Breast Augmentation

Patients have breast augmentation in the setting of cosmetic or reconstructive reasons after cancer surgery. Regardless of the reason, breast augmentation is a surgery where implants (saline or silicone) are placed in the breast to enhance breast size, shape, and/or symmetry. A breast augmentation may help improve body image or help clothes fit better. Some people choose to have a breast augmentation for rejuvenation after childbearing or breastfeeding.

A breast augmentation is typically performed under general anesthesia. During a breast augmentation an incision is made on or near the breast (around the nipple pigmented area, in the fold of the breast, or from the armpit area) in order to create a space to insert a breast implant. Usually, the incision is located in the crease below the breast and is about 3-4 cm long, but other locations for the incision are possible in select patients.

A good candidate for breast augmentation is a patient whose primary goals are an improvement in the shape, size, and symmetry of their breasts. It is important that patients considering breast augmentation have given careful thought to their motivations and expectations for surgery. Patients must be a minimum of 18 years old to receive a breast augmentation for cosmetic purposes. The FDA has approved the use of silicone implants for breast augmentation in patients 22 years and older, though they may be used off-label in select younger patients. Additionally, it is important that a patient is not experiencing external pressure to have a breast augmentation. A patient who is under peer, spousal, parental, or other pressure is not a good candidate for a breast augmentation. Additionally, patients with significant breast disease may not be good candidates for breast augmentation. Examples of significant breast disease include severe fibrocystic disease, ductal hyperplasia, and high-risk breast cancer. Patients must also be in sufficiently good health to undergo elective cosmetic surgery in order to have a breast augmentation.

Patients interested in breast augmentation should prepare for surgery by first consulting with a board certified plastic surgeon. Patients looking to have breast augmentation should also consider the financial and time commitment needed to have and recover from surgery. The price of a breast augmentation can vary based on surgeon, geographic location, and other factors.

An understanding of the recovery process can help patients prepare for surgery. Most patients will go home on the day of surgery. Driving is allowed after the first post-operative visit, as long as patients are no longer taking prescribed pain medications. About three-seven days after surgery, or when it is not painful, patients may begin doing certain exercises designed to help the implant settle into the proper place on the chest. Three to four weeks after surgery, patients may resume light aerobic exercise. For the first six weeks after surgery, lifting and upper body exercises are strictly limited. After surgery, wearing a bra is optional, but a bra underwire or a push-up bra cannot be worn for 6 weeks after surgery. Altogether, the healing process takes about 6 weeks.

Additionally, as they prepare for breast augmentation, patients should identify a family member or other support person to help them through the process. For patients who smoke, quitting smoking 6 weeks before and after surgery is important for optimal healing.

Like any surgery, breast augmentation carries risks. Potential risks of breast augmentation include scarring, bleeding, bruising, infection, and dissatisfaction with the cosmetic result. There may also be a change in or loss of nipple sensation. Additionally, there are risks associated with the use of breast implants. The implants and body interact with each other. Normally, the body forms a capsule of scar tissue around the implant. Occasionally, this capsule can distort the implant and cause a complication known as capsular contracture which sometimes requires another surgery to fix. Implants can also break. If an implant breaks, patients may or may not notice it immediately depending on the type of implant. Broken implants often need to be removed and replaced with surgery. Some patients have also experienced a constellation of symptoms such as fatigue and muscle aches after breast augmentation, referred to as breast implant illness. Finally, a rare, treatable type of lymphoma, called anaplastic large cell lymphoma, has been associated with certain breast implants that are no longer in use today.

References:

  1. Breast Augmentation Cost | American Society of Plastic Surgeons. Accessed October 19, 2021. https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/cost
  2. Breast Implants: What Patients Need to Know | ASPS. Accessed October 19, 2021. https://www.plasticsurgery.org/patient-safety/breast-implant-safety
  3. Janis, Jeffrey E., and John S. Silverton. Essentials of Plastic Surgery. Thieme, 2017.

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Samuel Lin, MD, FACS
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