Breast augmentation is performed to increase breast fullness and volume for women with small breasts or those who have experienced a decrease in breast size due to pregnancy or weight loss. There is a wide variety of implant designs, shapes, sizes, and textures, all of which have certain advantages and disadvantages. A breast implant is basically a soft, silicone envelope with various fillers that is surgically implanted under the tissues of your chest to simulate natural breast tissue.

The breast implant used for primary breast augmentation in the US is made of a silicone shell filled with a saline solution. Saline filled adjustable implants that are similar to the standard saline filled implants with the addition of a small connector tube through which the surgeon can adjust the size via injection. This implant requires a second incision to remove the injection port in an additional surgical procedure. Under certain conditions, including breast reconstruction, breast lift and other secondary breast procedures, silicone gel implants are now approved by the FDA.

Breast augmentation may be performed under local anesthesia with intravenous sedation, or general anesthesia. General anesthesia may be recommended for women desiring implant placement below the muscle. The surgery consists of making an incision, lifting the breast tissue, creating a pocket in the chest/breast area, and placing an envelope containing a soft, implant material underneath. An incision may be made either in the crease below the breast, around the areola, or under the armpit. The implants can be placed either under the chest muscle or directly under the breasts. Placement considerations include the anatomy of your breasts, breast feeding, and your personal preference. All of the options will be discussed in detail to allow you to make an informed decision.

Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Types of implants

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.

Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implants, the Food & Drug Administration (FDA) has determined that new gel-filled implants, at the present time, should be available only to women participating in approved studies. Some women requiring replacement of the implants may also be eligible to participate in the study.

Saline-filled implants continue to be available to breast augmentation patients on an unrestricted basis, pending further FDA review. You should ask your doctor more about the specifics of the FDA decisions.

All surgery carries some uncertainty and risk

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.