Breast augmentation: Breast implants reshape self-image

Thinking about breast augmentation? Understand the surgical process, including what it means to have breast implants, possible complications and what you can expect from the surgery.

Breast augmentation — surgery to enhance a woman's breasts — ranks as the third most popular cosmetic surgery. More than a quarter of a million women opted for breast augmentation in 2005, according to the American Society of Plastic Surgeons.

If you're considering breast augmentation, be sure you understand fully what's involved in the surgery, have realistic expectations, and know the possible risks and complications associated with implants.

Why have breast augmentation done?

Your reasons for choosing breast augmentation are highly personal. Breast augmentation may help you:

Enhance your breast appearance if you feel your breast size is too small
Adjust for a reduction in the size of your breasts after pregnancy
Reconstruct your breast after having breast surgery for cancer or other conditions
Correct a defect in the development of your breasts, such as having breasts of unequal sizes

Besides enhancing the breasts' appearance, some women find that breast augmentation improves self-image and self-confidence. The best candidate for breast augmentation is a woman looking for an improvement — but not perfection — in her appearance. Your ideal for how you want your breasts to look and the reality of the outcome of the procedure may not match exactly. Discuss this with your surgeon so that you can develop a realistic expectation of what's to come.

Before surgery: Consider pros and cons

Initially, you'll consult with a plastic surgeon about your preferences for size, feel and overall appearance of your breasts. Your doctor will describe the surgical techniques and provide you with educational materials about the implant you select and the surgical procedure. Review these documents carefully and keep copies of all pertinent information for your records.

Before you decide to have surgery, consider some important factors about breast augmentation:

Breast implants aren't lifelong devices. Your breast implants may need to be removed and replaced at some point.
You might need more surgery after breast implant removal. If you have your breast implants removed for any reason, you may experience unacceptable cosmetic changes — such as wrinkling, dimpling or droopy excess skin — which might require replacing the implants. Or you may need a breast lift (mastopexy) to remove excess skin and reposition your nipple.
Breast implants won't prevent your breasts from sagging after pregnancy. Some women actually need to consider a breast lift in addition to breast augmentation to correct sagging breasts. Also, depending on how it's done, breast augmentation surgery may make breast-feeding more challenging.
Mammograms may be more complicated. Additional views are necessary when obtaining images of your breasts. The quality of the mammogram will depend on the experience and expertise of your technician and the facility you select.
Insurance probably won't pay for the procedure. If it isn't medically necessary, many insurance companies won't cover breast augmentation. Be prepared to handle any financial obligations that accompany breast augmentation surgery and any related operations you might need in the future.

Considering these points may trigger many questions about your personal situation. Prepare a list of questions to review with your doctor. You may also find it helpful to talk with other women who have gone through the same procedure.

Breast augmentation: The procedure

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	Breast augmentation incision sites
	Placement of breast implants

Breast augmentation surgery — also known as augmentation mammaplasty — can be performed in a surgical center or hospital outpatient facility. You usually go home the same day, but on occasion you might require a hospital stay. Breast augmentation is usually performed under general anesthesia.

To insert the breast implant, your surgeon makes an incision in one of three places:

In the breast fold. An inframammary incision runs along the crease between the underside of your breast and your chest.
Around the nipple. A periareolar incision follows the natural line of the dark skin around your nipple (areola). This incision may leave a less noticeable scar than does the inframammary incision, but it might also impact your ability to breast-feed or affect sensation in your nipple.
Under the arm. The axillary incision is made in your armpit.

Breast implants may be smooth or textured, round or shaped like a teardrop. They consist of a silicone shell filled with salt water (saline) or silicone gel. For a number of years, only saline-filled implants were available for cosmetic use. But in November 2006, the Food and Drug Administration (FDA) approved silicone gel-filled implants for breast augmentation. This means that you now have a choice between saline-filled or silicone gel-filled breast implants. Your doctor can help you decide which type would be better for you.

After making the incision, the surgeon lifts your skin and tissue to create a pocket either behind the breast glandular tissue or behind the muscle in your chest (pectoral muscle). The surgeon inserts the implant and centers it behind your nipple. Saline implants, when inserted, are empty. The surgeon fills the implant with sterile saline once it's in place. Silicone implants are already filled at the time they're placed.

Breast augmentation surgery generally lasts one to two hours.

