Your breast augmentation questions answered

Written by Andre Rafizadeh, MD
Reviewed by: Jordan Frey, MD

What is a breast augmentation? 

Breast augmentation, or augmentation mammoplasty, is a cosmetic procedure aimed at enhancing the size and shape of the breasts. The main indication for a breast augmentation is small volume of breast tissue, however it may also be done for developmental causes. Conditions that are secondary to other developmental abnormalities are also indications for a breast augmentation. 

The procedure involves the insertion of implants either beneath the breast tissue (sub-glandular) or under the chest muscles (pre-pectoral) to boost fullness, improve symmetry, and replenish lost volume. Another option is the dual plane augmentation. Each implant position has its own benefits and drawbacks:

  • Sub-glandular: The implant is placed between the breast tissue and the pectoralis major muscle, which may result in less movement of the implant during muscle contraction but a slightly higher risk of capsular contracture.
  • Pre-pectoral: The implant is placed just below the chest muscle, potentially reducing the risk of capsular contracture, but putting the breast at risk for animation deformity.
  • Dual plane breast augmentation*: This technique combines the benefits of both sub-glandular and pre-pectoral placements, however it may require the use of a synthetic or biologic mesh.

* These procedures may also involve the use of an acellular dermal matrix, such as Alloderm®, to support the implant.

Consultation with a board-certified plastic surgeon is the first step, where you can articulate your aesthetic goals and review the surgical options available. Here they will review these goals with you and help formulate a plan that addresses all these concerns. Reviewing a plastic surgeon’s before and after photo gallery and reading their reviews will help inform your decision on who to choose for your procedure. 

Implant selection is a critical part of this process, and it is based on your preferred size, shape, and texture. Your surgeon will guide you through choosing the ideal implant, and once decided, you will proceed with planning the surgery, including the location of the incisions.

Which implant type would be ideal for me?

It is essential to discuss implant types with your plastic surgeon before surgery. The primary options are silicone or saline implants. The ultimate decision lays with the patient’s preferences after a discussion with your surgeon regarding the differences, risks, and benefits of each. In general, a saline implant can be placed under the pectoralis muscle through smaller incisions. When placed above the pectoralis muscle, wrinkling can become palpable and visible in some cases. While saline implants have benefits it terms of a more differential fill to correct minor breast or chest wall asymmetries, silicone is generally agreed upon to convey a more natural and softer feel. This is generally due to its mixture of semi-inorganic morpolymeric molecules made with varying length chains of polydimethyl siloxane monomers. This allows it to be produced with varying viscosities allowing these implants to maintain their shape in different positions and resist most deforming pressures around the breast tissue. Implants such as the Sientra HSC and Allergan’s Natrelle Inspira cohesive round implants and Sientra HSC+, Mentor MemoryShape and Allergan 410 cohesive silicone gel shape implants are more cohesive and allow for creation of an anatomic shape. Each implant balances stability and implant softness to characterize its feel, which will ultimately contribute to their function and patient selection. 

What is the right implant size and shape?

After deciding on the type of implant the decision on volume typically rests with the patient, guided by the surgeon's advice. During the consultation, your surgeon may take photographs to help determine the optimal breast size and manage post-surgery expectations. They might also use sizers in your bra to help visualize the desired volume. Some practices use a 4D imaging system to demonstrate the outcomes expected for each patient. Overall, it is important to select an implant width that respects the patient’s chest width to maintain the normal landmarks (anterior axillary line, appropriate cleavage, and intermammary distance). Determining the shape will also dictate part of its size as round implants have equal width and height, while shaped implants are sometimes different. Projection of the implant is dictated by compliance and potential laxity of the breast envelope. A tight envelope may entertain a lower profile implant to give less volume and a more natural look. A larger breast envelope may require a higher projecting implant as soft tissue laxity will require projection and volume to fill out this area to reach the patients desired aesthetic. 

