Breast augmentation surgery is an improving operation performed on women with small breasts. It is also corrects symmetry problem of the breasts and performed under general anesthesia. An incision is made to the breasts and artificial implants are placed. The Breast augmentation implants made of silicone shells contain salt water (saline) or gel. There are different breast augmentation methods depending on where the incision is made. The most common method is implant placement performed with an incision to the lower part of the breast, natural skin fold. Postoperative recovery process may take several weeks. It is crucial to follow doctor’s instructions during this period.

What is breast augmentation?

Why is breast augmentation performed?

• To increase size of the breasts when one or both of breasts are too small
• To restore the shape of breasts with reduced size as a result of pregnancy, breastfeeding or weight loss through natural or surgical methods
• To balance body size (for instance, someone with small breasts and wide hips may desire to have the size of her breasts increased)
• To correct breast asymmetry
• To enlarge inborn small size of the breasts
• To restore appearance of a breast removed due to a disease such as breast cancer

Who can undergo breast augmentation surgery?

This surgery is performed on women who have breast development completed, are older than 18, have good physical and psychological health. Moreover, it is important that the patient has realistic expectations. (2) The breast augmentation is performed with the aim of improving existing situation. The breast augmentation cannot be performed on pregnant and breastfeeding women.

Breast augmentation methods

1. An incision is made to the lower part of the breast, natural skin fold, and the implant is placed through this hole. This is the most common method performed.
2. The implant can be placed through an incision under the arm. This surgery is performed with endoscope.
3. An incision is made to the edge of areola (black-brown ring surrounding the nipple) and the implant is placed through it.
4. Saline (salt water) implants are generally placed through an incision made close to belly button. The endoscope is used in order to move under the breast. When placed in correctly, the implant is filled with salt water.

Implants used in breast augmentation

• Saline (salt water) implant: These are elastomer (an elastic substance like synthetic rubber) silicone shells which can be filled with different amount of sterile salt solution. This affects the tightness and shape of the breast. If the solution leaks, this can be naturally absorbed by the body and removed. Furthermore, the size of many saline implants can be increased or reduced after the surgery without requiring a new surgery. The surgeon uses only syringes to put in more saline or remove it
• Alternative composite implant: These are silicone shells which can be filled with polypropylene fiber, soybean oil or other material. (4)
• Silicone gel-filled implant: These are made of silicone outer shells filled with silicone gel. If it leaks, the leakage remains in the gel shell or escapes into the breast implant pocket and implant either deflates or not depending on situation. This practice requires regular check-up and MRI or ultrasound scan is taken due to the risk. These implants placed under the breast muscle or the breast tissue can be flat or textured, round or tear drop-shaped. The average lifespan is 7-12 years for these implants.

Breast augmentation with silicone

• Silicone gel is a thick and sticky liquid which best mimics natural fat and tissues in the breasts.
• Silicone implants previously filled according to the targeted breast size are placed in the breasts through an incision.
• The incision made is larger; therefore, it is more distinct even though the scar may fade over time, but especially the scars of the incisions made under the arm or breast remain hidden.
• The size of previously filled standard silicone gel implants cannot be changed as in the saline implants.

• This implant is performed in women at the age of 22 and older.
• If the implant ruptures for various reasons, it may not be noticed by either the patient or doctor with naked eye. This is called a silent rupture. Leaking silicone remains in the body and sometimes spreads outside the breast and to distant lymph nodes. Due to the risk, imaging tests such as MRI are required as often as recommended by the doctor.
• As the leaking silicone gel is considered to lead to health issues such as breast cancer, reproduction problems, and rheumatoid arthritis, a ruptured implant detected through imaging tests should be immediately removed with surgical intervention. If a new implant is desired, it can be generally placed at the same time.

• Even though a ruptured silicone implant cannot be easily noticed, it may cause mastalgia, breast thickening, and changes in the breast contour or shape over time. If you doubt that your silicone implant is ruptured, consult your doctor immediately.

The reliability of silicone breast implants was frequently discussed in the past as it was considered harmful to health. Today, it is concluded that if checkups are regularly made against the rupture risk, serious harm will not occur. However, there are ongoing discussions on its reliability and effectiveness.

What to consider before breast augmentation surgery?

• After a routine examination, especially women over 40 years old should have a mammogram taken against the possible of breast cancer.
• Pregnant women or patients planning to become pregnant should inform the surgeon.

• Smoking and alcohol use should be quitted at least 6 weeks before the surgery to prevent complications.
• The surgeon should be informed about over-the-counter drugs, supplements, and even herbs taken.
• Blood thinners such as aspirin etc. should not be taken a few days before the surgery.
• You may need to stay in the hospital overnight after the surgery, thus a companion should be arranged.
• You should eat or drink nothing at the night before the surgery as anesthetics will be administered.
• The patient may be asked to wear compression socks during the surgery to prevent deep venous thrombosis (sudden blockage of the veins in legs with a blood clot).
• It is necessary to wear or bring loose, button-front or zipped clothes and baleen-free bra vest.
• As recovery takes 1-2 weeks, especially those doing heavy work should take leave from work.

