Small breast size, whether natural or as a consequence of such things as pregnancies or other conditions, can be a very difficult situation for some women. A common request is, "I just want to be normal!" or "I just want to be the size that I used to be." There are no non-surgical methods that can reliably increase breast size. Plastic surgery has been able to successfully increase breast size by placing an implant under the breast tissue for many years. Recent controversy about the use of the common silicone gel implant has changed some of the options that you have. It has raised many as yet unanswered questions. Saline implants are available for use, but it is important that you realize that they don't answer all these questions, either. They are the only means of enlarging the breast that we can offer you.
Breast enlargement surgery is almost always considered cosmetic, and insurance or other third-party payers do not pay it for. In very rare cases that actually represent a breast reconstruction after accident, injury, or congenital deformity, there might be some reimbursement for the costs. Your doctor will be able to determine this. The costs of surgery will be discussed with you during your consultation.
For women who feel that their breasts are too small it can be a major problem and can lead to much unhappiness. Unfortunately, many people have preyed on these feelings with unproven, often quite expensive "treatments" of various kinds. We know of no pill, no ointment, no lotion, no exercise device or program, or any other non-surgical method to increase breast size. Some women have always been smaller than they would like. Many others lose breast size after pregnancies (involutional hypomastia).
Plastic surgery has offered breast enlargement surgery for more than 30 years. Lately, there has been tremendous controversy in this area with the questions and concerns that have arisen over the use of silicone gel implants, the most commonly used devices to make the breast larger. The answers are not all in. Additional information will become available that may help to sort truth from fiction. Patients interested in this type of surgery will need to keep their eyes and ears open.
Breast enlargement surgery can be performed under general anesthesia or heavy sedation with local anesthesia. Either method is done on an outpatient basis at either a hospital or surgical clinic facility. An incision is made in the armpit, around the areola, or under the breast in the crease, most commonly, so that a "pocket" can be created under the breast and/or the chest muscle tissue. A saline-filled implant of the appropriate size is placed in this pocket and the incisions are closed with stitches. Sometimes a bra is applied immediately, but a bandage is commonly used for at least a few days. Pain can be bad for a day or two, but usually improves quickly. Medication is prescribed to reduce this pain. Light duties can be resumed after the first few days. "Normal" activities are usually possible by one or two weeks, and unlimited activities, like aerobic exercise and other physical endeavors, are okay by four to six weeks. Scars and internal healing proceed for six to twelve months in total.
Benefits, Risks, and Complications
The obvious benefit of this surgery is an augmentation or enlargement of the natural breast size. Reasonably, a one-cup size increase is expected, although there will be many exceptions to this general rule. It is also true that a final result of 80% breast and 20% implant is probably more natural and "better" than a result that is 20% breast and 80% implant.
Like any surgery, augmentation mammoplasty has risks and the possibility of complications, but you should not worry needlessly about them. You do need to weigh them against the benefit that you expect to gain from the surgery. Your number one option is NOT to have this surgery. It is certainly elective in almost every case.
Risks and complications include such things as the scars, the chance for bleeding or infection, a possibility of additional surgery to correct problems, possible nerve damage with permanent numbness, lack of ability to breast feed, possible problems in having mammograms in the future, and problems with the implants. Implants are foreign to your system, and your body will form a scar tissue layer around them. This scar tissue can react through unknown mechanisms to cause problems like hardening, deformity of some kind, discomfort, or other changes. The saline implants have not solved these problems any more than the silicone implants did. Saline implants can leak and, although the saline itself would be totally safe, the broken, flat implant would have to be replaced.
Despite the terrible anecdotal headlines about the horrors of silicone implants, there has been no scientific proof of a cause-and-effect relationship. Maybe such proof will come. Up to this point, however, it is only speculation. It is something that you need to know about, and it is something that you will need to decide about as you consider this kind of surgery. Saline-filled implants do have a silicone shell, or covering, but this is chemically different from silicone gel. Whether this could be a health risk is unknown. The saline implants we can use today have not yet gone through the entire bureaucratic process that now prevents the use of the silicone gel implants. This FDA process is apparently proceeding very slowly.