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During surgery to enlarge the
breasts (augmentation mammoplasty), an implant is
placed under the breast tissue or under the chest muscle beneath the breast. An
implant is a soft silicone shell filled with silicone gel or a saline (saltwater) solution.
the implant, an incision is made in the bottom crease of the breast, the
armpit, or along the lower edge of the areola (the colored area surrounding the
nipple). The implant is inserted through the incision and may be placed under
either the breast tissue or the chest muscle beneath the breast. Some doctors
believe that putting the implant beneath the chest muscle lowers the risk for a
condition called capsular contracture (hardening of tissue surrounding the
implant) and interferes less with
mammography than when the implant is under the breast
tissue but in front of the muscle. After the implant has been carefully
adjusted to the correct shape and position, the incision is closed with
A breast lift (mastopexy) may be done at the same time
as the breast enlargement. A breast lift can raise sagging or drooping breasts
and elevate the nipple and areola. To lift the breasts, excess skin from the
bottom of the breast and the area around the areola is removed. The remaining
skin is then brought together, which tightens and raises the breast. A breast
lift requires larger incisions than a breast enlargement alone. Incisions may
extend from the areola down to the crease where the bottom of the breast meets
Breast enlargements and lifts are usually done as
outpatient procedures in a hospital or
outpatient surgery center. An overnight stay in the
hospital is not needed unless there are complications during surgery. General anesthesia is typically used, although
local anesthesia or an
epidural may be used.
Immediately after the surgery, gauze is
taped over the stitched incisions, and the breasts are wrapped in an elastic
bandage or supported by a special bra. The stitches may be removed in 7 to 10
Most women have some swelling, bruising, and soreness in
their breasts for several days after the procedure. Medicine can help relieve
the pain. Swelling and bruising may last for several weeks. Some women also
have a burning sensation in their nipples right after surgery. Wearing a
supportive bra 24 hours a day can help reduce swelling and support the breasts
while they heal.
Most women can resume their normal work and
social activities within a few days, unless those activities involve heavy
lifting or strenuous exercise. Your doctor will tell you when you can return to
more vigorous exercise and activities.
You will have scars after
breast enlargement surgery. But these are usually in well-concealed areas (such
as the crease under the breast, the armpit, or the border of the areola). These
procedures are designed to minimize scarring so that incisions are not easily
seen. Scars usually fade after several months. Having a breast lift in
addition to an enlargement leaves larger, more visible scars.
Breast enlargement surgery is done to
increase the size of the breasts and enhance their shape. You may decide to get
breast implants to:
Breast implants may also be used to reconstruct breasts
after surgery for
breast cancer (mastectomy).
Breast enlargement surgery can
increase your breast size by one or more bra cup sizes. It can also reduce
differences in size and shape between your breasts.
implants will not prevent the breasts from sagging as a result of future
pregnancy, weight gain or loss, or aging.
Most women who have
breast implants will need at least one more implant surgery in their
Breast implants may make it harder to
detect breast cancer on a
mammogram. Other risks of getting breast implants
Having more than one procedure at the same time, such as a
breast lift and breast enlargement, increases the risk of problems after the
implants contain a gel-like material instead of a liquid. These types of
implants do not leak if they are punctured or cut.
Most women who get breast implants
are satisfied with the results. You are likely to be happy with the results if
you have clear, realistic expectations about the surgery and share these with
your doctor. Implants will make your breasts larger and perhaps give them a
shape you are more pleased with, but no surgeon can guarantee
Also keep in mind that:
Insurance will not cover the cost of breast implants unless
they are being used as part of breast reconstruction after surgery for breast
cancer. Likewise, insurance may not cover the
costs of treatment for complications that arise during
or after surgery or for future surgeries to remove or replace the implants.
Check with your insurance company to find out whether getting breast implants
will affect how much you pay for your insurance and what you are covered
A breast implant can hide abnormal breast tissue or lesions, making
detection of abnormal or cancerous breast tissue during mammography more
difficult. To produce accurate, high-quality images, the breast has to be
squeezed fairly tightly. In rare cases, this causes a breast implant to leak or
rupture. Also, scarring and calcium deposits around the implant may look like
cancerous tissue and make the mammogram harder to interpret.
you have breast implants and need to have a mammogram, tell the technician when
you schedule the mammogram what type of implants you have (saline or silicone)
and whether they are behind or in front of the chest muscle. You may need more
views taken than are done during a typical screening. In some cases, MRI scans
may be needed to produce a clear image.
Research studies are looking at the possible connection between silicone gel breast implants and connective tissue disease. So far, studies don't show that these implants cause connective tissue disease.3
A few women with breast implants have developed anaplastic large cell lymphoma (ALCL) that started in breast tissue near the implant. Although these cases are very rare, the U.S. Food and Drug Administration (FDA) is gathering information about a possible connection between implants and ALCL.
For more information on the safety of breast implants, see the FDA's website at www.fda.gov/breastimplants.
Complete the surgery information form (PDF)surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
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.
U.S. Food and Drug Administration (2011). FDA update on the safety of silicone gel-filled breast implants. Available online: http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf.
July 31, 2012
Anne C. Poinier, MD - Internal Medicine & Keith A. Denkler, MD - Plastic Surgery
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