What is breast augmentation?

Breast augmentation is a surgical procedure used to improve the shape and size of breasts. It’s the most commonly performed plastic surgery procedure in the United States, and it’s growing in popularity—the number of breast augmentations jumped 4% between 2017 and 2018, up to 313,735.

Women choose to enlarge their breasts to enhance a naturally small chest or to correct sagging and volume loss associated with age, weight loss, pregnancy, or breastfeeding.

Most commonly, breast augmentation is performed using breast implants. These flexible, saclike devices, which are filled with silicone gel or saline (saltwater), are inserted via an incision, around the nipples, under the breasts (in the fold), or in the armpit and then placed under or over the pectoral muscle.

But breast augmentation can also be done via a breast fat transfer technique, in which fat is removed from one area (like the belly or thighs), via liposuction, and then injected into the breasts. In some cases, breast implants are paired with fat transfer because the extra fat can help the implant sit more naturally.

Another option is a breast lift, which elevates saggy breasts and repositions the nipple, for a perkier look. It can be combined with implants.

Pros 

• Breasts will be larger, higher, fuller, and generally more youthful-looking.


• Results are permanent, usually lasting well over 10 years.


• Breast implants are highly customizable, so you can select a size that works best for your body type and lifestyle. They’re available in a range of diameters (widths), projections (how far the implant projects from the chest wall), and volumes (the amount of fullness). A surgeon can suggest an implant with a diameter, projection, and volume that’s most appropriate for your body.


• Research in the journal American Surgeon showed that mammogram results are not significantly affected by implants, so you can still be effectively screened for breast cancer.

Cons

• Pregnancy, menopause, and weight loss can affect the appearance of a breast augmentation.


• There are certain risks associated with breast implants, including implant leakage or rupture, seroma (fluid buildup), capsular contracture (the formation of scar tissue around the implant), wrinkling of skin over the implant, and poor positioning of the implant. Additionally, a growing number of women report a constellation of symptoms—including cognitive issues, chronic fatigue, and joint pain—that’s come to be known as breast implant illness. While the FDA has publicly stated that studies show no evidence of breast implants causing these symptoms, research is ongoing, to better understand their cause.


• Breast implants aren’t intended to last for life. The longer you have implants, the more likely it is that complications will occur and you’ll need to have them replaced.


• You can still safely breastfeed with breast implants, but research published in the International Breastfeeding Journal shows that breast surgery can potentially damage milk ducts, which can lead to insufficient milk production, particularly with the incision around the nipple.


• If you have silicone implants, the FDA advises having biannual MRIs, to check for “silent rupture”—when an implant ruptures but doesn’t cause symptoms.

What happens during breast augmentation surgery?

Before you go in for surgery, you’ll have a consultation with your surgeon. “First, I go over the patient’s goals and past [health] history. Next is a physical examination, which includes examining the breasts as well as taking a number of measurements of the breasts and chest wall. We then sit down for a discussion that includes the options for the surgery, the risks, and the recovery,” says Dr. Jerome Edelstein, a plastic surgeon in Toronto. Many doctors also require a pre-surgery mammogram.

If you’re going for breast implants, your surgeon will help you determine the best implant type, incision location, and placement for your body and desired outcome. Data from the American Society of Aesthetic Plastic Surgeons (ASAPS) shows that 87% of breast implant surgeries today use silicone implants. Patients usually choose either highly cohesive gel implants, which are round and filled with thick silicone gel, or “gummy bear” implants, which are denser, firmer, and teardrop-shaped. Still, some patients choose saline implants, which have sterile saltwater in a silicone shell.  They can be filled after they’re placed, which means incisions and scars can be smaller. Some doctors consider saline rupture less of a concern, because your body naturally absorbs the saltwater and patients can more easily see signs of a rupture (such as a sagging breast), to catch it more quickly.

During the surgery, the surgeon will make an incision around the nipple, under the breast, or in the armpit—to minimize visible scarring. Then they will create a pocket, either above or below your pectoral muscles, and place the implants. The incision is closed with layers of internal stitches, and the skin is closed with stitches, skin adhesive, or surgical tape. The whole surgery takes about an hour; it doesn’t require an overnight stay in the hospital.

If you opt for a breast fat transfer, there’s more preparation for the procedure. A bra-like expansion device is worn, several hours a day, for three weeks prior to surgery. It uses vacuum-like pressure “to stretch the skin and breast tissue to make room for the fat,” says Dr. Edelstein.

During the surgery, liposuction is performed to remove fat from a fleshy area of the body, like the belly or thighs, then the surgeon injects the fat into the breasts. “The benefit to this method is that you’re using your own tissue to add volume to your breasts [as opposed to a foreign object],” says Dr. Edelstein. “The drawback is that you can’t get as much enhancement as you can with an implant.” In general, fat transfer can increase breasts one cup size.

For a breast lift, the surgeon either makes an incision around the nipple only; makes an incision around the nipple and extends the incision, from the lower border of the areola down to the breast crease; or makes an incision around the nipple, down to the breast crease, and across the breast crease. Then the surgeon lifts and reshapes the breast tissue, removing any extra saggy skin in the process. The nipple is also lifted and repositioned (though never detached from the breast)—and if the patient is unhappy with the size of her areolas, those can be reduced as well.

All three procedures are typically performed under general anesthesia.