Breast Enlargement (Augmentation Mammoplasty)

What is breast enlargement?

Breast enlargement, called augmentation mammoplasty, is a procedure in which a plastic surgeon enlarges your breasts. It is done only at your request. To enlarge your breasts, the surgeon will insert artificial implants into your breasts. The implants are silicone shells filled with saline (saltwater) or silicone gel.

When is it used?

This operation is designed only to improve the appearance of your breasts. It will not prevent or cure cancer. Ask your surgeon if you will be able to breast-feed a baby after this operation.

You get the best results from this surgery if you are in your 20s or 30s and have small but not sagging breasts. You must be at least 22 years old to have augmentation with silicone.

How do I prepare for augmentation mammoplasty?

Discuss candidly with your plastic surgeon the size and shape of breasts you would like to have. Remember that although this operation can reshape your breasts, it may not change how you think of yourself or how others think of you.

Plan for your care and recovery after the operation. Arrange for someone to drive you home after the procedure. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions provided by your provider. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a local or general anesthetic. A local anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the procedure. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

The surgeon will make a cut on the underside of your breast, around the areola, near the bellybutton, or by your underarm. He or she will implant a prosthesis (the bag or packet that contains saline solution or silicone gel) through the cut and place it between the breast tissue and chest wall or between the pectoralis muscle and the chest wall. The prosthesis will enlarge the size of your breast. The surgeon will close the cut and repeat this process on the other breast.

What happens after the procedure?

You will be observed for a number of hours and may then go home. For the next 2 or 3 weeks, you may have some swelling and your breasts may be bruised and tender.

It may take 2 or 3 months for your body to heal fully. Your doctor will arrange for follow-up appointments to check your progress.

When you have mammograms in the future, tell the X-ray technologist about your implant so the procedure can be adjusted.

Ask your healthcare provider what other steps you should take.

Implants can rupture (tear).

• If you have a saline-filled breast implant and it ruptures, you or your healthcare provider will know when it happens. The implant will deflate and the saline solution will leak into your body. You will notice that your implant has lost its original size or shape.
• If you have a silicone gel-filled breast implant and it ruptures, it is likely that neither you nor your provider will know. It is called a silent rupture. For this reason, MRI (magnetic resonance imaging) is recommended 3 years after you have the implant surgery and then every 2 years after that to check for rupture. Sometimes a rupture does cause symptoms. These symptoms include hard knots or lumps surrounding the implant or in the armpit, change or loss of size or shape of the breast or implant, pain, tingling, swelling, numbness, burning, or hardening of the breast.

If your implant ruptures, you may need a second operation and the implant may need to be removed.

What are the benefits of this procedure?

After the procedure you may have breasts that are matched in size or are a size more pleasing to you.

What are the risks associated with this procedure?

Risks of breast enlargement include:

• There are some risks associated with anesthesia. Discuss these risks with your healthcare provider.
• You may develop a hematoma, which is a collection of blood or a blood clot from a leak in a blood vessel that may form within hours after surgery in the pocket where the implant has been placed. This may cause swelling, pain, and bruising. A large hematoma may need to be drained surgically.
• An implant may harden and be painful.
• Your breasts may feel too firm or lumpy.
• Your breasts may bleed or become infected around the implant.
• Your nipples and areolas may be numb.
• Your breasts may be unequal in size, shape, position, or contour. You may want further surgery on one or both of the breasts to try to make them similar.
• Your breasts may droop.
• A capsule may form around the implant. That area may become firm or tender and need regular massage or additional surgery.
• Your arm and shoulder movements may be restricted or painful.
• A saline implant may rupture (tear) and deflate.
• A silicone implant may rupture (tear) and you will need another operation to remove it.
• You will likely need additional surgeries on your breasts due to rupture or other complications.
• Implants do not last a lifetime. You are likely to have your implant removed at some time over the course of your life because of one or more complications.

There have been some special concerns about the safety of implants filled with silicone gel. After rigorous scientific review, the US Food and Drug Administration (FDA) determined that the implants are safe and effective. The FDA announced approval of the use of silicone gel-filled implants in November 2006. For more information on breast implants and their safety, see the FDA Web site: http://www.fda.gov/cdrh/breastimplants/index.html.

You should ask your provider how the risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• The skin over the breast becomes irritated or starts to peel off.
• You have redness or unusual drainage from the cuts.
• You develop a fever or unexpected pain.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.