During surgery to enlarge the breasts, (augmentation mammoplasty), an implant is placed under the breast tissue or under the chest muscle beneath the breast. An implant is a soft silicone shell filled with a saline (saltwater) solution, silicone gel, or another substance, such as methylcellulose gel or hydrogel (not used in the United States at this time). Saline solution is currently the material most commonly used to fill breast implants because it can be safely absorbed by the body if the implant leaks or ruptures.
To position the implant, an incision is made in the bottom crease of the breast, the armpit, or along the lower edge of the areola (the colored area surrounding the nipple). The implant is inserted through the incision and may be placed under either the breast tissue or the chest muscle beneath the breast. Some doctors believe that putting the implant beneath the chest muscle lowers the risk for a condition called capsular contracture (hardening of tissue surrounding the implant) and interferes less with mammography than when the implant is under the breast tissue but in front of the muscle. After the implant has been carefully adjusted to the correct shape and position, the incision is closed with stitches.
A breast lift (mastopexy) may be done at the same time as the breast enlargement. A breast lift can raise sagging or drooping breasts and elevate the nipple and areola. To lift the breasts, excess skin from the bottom of the breast and the area around the areola is removed. The remaining skin is then brought together, which tightens and raises the breast. A breast lift requires larger incisions than a breast enlargement alone. Incisions may extend from the areola down to the crease where the bottom of the breast meets the chest.
Breast enlargements and lifts are usually done as outpatient procedures in a hospital or outpatient surgery center. An overnight stay in the hospital is not needed unless there are complications during surgery. The surgery takes 1 to 2 hours. General anesthesia is usually used, although local anesthesia or an epidural may be used in some cases.
What To Expect After Surgery
Immediately after the surgery, gauze is taped over the stitched incisions, and the breasts are wrapped in an elastic bandage or supported by a special bra. The stitches may be removed in 7 to 10 days.
Most women have some swelling, bruising, and soreness in their breasts for several days after the procedure. Medicine can help relieve the pain. Swelling and bruising may last for several weeks. Some women also have a burning sensation in their nipples right after surgery. Wearing a supportive bra 24 hours a day can help reduce swelling and support the breasts while they heal.
Most women can resume their normal work and social activities within a few days, unless those activities involve heavy lifting or strenuous exercise. Your doctor will tell you when you can return to more vigorous exercise and activities.
You will have scars after breast enlargement surgery, but these are usually in well-concealed areas (such as the crease under the breast, the armpit, or the border of the areola). These procedures are designed to minimize scarring so that incisions are not easily detected. Scars usually fade after several months. Having a breast lift in addition to an enlargement leaves larger, more visible scars.
Why It Is Done
Breast enlargement surgery is done to increase the size of the breasts and enhance their shape. You may decide to get breast implants to:
- Enhance breasts you consider too small. The definition of what is “too small” (or too large, for that matter) varies from woman to woman. There is no universal standard below which breasts are considered too small. If you are content with the size of your breasts, then they are not too small.
- Restore the size or shape of the breasts after significant weight loss or pregnancy. A breast lift may be done at the same time as the enlargement in these cases.
- Make the breasts more evenly proportioned. In many women, one breast may be larger or sit higher than the other.
How Well It Works
Breast enlargement surgery can increase your breast size by one or more bra cup sizes. It can also reduce differences in size and shape between your breasts.
Breast implants will not prevent the breasts from sagging as a result of future pregnancy, weight gain or loss, or aging.
Most women who have breast implants will need at least one more implant surgery in their lives.
Breast implants may make it more difficult to detect breast cancer on a mammogram. Other risks of getting breast implants include:
- Capsular contracture. One of the most common problems caused by breast implants, this condition occurs when scar tissue around the implant hardens and begins to squeeze the implant. It can cause hardening of the breast tissue, rippling in the skin of the breast, and changes in the shape of the breast. It may also be painful. Surgery is sometimes needed to remove the scar tissue or replace the implant when capsular contracture develops.
- Loss of feeling in the nipples or breast tissue due to nerve damage. Often this is temporary, but it may be permanent in some women.
- Differences in size or shape of the breasts after surgery.
