Breast Augmentation (Breast Enlargement)

What's Involved

Breast Enlargement: Before

In 2004, surgeons performed over 334,000 breast augmentation procedures, making breast enlargement the second most popular cosmetic surgical procedure after liposuction, according to the American Society for Aesthetic Plastic Surgery. Women often choose to enhance the size and shape of their breasts because they feel they are too small or their breast size has shrunk after pregnancy. Breast augmentation is also performed to balance a difference in breast size or as a reconstructive procedure following breast surgery.

Breast Enlargement: After

During breast augmentation, the surgeon makes an incision either in the bottom crease of the breast, the armpit, or along the lower edge of the areola (the colored area around the nipple). The doctor then inserts the implant -- usually a soft silicone shell filled with saline (saltwater) -- through the incision.* The implant is positioned either under the breast tissue or the chest muscle beneath the breast. Once the implant's shape and position beneath the nipple are adjusted, the doctor stitches the incision closed.

Breast augmentation is usually performed as an outpatient procedure in a hospital or outpatient surgical center. An overnight stay is usually not required unless there are complications. The surgery lasts one to two hours. General anesthesia with sedation is usually used, but the procedure may also be performed in some cases under local anesthesia.

*Note: Saline vs. silicone implants: Since 1992, the use of implants filled with silicone gel has been restricted in the United States and parts of Europe because of concerns that there is insufficient information demonstrating their safety if the implants leak or rupture. The Food and Drug Administration (FDA) has determined that new silicone gel-filled implants should only be available to women participating in approved studies. Saline implants are considered safe and are the most commonly used breast implants. If these implants leak or rupture, the body can safely absorb the saline. In the future, additional types of filler materials may become available, as new scientific data is collected. Ask your plastic surgeon to provide you with the most up-to-date information.

Pain Level/Recovery Time: Gauze dressings (if used) are removed within several days. Stitches may be removed within seven to 10 days. A surgical bra should be worn for support and comfort. Most women feel tired and experience soreness, swelling, and bruising for several days following surgery. (Some swelling may take three to five weeks to subside.) Pain relievers may help alleviate these symptoms. Some women experience a burning sensation in their nipples for about two weeks, but this will subside as the bruising fades. Most women can return to work and their normal routine within a few days, provided that they don't do any heavy lifting or strenuous exercise. Scars will usually be well hidden and may fade entirely after several months.

Cost

$3,437 (national average for surgeon's fees).** Average surgeon's fee for breast augmentation may vary by region:

For New England (CT, ME, MA, NH, RI, VT) and Middle Atlantic (NJ, NY, PA): $3,780 For East North Central (IL, IN, MI, OH, WI) and West North Central (IA, KS, MN, MO, NE, ND, SD): $3,162 For South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV): $3,265 For East South Central (AL, KY, MS, TN) and West South Central: (AR, LA, OK, TX): $3,299 For Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) and Pacific (AK, CA, HI, OR, WA): $3,643

** Note: These averages for surgeon's fees are provided by the American Association for Aesthetic Plastic Surgery. These figures do not include fees for the surgical facility, anesthesia, medical tests, implants, prescriptions, or other miscellaneous costs related to surgery. In addition, most insurance companies do not cover the cost of breast implants unless they are being used as part of a reconstructive procedure after breast-cancer surgery. They also will not cover costs of treatment after complications or future operations to remove or replace implants.

Is It Right for You?

Breast augmentation can increase a woman's breast size by one or more bra-cup sizes. The results are long-lasting, but it's important to note that breasts may still sag after pregnancy, weight gain, or from the natural effects of gravity. Some women undergo a "breast lift" to restore their figures. Like all other surgical procedures, breast augmentation carries risks, including the following:

Capsular contracture: This occurs when scar tissue around the implant hardens and squeezes the implant. Breasts may feel hard, skin may ripple, and breasts may change shape. Capsular contracture can also be painful. Surgery may be necessary to remove scar tissue or the implant itself.

Nerve damage in breast: This may cause numbness in nipples or breast tissue. These effects are usually temporary, but can be permanent in some women.

Uneven results: Breasts may be slightly different from one another in size and shape after surgery (as they often are prior to surgery, as well).

Damage to implants: Routine activity or injury can cause implants to leak or rupture. If a saline-filled implant breaks, the body absorbs the contents harmlessly. Over time, however, the implant may harden, shift, or change shape. Surgery may be necessary to remove the implant or replace it.

Infection: Though uncommon, this can occur one to two weeks after surgery. In rare cases, the implant will have to be surgically removed.

