They may just be mammary glands, but female breasts have fascinated society for millennia, and since time immemorial been associated with fertility and beauty. It comes as no surprise, then, that women have been eager to enhance their bosoms for as long as the surgical techniques and equipment have been available. Breast augmentation surgery is mostly performed for cosmetic reasons, but it is also used to reconstruct the breast area after a mastectomy, or as a component of sex reassignment surgery. It is currently the most common cosmetic surgical procedure performed in the United States.

Breast augmentation involves the insertion of implants filled with either silicone gel or a sterile saline solution behind the breast tissue, or beneath the chest muscles, to increase the size of the breast, improve its shape, or add fullness. The implants themselves are made of an elastomer shell with a self-sealing filling valve through which the desired content of the implant will be pumped. Though some implants are pre-filled beforehand, most are filled after insertion. Choosing the right size of implant is very important, as implants that are too large can cause complications during or after surgery, and may be visible through the breast skin. The shape of the implant is another consideration. Most women will select round implants, which have a fuller appearance, but some will opt for more natural shapes, so that the implant isn’t too apparent.

There are advantages and drawbacks to selecting either of the two available types of implants, silicone and saline. Silicone implants have a more natural look and feel, and are generally considered superior for women who have little breast tissue or are undergoing reconstructive surgery after a mastectomy. However, they are slightly more likely to rupture and cause various types of side effects, such as breast hardening and the formation of silicon granules in the breast. The latest silicone implant versions on the market today are manufactured to minimize these occurrences. Since saline implants are easier to fill after they have been inserted, smaller incisions need to be made, which reduces scarring and improves healing time. Also, as saline mimics the natural fluids found in the body, the complications inherent in silicone gel use are avoided entirely. However, being made of less stable material, saline implants are more likely to produce wrinkling or rippling on the breast surface, and are more obvious to sight and touch.

Placement of the breast implant is also crucial, as it each comes with its own pros and cons. Subglandular placement puts the implant directly behind the mammary gland and in front of the muscle. This is the least complicated process and leads to the swiftest recovery, but also exposes the implant the most and subjects it to the most risks, as only the breast skin and gland provide cover. Subpectoral placement lodges the implant under the major pectoral muscle, lessening risk but also taking longer to heal. Since the implant is only partially covered by the muscle, it is not recommended for women who have sagging breasts, as it may create separate bulges in the breast region. Submuscular placement inserts the implant firmly behind the muscle wall, providing the greatest support and least visibility or exposure of the implant, but is more complicated than the other insertion methods and has the longest recovery time. Submuscular placement is reputed to be best for mammograms, as the implant is positioned behind the area to be scanned.

Patients who undergo breast augmentation are generally able to resume work or non-strenuous activity within a week’s time, unless they have opted for submuscular placement, in which case the recovery time is increased to at least two weeks. Patients are also asked to refrain from exercise and intense physical activity for about four weeks after surgery. Scarring from breast augmentation lasts about six weeks and begins to fade a few months after the procedure.