Breast Augmentation Surgery


Sarah Lewis, PharmD

What is breast augmentation surgery?

Breast augmentation surgery is the surgical reshaping of the breast in order to make it larger. Breast augmentation is also called breast enlargement and augmentation mammaplasty. It uses breast implants to increase breast size. Most people seek breast augmentation for cosmetic or aesthetic reasons. Your doctor may also recommend the procedure to reconstruct your breast following breast surgery.

Breast augmentation surgery is a common but major surgery with significant risks and potential complications. You may have less invasive options to enhance breast size or shape. Consider getting a second opinion about all your treatment choices before having breast augmentation surgery.

Types of breast augmentation surgery

The types of breast augmentation surgery procedures include:

  • Inframammary surgery involves making an incision in the natural fold on the underside of your breast. Your surgeon will insert the implant through this opening. You will have a scar on the underside of your breast.

  • Periareolar surgery involves making an incision around the dark area that surrounds your nipple. Your surgeon will insert the implant through this opening. This technique may lead to the inability to breastfeed or loss of nipple sensation.

  • Transaxillary approach is a minimally invasive procedure. Your surgeon will make a small incision in your underarm and insert the implant through the opening.

  • Transumbilical approach is a newer, minimally invasive technique. Your surgeon will make an incision near your belly button and feed the implant up to your breast. He or she will then fill the implant.

Types of breast implants

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The types of breast implants include:

  • Saline implants are filled with sterile salt water. If this type of implant leaks, it will collapse. Your body will absorb the salt water and eliminate it.

  • Silicone implants are filled with a gel that feels more like natural breast tissue. If this type of implant leaks, it may not collapse. Your doctor may require regular follow-up visits with ultrasound imaging to verify the condition and function of these implants.

Types of implant placements

The types of breast implant placements include:

  • Subglandular or submammary placement involves positioning the implant in a pocket your surgeon makes under your breast tissue and on top of your pectoral muscle.

  • Submuscular placement involves placing the implant in a pocket your surgeon makes under your pectoral muscle.

Other procedures that may be performed

Your doctor may perform other procedures in addition to breast augmentation surgery. The most common combination is a breast augmentation with a breast lift (mastopexy). A breast lift is a procedure to lift, or boost, sagging or loose breasts.

Why is breast augmentation surgery performed?

Your doctor may recommend breast augmentation surgery if you want larger or more shapely breasts for cosmetic reasons. It is also used to reconstruct breasts following breast surgery, such as mastectomy.

Not everyone is a good candidate for breast augmentation surgery. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on breast augmentation surgery. 

Your doctor may recommend breast augmentation surgery for you if:

  • One breast varies in size or shape from the other one.

  • One or both breasts did not develop normally.

  • You are bothered by the feeling that your breasts are too small.

  • You are dissatisfied with the size, shape or firmness of your breasts after weight loss, pregnancy, or as a result of aging.

  • You are physically healthy and have realistic expectations of improvement, not perfection.

  • Your breasts are fully developed.

Who performs breast augmentation surgery?

A plastic surgeon or a cosmetic surgeon performs breast augmentation surgery. A plastic surgeon is a specialist in aesthetic and reconstructive surgery. A cosmetic surgeon focuses on aesthetic surgery—most procedures are elective and not medical necessary. A cosmetic surgeon performs some of the same surgeries as a plastic surgeon, including breast augmentation, but the surgeons’ education and training are different.

How is breast augmentation surgery performed?

Your breast augmentation surgery will be performed in a hospital or outpatient surgical center.

Surgical approaches to breast augmentation surgery

Breast augmentation surgery is performed using one of the following approaches:

  • Minimally invasive surgery involves inserting special instruments and an endoscope through small incisions in your underarm or near your belly button. An endoscope is a thin, lighted instrument with a small camera. The camera sends pictures of the inside of your body to a video screen viewed by your surgeon while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision(s) instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.

  • Open surgery involves making a larger incision under your breast or around your areola. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different breast augmentation procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used

Your surgeon will perform breast augmentation surgery using general anesthesia or regional anesthesia, depending on the specific procedure.  

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your breast augmentation surgery

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have. The surgeon provides anesthesia in some cases.

  • A surgical team member will start an IV.

  • The surgeon, anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of breast augmentation surgery?

As with all surgeries, a breast augmentation involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.  

General risks of surgery 

The general risks of surgery include: 

  • A anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clots, such as a deep vein thrombosis 

  • Infection 

Potential complications of breast augmentation surgery

Complications of breast augmentation surgery include:

  • Capsule contracture or thickening. Your