Most implants have a smooth surface, although a textured surface is sometimes used. The main benefit of using textured surfaces is the stability of the implant with less movement and rotation, potentially decreasing the incidence of capsular contracture as well. However, it should be noted that Allergan textured breast implants have been recalled from the market secondary to breast implant associated-anaplastic large cell lymphoma (BIA-ALCL). For those desiring a more pronounced shape, a round teardrop breast augmentation and teardrop breast augmentation provide options that mimic the natural slope of the breast while offering a fuller top. 

How long does the surgery take?

Breast augmentation surgery usually takes one to two hours. Incisions are strategically made in less visible areas to reduce the appearance of scarring. If your surgeon is planning to also do a breast lift at the same time or any other procedure, you should ask what to expect your incisions to look like postoperatively as these may involve vertical scars.

What happens after the breast augmentation surgery?

Post-operatively, patients are able to go home the same day and can resume most routine activities immediately, with a full recovery expected within six weeks. Generally, patients will be given an anti-inflammatory medication for pain control post operatively. They will then follow-up in the office with your surgeon in 3-4 days. Immediately after surgery, you will have an ace wrap around your chest that will stay for 24 hours. After this is removed, you will need to wear a sports bra for the majority of the day over the next 4 weeks. Pending what implant type you choose, you will start early range of motion followed by implant massage (unless you choose a textured implant). After 4 weeks of wearing a sports bra, you will be transitioned to a regular bra while still wearing a sports bra at night for 2-4 weeks. Normal activity may continue immediately after surgery, however exercise and other high intensity activities will need to be delayed for 3-4 weeks. Other than the first post-operative appointment at 3-4 days, there will be a 3 week follow-up, 3 month follow-up, and finally a 1 year follow up. 

When can I sleep on my side after breast augmentation?

Typically, this is allowed when comfortable, which is usually a few weeks after your surgery. 

When can I drive again after breast augmentation?

Driving can be resumed after the initial recovery period when a patient is off pain medications and can manage the steering wheel comfortably. Your surgeon will provide pain medications and antibiotics as well as muscle relaxants to ease chest muscle tension. The main considerations for driving include turning a wheel without pain, whether the patient is taking narcotics, and if your surgeon is okay with it.

What are the signs of complications?

Understanding the signs of complications is important; for instance, pictures of hematoma after breast augmentation can help patients identify collections of blood known as hematomas. Bruising is common after surgery, but should it worsen, or if you notice breast enlargement, contact your surgeon immediately, as this could indicate a hematoma, a rare but possible complication. Any significant pain or lightheadedness after surgery should also be addressed promptly with your surgeon or by visiting the emergency room. Other complications include infections for which your surgeon should be contacted immediately. Standard treatment options include antibiotics, wound care, and surgery if the implant is involved. Patients may also notice a change in sensation to their nipple area. In the immediate post-operative period, this can be simply observed. Other complications include deflation/implant rupture, capsular contracture, implant malposition/rotation, wrinkling/rippling, animation deformity, and finally anaplastic large cell lymphoma. It is important to continue your scheduled follow-up appointments to avoid any potential complications. 

How long does the healing take?

Incisions are typically concealed in the inframammary fold, the natural crease under the breast, making them less noticeable. In cases involving a breast lift, a vertical scar may be visible. Healing from breast augmentation occurs over several days to weeks. By about 6 weeks after surgery, you will be able to resume most of your normal activities including high intensity work outs. At this time, your incision will continue to heal in the form of a scar over the next several months. 

Breast augmentation scars after 6 months typically fade but may take longer to mature fully. 

If post-operative asymmetry or volume concerns arise, fat grafting can be utilized for correction and can further help camouflage any scarring.

While breast augmentation scars are a natural part of the healing process, techniques like fat transfer breast augmentation scars might leave less noticeable markings. The healing process breast augmentation scars involves proper care and time for scars to settle and lighten.