Breast implant surgery (augmentation mammoplasty) is a very popular procedure among women who want to change the size and shape of their breasts. The final result of the breasts after implant placement is primarily determined by the relationship of the implants to the pectoral muscles of the chest wall. Breast implants are known as “upper” and “lower”; these terms refer to whether the implant is placed above or below the pectoral muscles of the chest wall.

Breast implants are devices that can be filled with elastic silicone gel or saline. Over the past ten years, studies have been conducted to determine whether silicone gel-filled implants are associated with cancer or connective tissue disease; at this time, there is no evidence that breast implants are associated with these diseases.

The “under” approach

With the “under” approach, the implants lie completely behind the breasts. The advantages of this approach are ease of placement, no visibility of the implant, no rippling of the implant surface, low interference from mammography, and no scarring of the breast. The disadvantages of the “low” approach are that the surgery is much more difficult to master and there is postoperative muscle discomfort.

After the placement of the breast implants, you will normally have drainage tubes in place for approximately two days. Stitches are used to close the incisions, and a bandage is applied over the breasts to aid healing. You will feel sore and tired for several days after surgery, but most patients are up and about within 48 hours of the procedure. Within a few days after surgery, you should feel well enough to return to work, depending on the type of job you have. Women should refrain from upper body exercise for up to six weeks and lower body exercise for approximately three weeks.

The “on” approach

In the “over” approach, the implants are actually inside the breast. Some of the advantages of this approach are that the surgery is fairly easy to perform and can be performed by almost any surgeon; there is less postoperative discomfort; and this procedure allows for the insertion of large implants, which some women want.

However, there are several disadvantages to the superior approach, and many plastic surgeons do not recommend this type of implant. Some of the disadvantages are that the implants interfere with mammograms; there is a clear visibility of the edges of the implant (and they can also be felt); and there is a visible rippling of the skin over the implants.

There are many reasons why women consult a cosmetic surgeon to discuss breast implant surgery:

To restore breast volume after weight loss or pregnancy

To achieve better symmetry in shape/size of the breasts

To improve the shape of sagging breasts

To provide the foundation for the contour of the breast after a mastectomy for breast cancer

To improve the appearance or create the appearance of a breast that is disfigured or missing due to heredity, congenital deformities, or trauma

Feel that the breasts are too small

Having breast implants can be an exciting and satisfying experience that often makes women feel better about their appearance and themselves. Your decision to have breast implant surgery is a personal decision that not everyone will understand. Breast augmentation can certainly improve your appearance and your self-confidence, but it may not cause people to treat you any differently.