Breast augmentation is one of the most popular plastic surgery procedures in the world. Since the first available breast implants of the 1960s, breast augmentation has now evolved to become a common surgery that gives much better and safer results.
Over the years, questions around the safety of implants have been raised. But today’s breast augmentation surgery is safer after decades of improvements to both the implants and the techniques plastic surgeons use.
Our clients choose to have breast augmentation for a number of reasons. In all cases, Dr. Ginger Xu uses her technical expertise and artistic sense to make sure each client’s appearance matches their unique identity. Dr. Xu is a Board-Certified plastic surgeon with specialty training in aesthetic plastic surgery at Harvard and is now based in the San Francisco Bay area.
Breast augmentation (also known as augmentation mammaplasty) is surgery to:
- Increase the size of the breasts
- Increase the fullness and projection of breasts
- Improve the balance between the size of the breasts and the hips
- Improve self-confidence
Breast augmentation can also have the added benefit of lifting the nipples or breast shape if there is a small amount of sagging of the breast. But if you have more significant sagging, Dr. Xu might recommend a breast lift as the primary method to address this, which can be done in combination with breast augmentation to help give additional fullness in the upper breast. Surgeons typically use implants to increase breast size, but sometimes fat grafting is used. Breast implants are filled with either saline (a saltwater solution) or silicone gel.
Good candidates for augmentation are healthy and have fully developed breasts. Women want larger breasts for a variety of reasons such as:
- They are not happy with the size of their breasts
- They are not happy with the shape of their breasts
- One breast is larger than the other (breast asymmetry)
- They are unhappy because the upper breast lacks fullness
- The breasts have become smaller or deflated after pregnancy or through aging
- Weight loss has changed the appearance of their breasts
- They have had breast cancer or another medical condition or injury resulting in undesired breast size or appearance
The first step is for you to have a good understanding of why you want breast augmentation and what the surgery involves.
Most women have some breast asymmetry. But for some women, the difference in size, shape or position of their breasts is significant, causing low self-esteem and other difficulties.
Breast augmentation can help to correct breast asymmetry. In an initial consultation with Dr Xu, discuss your concerns and she can examine all aspects of your breasts and recommend a plan of action.
Dr. Xu can also advise women whose previous augmentation with another surgeon has resulted in some form of breast asymmetry over time. This can be due to internal scar tissue contracting around the implant leading to implant malposition over time, and is the main reason for breast revision surgery.
The term “tuberous breasts” can be used to describe a range of physical characteristics of the breasts. While women are born with the potential to develop tuberous breasts, they typically first notice unusual features of their breasts during puberty as the breasts develop. A woman’s sense of identity, self-esteem and femininity can be affected by the appearance of her breasts and so some women seek surgery to improve the aesthetics of their breasts.
Tuberous breasts are also known as tubular breasts, constricted breasts, and herniated areolas. The physical changes associated with tuberous breasts can be mild or more severe and can affect breast size, shape and symmetry.
Women with mild forms might seek surgery to correct their small breast size, not realizing they have a developmental condition. More severe forms can result in a wide variety of characteristics such as:
- Asymmetry – one breast looks different or is smaller than the other
- Small breast size or undeveloped breasts
- Constricted breasts – causing unusual breast shapes
- Prominent areolas
- Areolar herniation – puffiness or bulging of the areola
- Inframammary fold malposition – the crease under the breast is not in the typical position
- Breast skin deficiency
The physical characteristics and aesthetics of tuberous breasts can be improved with surgical techniques including:
- Breast augmentation – implants can be placed to change the size and shape of the breasts
- Areola procedures – to change the size and/or decrease the puffiness or bulging of the areola
- Lowering of the breast crease
- Release of the lower breast tissue to allow expansion of the breast
Correction of tuberous breasts can be complex. The characteristics of the breasts can vary considerably, even between the breasts of the same woman. For this reason, your surgeon must have technical precision and an artistic eye to ensure the aesthetics, size, and shape of both breasts are carefully balanced.
