Breast Augmentation

Many women gain a great deal of self-confidence and satisfaction from breast surgery.
Breast augmentation is the surgical placement of breast implants to increase fullness and projection of the breasts or to improve symmetry of the breasts.

Clinically referred to as augmentation mammaplasty, the procedure is used cosmetically to:

  • Enlarge a naturally small breast, most commonly the result of heredity.
  • Restore breast volume lost following pregnancy, as a result of breast-feeding or due to weight loss.
  • Achieve better symmetry when breasts are moderately disproportionate in size and shape.


A large percentage of women have breast augmentation before having children (greater than 50%). Although it is variable, in most cases breast implants do not interfere with breast-feeding. This is especially true when the implants are placed sub-pectorally (under the muscle). Some drooping can occur after pregnancy, but not any more than if the implants were not done. Some plastic surgeons feel that breast augmentation may decrease the overall drooping after pregnancy. If women are actively trying to get pregnant, it is best to wait until after that pregnancy.
The average age for breast augmentation is between 19 and 34 years of age. Many patients are 35-50 (35%) and about 3% are older than 51. Any cosmetic breast augmentation under age 18 is usually not performed (it is acceptable to do reconstructive and corrective surgery under 18 years old). If health allows, there is no age cut off, and many breast augmentations have been performed in patients in their 60′s. As women age, it is more likely that a breast lift may be needed. A breast lift procedure (mastopexy) can be performed either with or without a breast augmentation.
The most common type of implant used is high cohesive textured round silicone implants. The vast majority of implants are filled with saline (salt water), but silicone gel implants are available. Silicone brands include Eurosilicone, Mentor, Nagar, Cui.
Many techniques have been developed over the years to decrease the scar tissue (capsular contracture) around breast implants. Originally it was thought that a textured shell may decrease the capsule, but this in fact is probably not true. Some plastic surgeons feel that a capsule may cause more rippling and other difficulties, probably does not decrease the capsule formation rate. Round implants are used much more commonly than anatomic or “breast shaped” implants. This is a very personal decision but most plastic surgeons do not feel that the use of anatomic implants are warranted, and in fact may not look any better when placed under the breast or pectoralis muscle. Anatomic implants can also shift or rotate causing an unnatural appearance, and possibly needing a re-operation.
Silicone gel implants are currently available to certain patient groups who meet the following guidelines:
  1. Replacement or revision of saline implants
  2. Breast augmentation to the opposite breast for symmetry
  3. Augmentation with a breast lift (mastopexy)
  4. Severe asymmetries of the breast
  5. Tuberous breast deformity
  6. Breast cancer reconstruction
  7. Congenital breast reconstruction: The patients must be at least 18 years old, and can be excluded in the presence of infection, nursing mothers, autoimmune diseases, or other diseases that impair wound healing.
    The implants are most likely safe bases upon prior research, but the final study results will not be available for some time. This must be discussed with your plastic surgeon.
Newer implants are now on the market that gives greater projection per base diameter. This is greatly advantageous in those patients who have a narrow chest wall, and who want to have projection and size of their breast.
The data on implant longevity is variable. Implant leakage is usually caused by a leak in the valve area. Other causes of implant failure include a tear, hole or rip in the implant, this can occur over time. If a saline implant leaks, the salt water gets absorbed by the body with no adverse effects. Many women can get a lifetime out of their implants with no exchange needed, but it is best to think that you may need an implant exchange at sometime in your life. Implant leakage reports between 1to 5% per year.
The only reason to replace implants is if there is a problem with them. For example; leakage, capsular contracture, change in shape, asymmetry, or a patient who is unhappy with size or position. Some plastic surgeons will recommend changing silicone implants even if there is not a visible problem. Speak with your plastic surgeon about implant exchanges.
The correct incision depends on each patient’s own anatomy, and your plastic surgeon’s feelings about each procedure. Listen to the guidance from your individual plastic surgeon.
It usually takes approximately 1-2 hours for the routine breast augmentation procedure.
Ptosis a term that means droopiness of the breast. There are degrees of how droopy the breast is, and the degree of droopiness will determine if a procedure needs to be performed. Often a breast implant alone will take care of the droop, but at times a breast lift (mastopexy) may need to be performed either at the same time as the augmentation or as a delayed procedure.


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