Breast Augmentation


  • What is Breast Augmentation?
  • How is it done?
  • How does one decide which size implant is most appropriate?
  • Where are the incisions placed?
  • Is there a great deal of pain with breast augmentation?
  • How long will the breast implants last?
  • When is it the right time for breast implant surgery?
  • It involves placement of a saline-filled or silicone-filled implant behind the breast tissue or under the chest muscles.
  • This enhances the breast area by increasing the size of the breasts.
  • It enhances the body contour for women who feel that their breasts are too small.
  • It can correct the reduction in breast volume after pregnancy or after weight loss.
  • In some cases of breast asymmetry or poor development, breast implants may be used to help achieve improved symmetry.
  • Once the incision is made through the skin, it is continued through the breast tissue until the surface of the chest muscle is identified.
  • The pocket is then created for the implant either behind the breast tissue and above the chest muscle or behind the chest muscle itself.
  • THE IMPLANT IS NOT PLACED WITHIN THE BREAST TISSUE.
  • In many patients the pocket must be advanced towards the center to create better cleavage and slightly below the natural breast crease to allow a more appropriate position of the implant after healing. Failure to do so may lead to widely displaced implants and/or high-sitting implants.
  • Different shapes of the implants are used depending on the individual patient's needs.
  • The currently available FDA approved implant shapes include:
    • Round
    • Moderate profile
    • High profile
    • Tear-shaped (also called “anatomical” or “contoured”)
  • The patient’s desired final breast size is only one factor in choosing the appropriate implant.
  • The width of the breast, the thickness of the breast tissue, the distance of the nipple from the breast crease, and the diameter of the patient’s chest play a critical role in choosing the size and profile of the implant.
  • In thin patients with a narrow chest who desire a full breast, the high profile implant may provide the desired size without too much fullness along the sides of the breast.
  • In patients with an average or wide chest, a moderate profile implant provides the desired size with a greater chance of achieving the desired degree of cleavage.
  • The role of the round or tear-shaped implants are less clearly defined and depend on the patient’s anatomy and surgeon’s preference.
  • It is important to clarify that patients will NOT have breasts that look “round” if the surgeon uses a round implant.
  • Four possible incisions may be used.
  • An incision may be placed either along the crease below the breast, around the areola (brown area around the nipple), under the arm, or within the navel.
  • Most of the pain is experienced during the first 48 hours. Patients describe it as a pressure-type pain.
  • Implants placed behind the chest muscle are associated with greater pain than those placed in front of the chest muscle.
  • Currently, many plastic surgeons are using a device called the “pain pump”. This delivers local anesthetic to each breast through a very thin tube during the first 48 to 72 hours after surgery.
  • Despite the pain pump, some patients will require pain medication.
  • If the implants are placed behind the muscle, there is the potential for muscle spasm and muscle relaxing medications are also helpful.
  • The risk of rupture is approximately 2% per implant per year. The older the implant the greater the likelihood of rupture.
  • Both breast implant manufacturers in the United States (Allergan/InaMed and Mentor) have FDA approved saline and silicone implants. Both companies provide patients with a 5 year warranty against implant rupture and the ability to purchase an extended warranty for an additional 5 years. Since the risk of rupture increases with the age of the implant, most surgeons recommend that patients obtain the additional warranty.
  • The majority of patients usually present for a breast augmentation at two points in life.
  • The first group is women in their 20’s or early 30’s prior to having children and the second group is in their late 30’s or 40’s after they have completed having children and need to deal with all of the changes that occurred due to childbearing and aging.
  • Those younger then 20 years of age may be candidates for the procedure depending upon their physical, psychological and emotional maturity.
  • Many older women now present for breast augmentation and are considered good candidates for the procedure if their health status permits.
Illustrations of Procedure