Breast Augmentation (Enlargement) Surgery

In the past implants filled with silicone gel were used in breast augmentation surgery. When questions about the safety of silicone-gel implants arose, their use was banned in the United States. The controversy over silicone-gel implants is a large issue that is too complex to be treated in a short article here.

Breast augmentation surgery in the U.S. today uses one of two brands of implants filled with saline (salt water) approved by the FDA (Food and Drug Administration) for use in the U.S.

According to the American Society of Plastic Surgeons (ASPS), breast augmentation was the fourth most popular invasive surgical procedure among cosmetic plastic surgeries performed in 2000. In a press release dated July 12, 2001, the ASPS says that breast augmentation was performed on 212,500 women last year.

Breast augmentation surgery uses saline-filled implants to enhance the size and shape of the breasts. Women often desire breast enhancement surgery if their breasts have lost volume and changed shape after weight loss or childbirth or as a result of aging. Surgery can also correct cases in which a woman’s breasts are of significantly different sizes.

Augmentation can be performed at any age after the breasts have finished developing, but, according to the American Society for Aesthetic Plastic Surgery (ASAPS), federal regulations that took effect in May 2000 prohibit breast augmentation for purely aesthetic (that is, non-medical) reasons in women less than 18 years old.

Although breast augmentation will enhance the appearance of the breasts, it will not necessarily produce an ideal body. The ASPS says that the best candidates for breast augmentation surgery are “women who are looking for improvement, not perfection” in the way they look. When consulting a plastic surgeon about breast augmentation, women should be prepared to discuss their expectations about the results of the procedure as well as their past medical history and current health, including any family incidence of breast cancer.

The procedure can be performed in either an office surgical suite, a free-standing surgery center, or a hospital out-patient department under general anesthesia (being “put to sleep”) or with local anesthetic supplemented by medication for sedation. The doctor will then make a small incision either in the crease of the breast (just above where the breast joins the chest), below the areola (the pigmented skin around the nipple), or in the armpit—all places where the scar will be the least conspicuous. The doctor will insert the implant through the small incision, then fill it with sterile saline. The implant can be placed either behind the breast tissue (on top of the pectoral muscle, which sits between the breast tissue and the chest wall) or underneath the pectoral muscle.

Most women will be up and about within 24-48 hours after surgery. Most women return to work within a few days to a week, although the timing will vary with the job and the type of physical activity it requires. Swelling of the breasts should subside within 3-5 weeks after the surgery. Some women experience numbness or loss of sensation in the breasts or around the nipples, but this is usually temporary.

The most common complication of breast implants is capsular contracture, a tightening of the scar tissue that the body produces around the implant as a natural part of healing. Additional surgery may be required either to remove the scar tissue or to remove—and perhaps replace—the implant.

The FDA warns that a breast implant is not a lifetime device. The implant may rupture, causing the saline to leak out. Although the saline will be harmlessly absorbed by the body, the size and shape of the breast will again be reduced. This occurrence may require additional operations for removal and/or replacement of the implant. The FDA says that some implants rupture or deflate within the first few months, while others remain intact 10 or more years after surgery.

There is no evidence that breast implants affect pregnancy or the ability to breast feed.

There is also no evidence that implants increase the likelihood of breast cancer.

However, implants make both taking and reading mammograms (special low-dose x-rays used to detect breast cancer) harder. Women with breast implants should have regular mammograms at the interval prescribed for their age and medical situation. They should tell the radiology technician about the implants because the technician will have to take special additional films of the breast.