Breast augmentation surgery (breast implants)

Breast augmentation is a type of cosmetic surgery in which implants are inserted beneath the breasts to enlarge them. It is also known as augmentation mammoplasty or breast enlargement.

The procedure may also be performed for reconstructive reasons — for example, to:

• restore breast volume after weight loss, or after pregnancy and breastfeeding
• even up asymmetric breasts
• reconstruct a breast after mastectomy (breast removal) or injury.

The implant type and size depend on several factors, including how much bigger you want your breasts to be, your breast anatomy, skin thickness and elasticity, and your body type.

If you are concerned about the way you look, or are thinking about cosmetic treatment to boost your confidence, there are alternatives to surgery. These can include other treatments, wearing padded bras, or talking to a counsellor or psychologist to help you address concerns about your appearance.

Things to consider before surgery#

Before choosing to have breast implant surgery, keep some important points in mind:

• Breast augmentation does not correct droopy breasts. A breast lift — surgery to remove loose, excess skin, which often also involves shifting the nipple position — may also be needed.
• Breast implants may affect your ability to breastfeed.
• Implants are not guaranteed to last a lifetime, and future surgery may be required to replace one or both. There is no agreed product life for implants, but studies show the risk of problems increases about 8 to 10 years after surgery, and many people plan to have implants reviewed or changed around every 10 years.
• Cosmetic surgery is often not covered by public or private health insurance, so think carefully about the financial cost.
• Smokers are at increased risk of complications. To reduce this risk, and for your general health, try to quit smoking before surgery.

It is important to have as much information as possible before deciding. Consider asking another medical practitioner for a second opinion.

Choosing a qualified practitioner#

This procedure should be carried out by a medical practitioner who has specialist training and considerable experience in breast augmentation surgery. At your first consultation, ask about their training and experience, and ask to see the certificates showing they are qualified to perform this surgery.

Surgery and anaesthesia should always be carried out in an appropriately licensed and accredited facility. Where you live, check that the surgeon and anaesthetist are registered with the relevant medical regulator, and that the facility is registered to provide surgery and anaesthesia. A facility’s certificate of registration is usually on display where people can see it easily.

Your current medical status#

If you are considering breast augmentation, discuss your current medical status with your practitioner, including:

• your physical health and past medical history — diseases, illnesses, surgeries, immunisations, diet and exercise
• your mental health, including any mental illness and its treatment
• medications you take, including vitamins and supplements
• any allergies and any past reactions to medications.

This is also a good time for the practitioner to check your blood pressure, temperature, heart rate and rhythm, oxygen saturation and breathing rate. From this discussion, they can assess the risks and possible complications for you, and explain how to prepare so your recovery goes as smoothly as possible.

Types of breast implant#

The two main types of breast implant are:

• Saline implant — a silicone shell filled with sterile salt water (normal saline). The amount of filling affects the shape, firmness and feel of the breast. If the shell leaks, the implant collapses and the saline is absorbed and naturally cleared by the body.
• Silicone implant — a silicone shell filled with an elastic gel that feels much like natural breast tissue. If it leaks, the gel may stay within the shell, escape into the scar capsule around the implant, or move into the breast tissue. This may cause no symptoms, or it may lead to pain or a change in breast shape or size. A leaking silicone-gel implant may not collapse.

What happens during surgery#

Breast augmentation is usually performed under general anaesthetic, although some practitioners use a combination of local anaesthetic and sedation. A registered anaesthetist should be present to manage any adverse reaction to the anaesthetic.

In general, the surgery involves:

• The practitioner makes an incision. Its location is decided with you beforehand and depends on your physique, your tendency to scar, and the type and size of implant. It may be in the armpit (transaxillary), in the crease beneath the breast (inframammary) or around the areola (periareolar).
• A pocket is created, either behind the pectoral (chest) muscle or in front of it, beneath the breast tissue.
• The implant is inserted into the pocket. Sometimes it is already filled; in other cases an empty implant is inserted and then filled with saline through a thin tube until the desired size is reached.
• All incisions are stitched and dressings are applied.

Immediately after surgery#

After breast augmentation surgery, you may have:

• dressings or bandages
• a drainage tube in the wound to help prevent fluid build-up
• bruising and swelling
• antibiotics to prevent infection
• possible numbness, pain and discomfort.

Potential complications#

All surgery carries some degree of risk. Possible complications of breast augmentation include:

• bleeding and infection
• changes in breast and nipple sensation, including temporary or permanent numbness
• wrinkling of the skin over the implant
• an inappropriate implant size, or asymmetry (unevenness) of the breasts
• implant rupture or deflation, and movement of the implant from its original position
• capsular contracture, where firm scar tissue forms around the implant and causes it to lose shape and softness
• calcium deposits in the scar capsule around the implant
• granulomas (lumps) in nearby lymph node tissue formed by leaking silicone
• keloid or lumpy, raised, irregular scar tissue, which may be inflamed and itchy
• allergic reaction to suture materials, tape adhesive, topical lotions or ointments, or other medical materials
• breastfeeding difficulties, including reduced milk supply
• reduced effectiveness of breast cancer screening
• further surgery to treat complications
• rarely, serious events that may be life threatening, such as heart attack, or a blood clot in the deep veins of the legs (deep vein thrombosis) that can move to the lungs.

This is not a complete list. Your medical history or lifestyle may put you at increased risk of certain complications, so speak to your medical practitioner for more information.

Self-care after surgery#

Your practitioner will provide post-operative care instructions, such as:

• how to care for your surgical sites
• medications to apply or take by mouth to aid healing and reduce the risk of infection
• specific concerns to watch for at the surgical sites or in your general health
• when to follow up with your practitioner.

Breast device registries#

Some countries maintain a registry that records the breast devices people have implanted, along with any adverse events linked to those devices, to help improve patient outcomes. Taking part can help with your ongoing health and safety. Ask your medical practitioner whether such a registry operates where you live and how to participate.

Long-term outlook#

Careful review of independent scientific research has found no proven link between breast implants and autoimmune or other systemic diseases.

If you have silicone implants, you may need to see your practitioner regularly to check that the implants are working properly and not leaking. They may use ultrasound or MRI to assess the condition of your implants.

The risk of problems increases about 8 to 10 years after surgery, and you may need further surgery to replace one or both implants; many people plan to have them changed around every 10 years. Pregnancy, weight changes, ageing, menopause and gravity will all influence the appearance of augmented breasts over your lifetime. If you become dissatisfied with their appearance over time, you may choose a breast lift or an implant exchange.

Alternatives to breast augmentation#

• breast lift surgery (mastopexy)
• flap reconstruction after mastectomy — surgery to create a breast from skin and tissue taken from elsewhere on the body
• wearing padded bras.

Key points#

• Studies show that the risk of problems increases about 8 to 10 years after surgery.
• Smokers are at increased risk of complications.
• It is important to have as much information as possible before deciding to have breast augmentation surgery.
• A leaking implant may cause no symptoms, or it may lead to pain or a change in breast shape or size.
• All surgery carries some degree of risk.

Where to get help#