American Society of Plastic Surgeons
For Medical Professionals

What to consider when having breast augmentation surgery

With nearly 300,000 procedures performed every year, breast augmentation is one of the most popular plastic surgery procedures. Women who want to improve their breast shape have a number of great options, and though most think only of the many "rewards" of having larger breasts, like any surgery, there are also some potential risks.


There are many reasons why a woman may consider her breasts to be too small. In some cases, the breasts once seemed to be larger but hormonal imbalances, aging, weight loss or changes due to pregnancy or breastfeeding may have altered the breast tissue. In other cases, simple genetics are the cause for small breasts.

Breast enlargement is ideally used to balance the chest with the rest of the body for a natural appearance. Most women don't need to go up more than two bra cup sizes, and when breasts are enlarged too much results may appear obvious and unnatural and may increase the risks of side effects such as scarring and breast sagging. In many cases, women who start out believing they want much larger breasts may ultimately be happier with a full but natural look.


Today, women who want breast augmentation have a number of options in what will be used to do the enlargement and how it will be done.

Silicone implants

Implants filled with silicone gel are placed to enlarge the breast, generally under the chest muscle. Reintroduced to the U.S. market in 2006, silicone implants are considered safe and are often preferred for their natural feel.

Saline implants

Similar to silicone but filled with a saline solution. Both silicone and saline implants come in a variety of sizes. For cosmetic breast enhancement in patients between the ages of 18 and 22, saline implants are the only option allowed by the FDA.

Fat transplant

Fat cells can be "transplanted" from one area of the body to another. This requires a liposuction surgery which increases the surgical risks.

Like all plastic surgical procedures, each type of augmentation procedure has certain advantages and limitations. Saline implants may not feel as natural, particularly if breast tissue is sparse, but in the event of a rupture, saline is easily absorbed. Silicone implants have a more natural feel, but "silent leakage" is possible. Though they are considered safe, the FDA recommends that an MRI is done three years post placement and then every two years to ensure the implant is still intact.

Enhancements using fat transplants may not produce as much volume as the patient desires if the body is unable to establish good blood supply with the transplanted cells. In most cases, about 40-50% of the injected fat is "lost" and most patients will not gain more than one breast size. This does not pose a significant health concern but enlargement may not be adequate.


There are two locations that an implant can be placed – either under the breast tissue or underneath the chest muscle. Most plastic surgeons prefer to place an breast implant beneath the chest muscle, as it often results in a more natural feeling but there are other advantages as well. Implants placed beneath the muscle can reduce the chance of "hardening" of the implant which will require revision surgery. All women should know that breast augmentations generally have a lifespan of 10-15 years and artificial implants will need to be removed or replaced after this time.


In addition to choosing the implant type and placement, the surgeon, along with the patient, will need to determine where the incisions will be made. Most plastic surgeons have a preference but each woman's specific circumstances or physiology may be determining factors.

Inframammary incision

Made under the breast fold. It is the most direct route to the inside of the breast tissue and resulting scars will be hidden from view. Most asymmetries can be corrected through this route and future surgeries including removal or replacement of implants can be done through same incision site.

Transaxillary incision

Made in the armpit. Hides scars away from the breast area but may still be visible. May make the procedure more complicated as the incision is further from breast area and revision rate may be higher. In addition, there is a higher risk for loss of sensation in the nipple area and may result in inner arm numbness.

Periareolar incision

Made around the nipple for concealment in the color/texture change between areola and rest of breast. Has a higher rate of loss of nipple sensation and may increase the risk of bacterial infection of the implant. Periareolar incision may be needed as part of an augmentation procedure which also includes a breast lift.

Any type of surgery, including plastic surgery, has inherent risks. Though most women may ultimately have a good outcome, there can be complications with anesthesia, post-surgical healing, scarring and even implant rejection. A woman should discuss all possible risks with her plastic surgeon before making a decision to get breast augmentation.

There is no "perfect size" but some women simply want to have larger breasts. Everyone has seen examples of women who have gone "too far" and breast augmentation should not be undertaken lightly. As with all plastic surgeries, breast augmentation should ideally be done to balance the appearance while still allowing comfort.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.


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