During a consultation, Dr. Xu can recommend the best technique or combination of techniques after she examines your breasts and skin and has a good understanding of your vision and goals.
Breast augmentation is rarely done for people younger than 18 years of age unless it is to reconstruct a congenital breast deformity.
- Women between 18 and 21 years of age who want breast implants are candidates for saline implants.
- Women older than 22 years of age can choose to either have silicone breast implants or saline implants. Breast changes such as excess or sagging skin in middle age or after pregnancy might mean you need either augmentation alone or in combination with a breast lift.
Your body type influences the recommendations Dr. Xu will make for your breast surgery.
In thin women, an implant placed over the muscle might be more obvious and easily seen. In this case, it might be better to place the implants under the chest muscle (pectoral muscle).
On the other hand, very active or muscular women with sufficient fat to camouflage the implant might be better off with the implant placed over the muscle, which avoids cutting the muscle in order to place the implant underneath. Vigorous use of the chest muscles might also cause obvious movement of the implants and also lead to implant migration over time.
Heavier clients who need large implants should consider that 800 cc is the largest available size for silicone implants. Saline implants can be overfilled but only to a certain extent.
Women who have had significant weight loss can have breast deflation and excess or sagging skin. In these cases, augmentation can improve the fullness of the upper breast but a breast lift might also be needed.
A good plastic surgeon will recommend an approach tailored to your needs. Choosing an experienced surgeon with a sense of artistry is an important first step. Your ability to communicate with your surgeon is essential and you should make sure your surgeon understands your needs.
During a consultation, Dr. Xu will discuss all the factors to think about when choosing an approach for your surgery. These include:
- Type of implant – silicone or saline
- The shape of the implant, including dimensions and projection
- Size of the implant
- Plane of the implant placement
- The firmness of the implant
- Placement of incisions
Breast implants are medical devices with an outer silicone shell, which can be either smooth or textured. They can be either round or “anatomic” tear-drop shaped, and are filled with:
- Saline – smaller incisions needed, but rupture causes immediate deflation, less natural look and feel
- Silicone gel – gives a more authentic feel and is more robust
- A new type of silicone gel – called “gummy bear implants”, which hold their shape better
Of note, anatomically shaped implants only come as textured implants, which have been linked to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL – see below). Dr. Xu never uses textured implants for this reason. She only uses smooth implants, which have not been linked to this condition.
Option for the placement of incisions are:
- Around the nipple (periareolar) – where the nipple border can help to hide the scar
- Under the breast fold (inframammary) – gives the easiest access for placing implants and the scars are almost invisible
- In the armpit (transaxillary) – the scar is hidden under the arms but this is only an option for saline implants, because of more restricted access and view for the surgeon
The surgery involves placing the implants either:
- Under the breast tissue – faster recovery time, less discomfort and fills loose skin more effectively
- Under the chest muscle – more natural appearance in the upper chest, less risk of rippling or hardening of the tissue around the implant
You and your surgeon must communicate and work together so you have a good understanding of the process that will give you the best results. The goal of a good surgeon should be to arm you with the knowledge to make decisions about your breast augmentation surgery.
Dr. Xu can help you to understand how different implants will affect the final look you will achieve. It is important you have a realistic understanding of:
- How your breasts will look after surgery
- Limitations of the surgery
- The differences between saline and silicone implants
- Any short- and long-term effects – such as the potential need for more surgery
- Any possible complications
Dr. Xu encourages open and honest communication about your body, your lifestyle and what you want for the future. Photos of your desired outcome can help her understand your needs. Your medical history is also important, including any information about pregnancies and breast cancer or other medical conditions.
Things to discuss with Dr. Xu include:
- Why you want the surgery
- Your future lifestyle goals
- What appearance you hope to achieve – for example, a natural look or a more voluminous look
- What sort of breast shape or form you would like
There is a cultural element to all cosmetic plastic surgery, including breast augmentation procedures.
