What is breast enlargement?

Breast enlargement, called augmentation mammoplasty, is a procedure in which a plastic surgeon enlarges your breasts. It is done only at your request. To enlarge your breasts, the doctor will insert artificial implants into your breasts or use tissue from other parts of your body.

When is it used?

This operation is designed only to improve the appearance of your breasts. It will not prevent or cure cancer. You may not be able to breast-feed an infant after this operation.

You get the best results if you are in your 20s or 30s and have small, but not sagging breasts.

One alternative to silicone implants are saline (salt water) implants that seem not to have nearly as many possible side effects. Another alternative is to ask your doctor to use tissue from other parts of your body to enlarge your breasts. Another choice is to accept the present size of your breasts. You should ask your doctor about these choices.

How do I prepare for augmentation mammoplasty?

You will want to discuss candidly with your doctor what size and contour of breasts you want. It may help you to remember that although this operation can reshape your breasts, it may not change how you think of yourself or how others think of you.

Plan for your care and recovery after the operation. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow instructions provided by the doctor. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning of the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

The doctor will give you anesthesia. An anesthetic relaxes your muscles and prevents you from feeling pain.

The doctor will make a cut on the underside of your breast, around the areola, or by your underarm. He or she will implant a prosthesis (a bag or packet that contains a gel or a saline solution) through the cut and place it between the breast tissue and chest wall or between the pectoralis muscle and the chest wall. The prosthesis will enlarge the size of your breast. The doctor will close the cut and repeat this process on the other breast.

What happens after the procedure?

You will be under observation for a number of hours and may then go home. For the next 2 or 3 weeks, you may have some swelling and your breasts may be bruised and tender. Allow 2 or 3 months for your body to heal fully.

The doctor will arrange for follow-up appointments to check your progress.

When you have mammograms in the future, tell the x-ray technician about your implant so the procedure can be adjusted.

Ask your doctor what other steps you should take.

What are the benefits of this procedure?

After the procedure you may have breasts that are matched in size or are a size more pleasing to you.

What are the risks associated with this procedure?

Warning: Many doctors are concerned about the safety of the silicone-gel implant. The US Food and Drug Administration (FDA) has now issued new rules limiting the use of implants with silicone gel. As a result, the number of breast surgeries using silicone gel will be only a fraction of what it was before.

According to FDA regulations, you can have a silicone-gel implant if you are 18 years old or older and have a medical need for breast reconstruction for which saline-filled implants are not suitable. Before you can have a silicone-gel implant, you must agree to two things:

• First, you should discuss the possible risks with your doctor and sign an informed consent form. The consent form states that your doctor has explained all the possible risks and that you understand them.

• Second, you must agree to enroll in a special clinical study so that the FDA can get reports on your progress. The FDA hopes that all these data will help them find out what the risks are.

The risks of silicone implants to the breast include:

• An implant may harden and be painful.

• An implant may rupture and silicone may leak inside it.

• There may be infection.

• It may be slightly harder to find cancer in the breast when a mammogram is taken because of the shadow of the implant. (If you have implants of saline or tissue from other parts of your body, you can still have an effective mammogram for breast cancer.)

The risks of silicone implants to the body, which are less clear, include:

• Small amounts of silicone may leak out of an implant over a long period, even if it doesn't rupture. These small amounts of silicone may cause some women to develop autoimmune diseases such as arthritis, lupus, or scleroderma.

• Silicone may affect a developing baby during pregnancy.

The FDA stresses that there is no conclusive evidence that the above risks happen.

Other risks of breast enlargement include:

• There are some risks associated with anesthesia. Discuss these risks with your doctor.

• Your breasts may be hard or lumpy.

• Your breasts may feel too firm.

• The breasts may bleed or become infected around the implant.

• Your nipples and areolas may be numb.

• Your breasts may be unequal in size, shape, position, or contour. You may want further surgery on one or both of the breasts to try to make them similar.

• Your breasts may droop.

• A capsule may form around the implant. That area may become firm or tender and need regular massage or additional surgery.

• Your arm and shoulder movements may be restricted or painful.

• Saline implants may leak all of the fluid and become flat.

• The implants may need to be removed.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• The skin over the breast becomes irritated or starts to peel off.

• You have redness or unusual drainage from the cuts.

• You develop a fever or unexpected pain.

Call the doctor during office hours if:

• You have questions about the procedure or its result.

• You want to make another appointment.