- Changes in the implant. Normal activity or an injury to the breast can damage the implant, causing it to leak, deflate, or rupture. Over time, the implant may harden, develop ripples, shift position, or change shape. Surgery may be needed to remove the implant and replace it (if desired) if any of these changes occur.
- Infection (not common). This can occur at any time, but it typically occurs during the first week after surgery. In some cases of infection, the implant may have to be removed for several months and then replaced.
- Blood collection under the skin, or hematoma (uncommon).
- Abnormal scarring (uncommon).
Having more than one procedure at the same time, such as a breast lift and breast enlargement, increases the risk of problems after the surgery.
What To Think About
Most women who get breast implants are satisfied with the results. You are likely to be happy with the results if you have clear, realistic expectations about the surgery and share these with your doctor. Implants will make your breasts larger and perhaps give them a shape you are more pleased with, but no surgeon can guarantee perfection.
Also keep in mind that:
- Breast enlargements and lifts do not prevent changes in the breast that occur as a result of future pregnancies, weight gain or loss, or the force of gravity over time.
- Implants may later need to be surgically removed or replaced if they leak, rupture, wrinkle, change shape, or develop other problems. It is likely that you will have to have a second surgery at some point. Saline implants rupture at a rate of 1% per year.1
- Some of the changes in the breast tissue and skin caused by implants are permanent. If you later have the implants removed, the breasts may have permanent wrinkles, dimples, or other changes.
- The U.S. Food and Drug Administration (FDA) recommends that women with breast implants have a breast MRI 3 years after getting the implant and then every 2 years after that.2 The MRI is done to check if the implant is intact and the breast tissue looks healthy. The costs of this regular testing can be greater than the initial cost of getting the implant.
- Some studies suggest that breast implants may affect a woman's ability to breast-feed, but this has not been proven.
Insurance will not cover the cost of breast implants unless they are being used as part of breast reconstruction after surgery for breast cancer. Likewise, insurance may not cover the costs of treatment for complications that arise during or after surgery or for future surgeries to remove or replace the implants. Check with your insurance company to find out whether getting breast implants will affect how much you pay for your insurance and what you are covered for.
Breast cancer screening (mammography) after surgery
A breast implant can hide abnormal breast tissue or lesions, making detection of abnormal or cancerous breast tissue during mammography more difficult. To produce accurate, high-quality images, the breast has to be squeezed fairly tightly. In rare cases, this causes a breast implant to leak or rupture. Also, scarring and calcium deposits around the implant may look like cancerous tissue and make the mammogram harder to interpret.
If you have breast implants and need to have a mammogram, tell the technician when you schedule the mammogram what type of implants you have (saline or silicone) and whether they are behind or in front of the chest muscle. You may need more views taken than are done during a typical screening. In some cases, MRI scans may be needed to produce a clear image.
Controversy over breast implant safety
The possible connection between silicone gel breast implants and connective tissue disease has been the subject of much research and public debate. But studies have not shown a clear link between implants and connective disease. The use of implants filled with silicone gel has been restricted in parts of Europe and in Canada, and in the United States between 1992 and 2006. This is because of concerns about harm that could come from silicone gel leaking into the body if an implant leaks or ruptures.
In late 2006, the FDA again approved silicone breast implants. This approval was based on studies of women with silicone implants for up to 4 years. Each maker of these implants is now required to study 40,000 women during the first 10 years they have silicone implants. These studies will begin to show how safe silicone implants are over a woman’s lifetime.2
Newer silicone implants contain a gel-like material instead of a liquid. These types of implants do not leak if punctured or cut.
Saline-filled implants are considered safe and are the most commonly used breast implant today. Saline solution can be safely absorbed by the body if the implant leaks or ruptures.
- Vasconez HC, et al. (2006). Plastic and reconstructive surgery. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 1209–1248. New York: McGraw-Hill.
- U.S. Food and Drug Administration (2006). FDA approves silicone gel-filled brest implants after in-depth evaluation: Agency requiring 10 years of patient follow-up. FDA News P06-189. Available online: http://www.fda.gov/bbs/topics/NEWS/2006/NEW01512.html.
Last Updated: August 4, 2008
Author: Maria G. Essig, MS, ELS