Many women in the San Francisco area prefer a “Bay Area aesthetic” for their appearance after surgery. This involves achieving a more natural appearance, with a breast size that is augmented but doesn’t necessarily draw attention to the chest, and also is balanced with the rest of the body frame. A sporty or athletic look is also a common goal because this is in keeping with many women’s more physically active Bay Area lifestyle.
Fat transfer can be an option for natural breast augmentation, but it is not yet a widely used technique. The technology for fat transfer has evolved and the survival of fat cells has improved, but it is a more experimental option than implant surgery.
Women who consider fat transfer include those who:
- Want breast augmentation but do not want an implant
- Have had mastectomy reconstruction and seek touch-up
- Have had complications with breast implants in the past
The ability to use this technique depends on the body of the client and the distribution and availability of fat. The technique to increase the breast size by one cup size involves:
- Adequate liposuction of fat from the abdomen or other areas
- Transfer of this fat to the breast.
For women who want a much larger breast size using fat transfer, the skin over the breast may first be stretched using a negative pressure device worn over the breast to expand the skin. This leaves more room under the skin so more fat can be grafted to create a fuller breast.
Dr. Xu uses different approaches to help you to choose your breast size including:
- Discussing your goals and vision for your body
- Trying “sizers” in the office – breast implants you can try on under your clothes
- Looking at “before and after” photos
- Her sense of artistry and technical experience of what can be achieved
Breast implant manufacturers in the US have warranties. For the latest details, ask your surgeon or search the manufacturer’s website:
- Allergan® Natrelle® ConfidencePlus® Warranty Program and Natrelle® ConfidencePlus® Premier Breast Implant Warranty
- Mentor® – Saline-filled Breast Implants Warranty and MemoryGel® Breast Implants Warranty
- Sientra® – Platinum20TM Limited Warranty and Lifetime Product Replacement Program
Dr. Xu understands the responsibility of transforming a person’s appearance to better reflect their identity and build self-esteem. Her top priority is understanding your vision and desires. During a consultation, Dr. Xu will explain:
- The different types of saline and silicone implants
- Implant sizes and shapes
- Options for incision placement
- Placement of implants over or under the chest muscle
- Need for further operations
- Potential complications
Once she has examined your body, breasts, and chest, she will use her artistic sense to recommend an approach to your surgery that will suit your identity and vision for your body.
Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least 6 weeks prior to surgery.
You may need to get a blood test or undergo additional workup depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare for your breast augmentation surgery include:
- Making sure you get enough sleep and rest
- Eating a healthy diet with adequate protein and nutrition
- Exercising or engaging in physical activity to strengthen your body
- Maintaining a positive state of mind
- Prioritizing your well-being and reducing stress levels
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.
After your surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on a number of factors such as:
- Where the implant is placed – for example, the pain might be more noticeable if the breast implants are under the chest muscle
- Size of the implant and the degree of skin stretch
- Your age
- Your health before the surgery
Prescription pain medications might be needed for the first few days. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
Recovery typically takes approximately two weeks. During this time, you should avoid lifting any heavyweights. Once bruising and tenderness have gone, you can return to normal activities. Most clients can return to work after a week, but strenuous exercise should be avoided for four to six weeks.
Some women do not get the results they hoped for because the surgeon used the wrong technique. This is especially the case for women with excess or sagging skin because of age, weight loss or pregnancy.
Some surgeons prefer implant surgery because it is an easier technique than a breast lift or a combination surgery with a breast lift and augmentation. For this reason, some surgeons might recommend implants when a breast lift would have been a better option.
Women seeking breast revision surgery often complain that another plastic surgeon inserted an implant that gave them a larger breast size than they wanted. Women thinking about breast augmentation should be careful if a surgeon is encouraging them to accept a larger breast size rather than respecting the woman’s vision for her own body.
Implants that are too large can increase the risk of permanent unsightly stretch marks, wound complications or the implant may push through the overstretched skin and become exposed.
