breast tissue or who have a history of breast cancer in their family. Submuscular placement often looks more natural, but implants may distort when the pectoral muscles are flexed, which may be a concern for bodybuilders.
A breast lift may be performed concurrently with breast augmentation if your breasts are sagging due to aging, pregnancy, breastfeeding, or weight loss. A breast lift can help provide a younger, firmer, and perkier looking breast.
You can assess whether a breast lift is right for you by standing in front of a mirror and looking at your nipples and the crease underneath your breasts.
- Are the nipples at or below the level of breast crease?
- Do you have a significant degree of skin laxity to your breasts?
If you answered yes to one or both of the questions above, a breast lift may be an appropriate procedure for you.
There is an alternative to artificial implants called fat transfer. This is where your own body fat is taken from areas that have a surplus via liposuction and then transferred into the breasts via injection.
Because the fat transferred was your own fat, there’s no risk of allergic reaction. Also, your plastic surgeon may shape your breast more easily with your body’s own fat. With this procedure, only small incisions from the liposuction and tiny holes from injections replace the larger incisions found with implants.
With fat transfer, there’s a limit as to how much volume may be transferred during one procedure; multiple procedures may be necessary. The fat transfer method can be expected to increase bust size by a cup size or less. Furthermore, the body may reabsorb some of the fat transferred, although the fat that does stay remains there permanently.
Breast augmentation surgery typically does not prevent women from breastfeeding normally. However, there are some concerns you should consider if you may become pregnant:
Ruptured implant: A ruptured saline implant poses no risk to a fetus or a breastfeeding child. A ruptured silicone implant may pose some risk for silicone getting into breastmilk, but a clinical study that compared canned formula to breast milk from women with silicone implants determined that the highest levels of silicone were found in the canned formula – not the breast milk from moms with silicone implants.
Reduced milk production: Implants may exert pressure on the surrounding breast tissue, which can slow milk production. In addition, if the surgery causes nerve damage, a loss of sensation in the nipple may inhibit milk let-down responses that normally occur when a mother breastfeeds.
Damaged milk ducts: In rare cases, periareolar incisions that are made too close to the areola (the dark skin surrounding the nipple) can disrupt the ducts that provide breastmilk.
If there is a chance that you may become pregnant following your breast augmentation, make sure to discuss potential risks and complications with your surgeon.
The number one reason for breast implant revision surgery is to increase the size of the implants. Revision surgery for aesthetic reasons is generally only done in women who have had their implants for at least one year. Revision surgery may be done sooner in the case of complications like capsular contracture.
The best way to prevent the need for revision surgery is to work closely with an experienced plastic surgeon when you get your initial breast augmentation. It is important that you feel comfortable with your surgeon and that you are able to communicate clearly with each other. You should look at lots of before and after photographs with your surgeon so you can get an idea of what you can expect from different types and sizes of implants.
Breast implant removal may be done for a number of reasons, including shifting or deflating implants, discomfort, infections or other complications, or breast cancer. As with breast augmentation surgery, implant removal is generally considered an elective, cosmetic procedure by insurance companies, so it is unlikely to be covered by insurance. Implant removal surgery usually costs between $1,500 and $4,000.
Every surgical procedure has risks, and it is important to discuss all potential risks, complications, and side effects with your plastic surgeon before you undergo surgery.
Potential risks and complications that can occur with breast augmentation surgery include:
- Implant rippling or displacement
- Nerve damage leading to reduced or lost sensation
- Implant leakage or rupture
- Mammography (implants can obscure mammogram images)
- Capsular contracture
- Reactions to anesthesia
The best way to prevent these or other complications and to ensure the best outcome is by choosing a board-certified plastic surgeon who is experienced in performing breast augmentation procedures.
In the first few days following your surgery, your breasts will be swollen, which will cause your implants to appear too big, too tight, and/or too high. This is normal, and as the swelling goes down your implants will settle into a more natural position.
Swelling will persist for the first several weeks after the surgery. By one month, the swelling should be subsiding. However, it will take several months before the swelling is completely resolved. During this time, your implants may appear asymmetrical, or one may appear tighter or fuller than the other.
It will take 4-6 months before your implants drop into their intended location, and another several months before you can appreciate the final results.
Each patient will have a somewhat unique recovery process, but in most cases the implants will settle into the pocket that was created during surgery within 4-6 months after the surgery. Factors that influence how quickly your implants will settle include the size of the implants, the tightness of the overlying skin/muscle, and the size of the surgically created implant pocket.
It is important to be patient. It may take some patients up to a year before all swelling is fully resolved and contouring becomes stable to see final results.
The total average cost for breast augmentation surgery ranges from $5,000 to $10,000. Breast augmentation costs may include:
- Surgeon’s fee
- Anesthesia fees
- Hospital or surgical facility costs
- Medical tests
- Post-surgery garments
- Prescriptions for medication
When you get a quote for the cost of your surgery, be sure that it includes all applicable charges, not just the surgeon’s fee.
Many plastic surgeons offer payment options to make the breast augmentation cost more affordable to patients who cannot pay upfront. Always ask about the financing options during your consultation.
Many breast implant manufacturers offer warrantees for their implants if a rupture, deflation, or capsular contracture occurs. When you have breast augmentation surgery, there is no charge to enroll in these company programs. However, the warranty will not cover complications from infections or rippling.
Read the breast implant warranty carefully before you move forward with breast augmentation surgery. Know what the warranty covers and what it doesn’t.
Most breast augmentation procedures are considered cosmetic and elective, so they are not covered by insurance. However, there are times when this procedure may be covered by insurance, such as reconstructing breast tissue lost during a mastectomy after breast cancer or after a trauma.
Always check with your insurance company to see if your coverage includes breast augmentation surgery.
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