Breast augmentation surgery

Breast augmentation is done by placing implants behind breast tissue or under the chest muscle.

An implant is a sac filled with either sterile salt water (saline) or a material called silicone.

The surgery is done at an outpatient surgery clinic or in a hospital.

• Most women receive general anesthesia for this surgery. You will be asleep and pain-free.
• If you receive local anesthesia, you will be awake and will receive medicine to numb your breast area to block pain.

There are different ways to place breast implants:

• In the most common technique, the surgeon makes a cut (incision) on the underside of your breast, in the natural skin fold. The surgeon places the implant through this opening. Your scar may be a little more visible if you are younger, thin, and have not had children.
• The implant may be placed through a cut under your arm. The surgeon may perform this surgery using an endoscope. This is a tool with a camera and surgical instruments at the end. The endoscope is inserted through the cut. There will be no scar around your breast. But, you may have a visible scar on the underside of your arm.
• The surgeon may make a cut around the edge of your areola. This is the darkened area around your nipple. The implant is placed through this opening. You may have more problems with breastfeeding and loss of sensation around the nipple with this method. There may be a higher risk of capsular contracture with this incision. Capsular contracture is when scar tissue causes the breast to become hard or misshapen.
• A saline implant may be placed through a cut near your belly button. An endoscope is used to move the implant up to the breast area. Once in place, the implant is filled with saline.

The type of implant, size of the implant, and implant surgery can affect:

• How much pain you have after the procedure
• The appearance of your breast
• The risk for the implant breaking or leaking in the future
• Your future mammograms -- additional views will be required to allow visualization

Your surgeon can help you decide which procedure is best for you.

Watch this video about:Breast lift

Breast augmentation is done to increase the size of your breasts. It may also be done to change the shape of your breasts or to correct a defect you are born with (congenital deformity).

Talk with a plastic surgeon if you are considering breast augmentation. Discuss how you expect to look and feel better. Keep in mind the desired result is improvement, not perfection.

Risks for anesthesia and surgery in general are:

• Reactions to medicines, breathing problems
• Bleeding, blood clots, infection

Risks for breast surgery are:

• Difficulty breastfeeding
• Loss of feeling in the nipple area
• Small scars, often in an area where they do not show much
• Thickened, raised scars
• Uneven position of nipples
• Different sizes or shapes of the two breasts
• Breaking or leakage of the implant
• Visible rippling of the implant
• Need for more breast surgery

It is normal for your body to create a "capsule" made up of scar tissue around your new breast implant. This helps keep the implant in place. Sometimes, this capsule becomes thickened and larger. This may cause a change in the shape of your breast, hardening of breast tissue, or some pain.

Emotional risks for this surgery may include feeling that your breasts do not look perfect. Or, you may be disappointed with people's reactions to your "new" breasts.

There are some risks that may occur months or even years after an implant is in place.

A rare type of lymphoma (cancer of the immune system) has been reported with some types of implants. It is called breast implant-associated lymphoma. Symptoms include a mass or swelling around the implant and breast pain. It can be treated with removal of the implant and the area around the implant. Ongoing research in this area may discover other uncommon links between breast implants with other types of cancer.

Some patients have experienced systemic symptoms after receiving implants. This has been called "breast implant illness" although there is not enough evidence yet for it to be a recognized illness. Reported symptoms include:

• Fatigue
• Memory and concentration problems ("brain fog")
• Pain in joints and muscles
• Anxiety
• Hair loss
• Depression
• Rash
• Autoimmune diseases
• Inflammation
• Weight gain or loss

Some women report that symptoms improve after the implant is removed. Despite these rare risks, breast implants are considered safe.

Tell your health care provider:

• If you are or could be pregnant
• What medicines you are taking, including medicines, supplements, or herbs you bought without a prescription

During the days before your surgery:

• You may need mammograms or breast x-rays before surgery. The plastic surgeon will do a breast exam.
• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
• Ask your provider which medicines you should still take on the day of surgery.
• You may need to fill prescriptions for pain medicine before surgery.
• Arrange for someone to drive you home after surgery and help you around the house for 1 or 2 days.
• If you smoke, it is important to stop. Smoking can cause problems with healing. Your surgeon may postpone surgery if you continue to smoke. Ask your provider for help quitting.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after midnight the night before surgery.
• Take the medicines your provider told you to take with a small sip of water.
• Wear or bring loose clothing that buttons or zips in front. And bring a soft, loose-fitting bra with no underwire.
• Arrive on time at the outpatient clinic or hospital.

You will likely go home when the anesthesia wears off and you can walk, drink water, and get to the bathroom safely.

After breast augmentation surgery, a bulky gauze dressing will be wrapped around your breasts and chest. Or, you might wear a surgical bra. Drainage tubes may be attached to your breasts. These will be removed within 3 days. Your surgeon will give you instructions about when you may bathe or shower.

The surgeon may also recommend massaging the breasts starting 5 days after surgery. Massaging helps reduce hardening of the capsule that surrounds the implant. Ask your provider first before massaging over your implants.

You are likely to have a very good outcome from breast surgery. You may feel better about your appearance and yourself. Also, any pain or skin symptoms due to the surgery will likely disappear. You may need to wear a special supportive bra for a few months to reshape your breasts.

Scars are permanent and are often more visible in the year after surgery. They may fade after this. Your surgeon will try to place the incisions so that your scars are as hidden as possible.

Breast augmentation; Breast implants; Implants - breast; Mammaplasty - augmentation

Calobrace MB. Breast augmentation. In: Nahabedian MY, Neligan PC, eds. Plastic Surgery, Volume 5: Breast. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 4.

Padilla PL, Khoo KH, Ho T, Cole EL, Sirvent RZ, Philips LG. Plastic surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 69.

US Food and Drug Administration website. Medical device reports for systemic symptoms in women with breast implants. www.fda.gov/medical-devices/breast-implants/medical-device-reports-systemic-symptoms-women-breast-implants. Updated August 4, 2022. Accessed April 12, 2023.

US Food and Drug Administration website. Risks and complications of breast implants. www.fda.gov/medical-devices/breast-implants/risks-and-complications-breast-implants. Updated March 8, 2023. Accessed April 12, 2023.

Updated by: David A. Lickstein, MD, FACS, specializing in cosmetic and reconstructive plastic surgery, Palm Beach Gardens, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.