Definition and Overview

Also referred to as augmentation mammaplasty, breast augmentation is an invasive cosmetic surgical procedure that aims to increase the fullness and improve the projection of the breasts using implants. It can also be performed using autologous fat transfer wherein excess fat from different parts of the body, such as buttocks and thighs, is harvested through liposuction and injected into the breasts. This is an option for women who prefer more natural-looking results and seek a relatively small increase in their breast size.

Breast augmentation can be combined with other breast-related surgical procedures such as mastopexy (breast lift) and breast reconstruction, which is recommended for patients who have undergone mastectomy or whose breasts have been damaged by a congenital deformity or trauma.

Who Should Undergo and Expected Results

Breast augmentation may be ideal for women who:

  • Want to increase their level of self-confidence by improving their overall appearance
  • Think their breasts are smaller in relation to the size of their body
  • Wish to restore the shape and size of their breasts prior to weight loss, aging, and pregnancy
  • Desire to achieve symmetry for both breasts

Breast augmentation is also one of the many surgical procedures performed in male to female sex reassignment.

Just like other types of cosmetic surgical procedures, breast augmentation also has certain limitations the primary of which is its inability to improve breast sagging or drooping breasts (ptosis), unless it is combined with a breast lift (mastopexy). It may also not be recommended for those who are:

  • Overweight or obese – Studies suggest that the risk of developing serious complications when undergoing breast augmentation is higher for patients who are obese or overweight.
  • Thinking of getting pregnant – Surgeons may advise women who plan to get pregnant or have more children to delay the procedure. Although pregnancy itself doesn’t affect the implants’ integrity, the breasts themselves will undergo changes, which means adjustments, which may require additional procedures, may become necessary in the future.
  • Breastfeeding – Whether breast augmentation affects breastfeeding has been the subject of debate and confusion. While some experts contend that 90 percent of women with augmented breasts can breastfeed, some argue that the procedure may have a negative impact on milk production, depending on where the incisions are made, if there’s not enough glandular tissue, and if certain nerves and milk ducts were damaged during surgery.

When it comes to satisfaction and overall success rate, a study has shown that in 2013, at least 98 percent of women who had breast augmentation were satisfied with the results and that 75 percent claimed the firmness and size were just right. However, about 13 percent wanted bigger breasts while 1 percent had issues with scarring.

How Does the Procedure Work?

Prior to the procedure, the patient decides on the type of implants to use with the guidance of her surgeon. The options include the following:

Filled breast implants

Two of the most popular choices for breast implants are saline and silicone, each with its own advantages and disadvantages.

Saline implants are silicone shells with sterile salt water. Although this type of implant doesn’t feel as natural as silicone and is more prone to rupture or wrinkling, it is safer in case it bursts as the solution is absorbed by the body.

Meanwhile, silicone implants are silicone shells prefilled with a sticky silicone gel. It is preferred by many women because of its natural firmness and lower risk of rupture. However, if it ruptures, the gel typically causes lumping in different parts of the breasts.

Cohesive or high-strength gel silicone implants (gummy bear implants)

A variant of silicone implant, these implants are commended for their lower rupture rate, improved thickness, and natural firmness. They are also able to maintain their shape even when split in half, much like a gummy bear.

Autologous fat

Patients who are uncomfortable with having foreign materials in their body and who seek a relatively small increase in their breast size may opt for an autologous fat transfer. In this procedure, the surgeon performs a liposuction to obtain fat typically from the buttocks and thighs. The harvested fat is then processed and injected into the breasts. This option is less popular than breast implants but has shown great potential. It is believed to have fewer risks because of biocompatibility and produces more natural-looking results.

Breast augmentation is an invasive procedure. Before it is carried out, the patient is scheduled for a pre-surgery consultation with her doctor to discuss the following:

  • Risks and complications of the surgery
  • Best incision technique and implant to use
  • Pre- and post-operative care
  • Expectations and maintenance of implants
  • Medical history, including past cosmetic surgeries

The patient may also have to undergo a series of routine physical exams, blood tests, and even psychological counseling to ensure she is suitable for the procedure.

During the surgery, the patient is administered with general anesthesia or local anesthesia with sedation. An incision is then made on the underside of the breast just above the crease (inframammary), around the nipple (periareolar), or underneath the arm (transaxillary). If breast augmentation is part of a reconstructive procedure or is performed following a mastectomy, the surgeon will make an incision on the same site where the previous incision was made to prevent additional scarring.

The surgeon then proceeds to create a pocket either on the submuscular (below) or subglandular (on top) of the chest muscle where the implant will be placed. If a saline implant is used and it is not pre-filled, a valve is attached to the implant to fill it with the solution.

It may also be necessary for the surgeon to use an endoscope, a narrow flexible tube with a camera and light source, to provide clear images of the breast’s internal structure and guide the placement of the implant.

Once the implant is secured, the incisions are closed and chest area is gauzed. The patient may also have to wear a surgical bra or a compression garment throughout the recovery period to help keep the implants in place.

The entire procedure may take between one and two hours and most patients are able to return to their routine within 7 days after the operation.

Possible Risks and Complications

Implants are not meant to last a lifetime and are designed to be replaced or removed within 10 to 15 years.

Although breast augmentation techniques have greatly improved over the years, surgical risks such as bruising, pain, allergies to anesthesia, and infection can still occur.

In the long term, the patient runs the risk of experiencing:

  • Implant rupture
  • Loss of sensation in the breasts if certain nerves are affected
  • Chronic breast pain
  • Scarring
  • Misshapen or hardened breasts
  • Siliconomas (lumping around the breasts due to silicone rupture)
  • Seroma (fluid buildup around the implant)

References:

  • Vasconez HC, Habash A (2010). Plastic and reconstructive surgery. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed., pp. 1092-1131. New York: McGraw-Hill.

  • U.S. Food and Drug Administration (2006). FDA approves silicone gel-filled breast implants after in-depth evaluation: Agency requiring 10 years of patient follow-up. FDA News P06-189. Available online: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108790.htm.

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