Breast Enlargement

Surgery Overview

Breast enlargement is surgery to make the breasts bigger and improve their shape. This surgery may also be called breast augmentation or augmentation mammoplasty. During breast enlargement, the surgeon places an implant in the breast. An implant is a soft silicone shell filled with silicone gel or saline (salt water).

To position the implant, the surgeon makes a cut (incision) in the bottom crease of the breast, in the armpit, or along the lower edge of the areola. (The areola is the colored area around the nipple). The surgeon carefully adjusts the implant to the correct shape and position. Then the incision is closed with stitches.

The implant may be placed under the breast tissue or under the chest muscle beneath the breast. Some doctors think that putting the implant under the chest muscle lowers the risk for a problem called capsular contracture (hardening of tissue around the implant). This placement may also interfere less with mammography.

A breast lift may be done at the same time as a breast enlargement. This surgery can raise sagging breasts as well as the nipple and areola. For a breast lift, the surgeon removes excess skin from the bottom of the breast and around the areola. The remaining skin is then brought together. This tightens and raises the breast.

A breast lift requires a larger incision than a breast enlargement alone. The incision may go from the areola to the crease below the breast.

Breast enlargements and lifts are usually done in a hospital or surgery center. You will not need to stay overnight in the hospital unless problems occur during surgery. You will probably get medicine to make you sleep during the surgery (general anesthesia). Or you might be awake and get medicine that makes the area numb (local anesthesia or epidural).

Most women who get breast implants will need at least one more implant surgery in their lives. Implants don't last forever. They may need to be removed or replaced if they leak, rupture, change shape, or develop other problems.

Newer silicone implants have gel in them instead of liquid. These types of implants don't leak if they are punctured or cut. About 1 out of 100 saline implants ruptures each year.^{footnote 1}

The U.S. Food and Drug Administration (FDA) recommends having a breast MRI 3 years after getting implants and then every 2 years after that.^{footnote 2} The MRI is done to check if the implants are intact and the breast tissue looks healthy. This testing can cost more than getting the implants, and it may not be covered by insurance.

Also keep in mind that:

• Breast implants will not keep the breasts from sagging as a result of future pregnancy, weight gain or loss, or aging.
• Implants cause lasting changes in the breast tissue and skin. If you later have the implants removed, your breasts may have permanent wrinkles, dimples, or other changes.

Insurance will not cover the cost of breast enlargement surgery. It may not cover the costs of treatment for problems during or after surgery or the costs of future surgeries to remove or replace the implants. Check with your insurance company to find out what is covered. Also ask if getting breast implants will affect how much you pay for your insurance.

Breast cancer screening after surgery

Breast implants may cause problems during mammography.

• Having implants may make it harder to find abnormal breast tissue or breast cancer.
• Scarring and calcium deposits around the implant may look like cancerous tissue. This may make the mammogram harder to interpret.

During mammography, the breast has to be squeezed tightly to get accurate images. In rare cases, this causes a breast implant to leak or rupture.

Be sure to tell the person who schedules your mammogram that you have implants. The technician will need to know what type of implants you have (saline or silicone) and whether they are behind or in front of the chest muscle. The technician may need to take more views than during a typical screening. In some cases, MRI scans may be needed to get a clear image.

Questions about breast implant safety

The U.S. Food and Drug Administration (FDA) reports that both saline- and silicone-filled breast implants appear to be safe.

For more information on the safety of breast implants, see the FDA's website at www.fda.gov/breastimplants.