Dr. Xu believes in focusing on understanding each client’s goals and respecting their vision, anatomy, and desires. Combined with her surgical technique and sense of artistry, Dr. Xu can optimize your results by:
- Recommending the correct surgery – she will take into account your anatomy and the condition of your chest and breasts and let you know if a breast lift is needed
- Recommending the correct implant – she will balance your desired breast size with your skin stretch and its ability to tolerate a certain size of breast implants to decrease the risk of complications
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare and highly treatable type of lymphoma that can develop around breast implants. This is a relatively new disease entity that the medical community continues to learn more about as additional data unfolds with time. If you have questions, Dr. Xu can review the latest updates and safety advice with you in detail at the time of consultation. At this stage, BIA-ALCL is only associated with textured surfaces and this is why Dr. Xu does not use implants with textured surfaces.
Capsular contracture is the formation of scar tissue around the implant. The scar thickens and hardens over time. This can squeeze the implant and increase firmness, leading to poor positioning of the implant (malposition) and pain. The implant is typically pulled in an upward direction, higher up on the chest.
Implant migration or malposition is caused when the implant moves with gravity downwards or laterally, with the implants moving into the wrong position. If this happens only in one breast, it can cause asymmetry. Surgery will be needed to correct this.
Stretched skin can be caused by implants that are too large.
Implant leakage or rupture can occur with either saline or silicone breast implants. For saline implants, the ruptured or leaking implant will lead to deflation. Salt is naturally in the body and so the saline from the implant will be absorbed and eliminated. You will need surgery to remove the deflated implant and insert a new one. Leaking silicone implants are more difficult to detect as the leaked silicone gel often stays in the “pocket” holding the breast implant. Sometimes, the silicone leaks out of the pocket and can be felt around the edges of the implant. You should see your surgeon if you feel any irregularities. If the implant has leaked or ruptured, you will need surgery to remove the old implant and insert a new one.
Infections after surgery can appear within a few days and up to two weeks. Surgeons take precautions to reduce the risk of infections such as giving you antibiotics before, during and after surgery. If you do get an infection, most can be treated with antibiotics. On rare occasions, the breast implant will have to be removed and can later be replaced after the infection clears.
It is important to understand that breast implants are not guaranteed to last a lifetime. While newer generations of implants are more robust than older models, future surgery may still be needed to replace an implant if rupture or leaking develops. After breast augmentation, it is a good idea to have regular breast exams to check the condition of your implants.
Saline implant rupture would result in obvious deflation and a change in the size of the affected breast. However, silicone implant rupture is often “silent” and undetectable by the woman or even by physical exam. In this scenario, MRI is a useful tool that can detect silent rupture. Currently, the Food and Drug Administration (FDA) recommends MRI screening for silent rupture three years after receiving a silicone implant and every two years after that.
There are many options for all aspects of your breast augmentation surgery. To choose the best implants and surgical technique for your situation, schedule a consultation and examination with Dr. Xu. Once she understands all aspects of your situation, she can recommend a breast implant that will best serve your needs and body type.
After your surgery, you may feel some pain and discomfort. Medication can relieve the pain and you can return to work and light activities within one week.
Women with breast implants can breastfeed normally. Research shows the implant does not affect the quality of the milk, although the amount of milk you produce might decrease. You might also consider waiting for breast augmentation until after you have finished breastfeeding.
During the recovery time, women might feel more or less nipple sensation but that will usually resolve. In rare cases, women lose sensation in the nipples.
The positioning of any scars depends on where the incisions are made during surgery. Most scarring is out of sight or well hidden, especially when the incisions are under the breast. Scars will appear red or pink and slightly raised until they begin to heal and become less noticeable over time. Scars will heal at different rates (up to 18 months) depending on your age, skin tone and exposure to the sun.
After the standard recovery time of 4–6 weeks, a swimsuit with a bikini top may irritate if you have scars under the breast. Underwires can irritate healing scars and should be avoided until your scar is not tender to the touch. Sun and water exposure should also be avoided while your scar is healing. Ask your surgeon when you can safely wear a swimsuit and enter the water.