Recovering from breast augmentation surgery

You'll be sore the first few days after breast augmentation surgery, but your doctor can prescribe medication to help relieve your pain. If you don't have a physically demanding job, you may be able to return to work within a few days. Getting back to normal activities may take longer — about two to three weeks — as your breasts will be sensitive to physical contact or jarring movements. Follow your doctor's instructions for how long you should wait before engaging in your regular activities.

You'll have stitches (sutures) in place after surgery. Often, absorbable sutures are used, so you won't need to have them removed. Some women also have drainage tubes in place after surgery, although not many women require them. If you have drainage tubes, they'll probably be removed a few days after your surgery. Your doctor may recommend using a compression bandage or sports bra for extra support and positioning of the breast implants during this time.

You may notice a burning sensation in your nipples for a few weeks, but that usually goes away as you heal. Expect some pain, swelling, tenderness and bruising as you heal. If you notice warmth and redness in your breast or you run a fever, you might have an infection. Contact your doctor as soon as possible.

After surgery, your scars may initially appear firm and pink. The scars fade gradually over time, but they won't go away completely. The darker your skin, the more noticeable your scars may be.

Risks of breast augmentation

Be aware of the risks associated with breast augmentation surgery:

Repeat surgery. You may need more surgery down the road, either to replace the implants or to remove them altogether. In clinical trials studying the safety and effectiveness of saline-filled breast implants, as many as one in four women required a second operation within five years of the initial surgery.
Rupture. Implants can rupture, causing fluid to leak into your breast and surrounding tissue. This can happen as a result of a blunt-force injury — if you're thrown against the steering wheel in a car accident, for example — or from tiny cracks in the implant shell that can occur over time.

If you have a saline-filled implant, a rupture will cause your implant to lose its original size or shape. If you have a silicone gel-filled implant, a rupture may not be as obvious. Your doctor may use occasional imaging tests, such as magnetic resonance imaging, to screen for rupture.
Deflation. A rupture or a slow leak can cause an implant to collapse, deflating the size of your breast. This may result in breasts that are noticeably different in size or in a change to the cosmetic appearance of your breast, such as sagging or wrinkling.
Capsular contracture. Fibrous scar tissue forms a capsule around your breast implant. The scar tissue builds up over time and constricts your implant — a painful and potentially disfiguring condition. Surgery is usually necessary to correct capsular contracture.
Infection. Breast augmentation surgery can lead to infection. Medications may help, but antibiotics aren't always successful in treating infections of this type. Removing your breast implants may be necessary if you develop a severe infection. You may have to wait six months to a year after implant removal before you can get new implants placed.
Hematoma. Blood and other fluids can pool around the implant, causing pain, infection or other problems. If you develop a hematoma, you might need to go back into the operating room so that your doctor can find the cause of the bleeding.
Pain. You could experience significant pain after surgery — more than what's considered normal — which indicates a bigger problem, such as implant rupture or capsular contracture. To remedy the problem, you may need surgery to remove or replace the breast implants.

Other possible risks include dissatisfaction with the results of your surgery. You might experience changes in the sensation of your breasts and nipples, or you might be able to feel the implant beneath the surface of your breast tissue.

Debunking myths surrounding breast augmentation

To address health concerns about breast implants and breast augmentation surgery, a committee at the Institute of Medicine (IOM) reviewed the issues and concluded:

Breast implants don't increase breast cancer risk. The IOM found evidence that breast implants don't cause breast cancer or the recurrence of breast cancer. However, it's still essential that you undergo routine screening for breast cancer — breast self-exams, mammograms and clinical breast exams — just as you would if you didn't have breast implants.
Breast implants don't weaken your immune system. When your body detects something foreign in your system, such as a virus or bacterium, it responds by kicking your immune system into high gear. However, the IOM found no evidence to suggest this happens with breast implants. Nor did it find evidence linking implants to any autoimmune or connective tissue disorder.
Breast-feeding is safe. Your breast milk could absorb some of the silicone from breast implants but in an amount that's not considered harmful to your baby. Because breast milk is the best thing you can feed your baby, the IOM encourages women with breast implants to breast-feed if they're able to do so.
Satisfactory results can be achieved with saline-filled breast implants. Women with saline implants used to complain about sloshing — hearing the liquid inside the implant — and being able to feel the implant beneath the surface of the skin (rippling effect). Some women preferred implants filled with silicone gel for these reasons, claiming they looked and felt more natural. However, better results from saline implants are now possible by slightly overfilling the implant and placing it behind, rather than on top of, the chest muscle.

Know that health risks associated with breast implants do exist. Take these risks into consideration, consult with your doctor, and be confident that you're making a fully informed decision before you proceed with breast augmentation.