How is breast augmentation surgery performed?

• While deciding on that the patient is suitable for the surgery, the breasts are measured and the surgery sites are marked considering the shapes of the breasts, the skin and the location of nipples. They can be photographed.
• Tests can be performed, placing a bra to choose the implant size required by the patient.
• General anesthesia and sometimes local anesthesia can be used. If local anesthesia is used, the patient will be awake, and the breast area is numbed to prevent pain.

• To place the breast implant, the surgeon makes an incision to wrinkles under the arm or around the nipple and creates a pocket separating the breast tissue from the muscles and connective tissues.
• The implant is placed into this pocket and centered behind the nipple. Saline implants are placed empty and then filled with sterile salt water. Silicone implants are previously filled with silicone gel.
• If the breasts are sagging and cannot be supported with implants, breast lifting surgery can also be performed during the surgery.
• When the implant is in place, the incision is stitched or closed with skin adhesive and surgical area is bandaged.
• It may be necessary to stay in the hospital overnight as a tube will be inserted under the skin and excess blood or fluid will be drained.
• The surgery generally takes 1-2 hours.
• Drugs are prescribed for possibility of infection and pain.
• If dissolvable suture is not used, sutures are taken after 1 week.

There may be pain, swelling and bruising in the surgery site for 15 days, but these symptoms will relieve over time. The size of the scar is decreased, but it will not vanish completely. (6)

Breast augmentation recovery timeline

What to consider after breast augmentation surgery?

• You shouldn’t drive for 1 week.
• You shouldn’t do forceful physical activities and carry heavy things for 6 weeks. In addition, remember that the breasts are sensitive to physical contact or shaking movements.
• You should do exercises such as stretching and moving arms recommended by the doctor to relieve pain and discomfort.
• It may be necessary to wear compression bandage or sports bra for 3 months without taking it off for the breast implants to be supported more and placed correctly.
• Massage techniques recommended by the doctor should be applied 5 days after the surgery to prevent the hardening of the capsule surrounding the implant.
• You should contact the surgery clinic immediately in case of infection symptoms such as burning, redness, unexpected swelling, chest pain, unusual heartbeats or shortness of breath.
• While taking mammogram for cancer screening, the healthcare provider should be informed that there are implants in the breasts.

If the patient is not satisfied with the appearance of the breasts, further surgery may be required. Moreover, the appearance of the breasts may change over time due to aging, gaining or losing weight after the augmentation surgery.

Natural breast enlargement methods

Breast enlargement exercises

You can have rounded breasts by developing muscles in the upper and lower parts of the body with exercise. Some exercise examples done standing are as follows:

• Hold your hands and arms straight, place on the wall and do push-ups movements, approaching the breasts to wall and pull them away.
• While standing legs close and keeping palms facing upwards, open your arms to both sideways and back and then slowly approach your arms straight in front of the chest area, and open them again to both sides.
• Keep your legs close, open your arms to both sideways, and move them by drawing small circles backwards and forwards respectively.

Breast enlargement with massage

If the massage is given correctly, it can help enlarge the breasts positively affecting the structure of the breast muscle and tissue. For example, you can give a massage from the inner part of breast to outer part with soft circular movements approximately 100 times. Then, you can approach the breasts to each other and move them away 30 to 40 times.

Herbal solution for breast enlargement

• Boil 5 to 6 gr hops and drink a glass of it when it is lukewarm.
• This cure should be applied for 1 month to see its effects.
• The mixture should be prepared daily and consumed fresh.
• Hops are a medicinal herb that should be carefully consumed. To eliminate its adverse effects, a half avocado, raisin or walnuts should be consumed once in two days while applying the cure.

Breast enlargement creams

There are many breast enlargement creams and serums in pharmacies and cosmetic stores. How effective these are is a controversial topic. Especially some doctors argue that these creams containing phytoestrogen (herbal hormones) are harmful for health. (7)

Cost of breast augmentation surgery

Risks of the breast augmentation surgery

As in all surgeries, the breast augmentation surgery has the risk of developing allergic reaction to anesthetics, bleeding, pain, blood clot (deep venous thrombosis), infection and respiratory problems. (8) Possible complications are as follows:

• Changes in the nipples or breast sensation
• Feeling of hardness in the breast tissue
• Irregular nipple position
• Persistent pain
• Hematoma (collection of blood coming out of the veins under the uninjured skin)
• Pale scar
• Wrong or incorrect position of the implant
• Implant leakage or rupture
• Movement of the implant in breast losing its stability
• Surge of the implant
• Thick scar tissue formation around the implant (capsular contracture)
• Fluid accumulation (seroma)
• Wrinkling skin on the implant
• Different size or shape of the breasts
• Difficulty in breastfeeding
• Development of a rare form of lymphoma
• Possibility of revision surgery