Excessive bleeding following surgery: This may lead to swelling and pain. If bleeding continues, another operation may be necessary.

Complications with future mammography: Breast implants can hide abnormal breast tissue or lesions during mammography, making breast-cancer screening more difficult. Be sure to find an x-ray technician experienced with breast implants. Squeezing the breast to obtain high-quality images may lead to rupture of the implant. Your doctor may also require additional views, ultrasound, or an MRI.

Excessive milk production: There is no evidence showing that breast augmentation impedes nursing, fertility, or pregnancy. However, if you have nursed a baby within a year before surgery, your breasts may produce milk a few days after surgery. Your doctor can prescribe medication to stop milk production.

What Real Women Say

Josie, 33, Bronx, New York

"I'm more bottom accentuated than I am on top and I've always felt disproportioned," says Josie, an emergency-room nurse and gymnastics instructor. "I'd always kid around with my husband and say, 'I want to get a boob job one day.'" After having two children, Josie felt even more out of proportion and droopy from nursing. Last June she had a consultation with a plastic surgeon, who recommended breast augmentation with a breast lift, a procedure in which the surgeon cuts skin in order to raise and reshape sagging breasts.

The surgery, which was done under intravenous anesthesia in the doctor's surgical suite, lasted about two hours. The total of cost of breast implants was $6,000, plus $1,500 for the lift. For a few days following surgery, Josie experienced a lot of pain, mainly from the breast lift. "They say it's like a C-section because muscle had to grow back together," Josie says. "It felt like someone beat me up in the chest. I couldn't sit up. It's a sore, achy feeling, 10 times worse than feeling engorged."

Nevertheless, four days after surgery (against her doctor's recommendation), "I did an overtime shift at work," Josie admits. She wore a constricting bra, which helped ease the pain and swelling.

Six months later, she's very happy with the results. She went from a 36A to a 36C. "When I teach gymnastics, I think I'm 16 again, but when I try to stand up I feel the implants shift," Josie says. "I still feel every now and then like I'm going through a recovery process. The doctor said I could feel that [for] up to a year." She says she would recommend the procedure to a friend, but only in the hands of a skilled physician like her own.

Overall, she feels great. "I'm happy I did it. I did it for me. I wasn't trying to put on a show for anyone else," Josie says. "Once I made up my mind there was nothing anyone was going to do to change it."

Gina, 25, Mahopac, New York

Gina, a stay-at-home mom, was always flat-chested. She had hoped that after having two kids, her breasts would get bigger. "But they were worse," she says. "Instead of being flat, they were almost sunken in." After a friend recommended breast augmentation, she was determined.

Before the surgery, the doctor asked her to fill two plastic baggies with water and place them in a bra to decide on the size she wanted. She chose to go from a size A to a C cup.

"I expected the surgery to be really painful, but it wasn't," Gina says. The procedure was performed in November in her doctor's office and she went home the same day. The total cost was $6,650.

The doctor prescribed painkillers, but by the third day, she didn't need them. "The pain was gone after a few days, but I felt awkward with them. I couldn't move my arms or drive. After about a week and a half, they felt normal," she says.

Unfortunately, Gina developed an infection two weeks after surgery. "The dissolvable stitches on the inside weren't dissolving. They were coming out and oozing," she says. The surgeon had to remove them. The infection lasted about two weeks. "I was hysterical and depressed. I thought I made the biggest mistake of my life," Gina says. But her doctor reassured her that once she healed, she would be happy.

"They look really good, but in the back of my mind I'm not totally secure with them," Gina admits, six weeks after the procedure. "I look much better in my clothes. But every day in the back of mind there's a fear that something might go wrong. I'm worried that they're going to leak. They're so new. They're still growing on me."

Would she recommend breast augmentation to her young daughter if she ended up with small breasts as an adult? "I feel like this is such a vanity thing," Gina says. "You should be happy with what you were given. But if she ever asked me, I'd say, 'When you have kids and you see what your body is going to look like for a long time, then you can decide.'"

To Learn More: Visit the Public Site section of the American Society for Aesthetic Plastic Surgery's Web site. Or call their toll-free referral line at 1-888-ASAPS-11.

Check out the Learn section of BeautySurg.com, the "cosmetic surgery supersite."

For physician referrals, call the American Society of Plastic Surgeons referral service at 1-888-4PLASTIC or visit them online. Click on "Learn About Procedures" to find out more.

Visit Implant Forum, a Web site created by women who have undergone augmentation procedures.