There is no evidence that breast implants cause breast cancer.  In fact, there are several studies that show a lower incidence of cancer in women with breast implants.  The presence of implants may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Planning your surgery

In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. Detailed measurements of your body and breast proportions are performed to help you select an implant.  If your breasts are sagging, your doctor may also recommend a breast lift.

Be sure to discuss your expectations frankly with your surgeon. He should be equally frank with you, describing your alternatives and the risks and limitations of each. And, be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs.

Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.

Preparing for your surgery

Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where your surgery will be performed

Your surgery will be performed in a hospital outpatient facility.  You will go home after release from the recovery room.

Types of anesthesia

Breast augmentation is performed with a general anesthesia, so you'll sleep through the entire operation.

The surgery

The method of inserting and positioning your implant will depend on your anatomy and your surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. It also prevents any interference with the milk ducts and blood supply to the breast.

Incisions are made to keep scars as inconspicuous as possible, in the breast crease, around the nipple, or in the armpit. Breast tissue and skin is lifted to create a pocket for each implant.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.

Placing the implants behind your chest muscle reduces the potential for capsular contracture.  This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue.

The surgery usually takes one to two hours to complete. Many layers of internal stitches are used to close the incisions, which will be taped for greater support. There are no outside stitches. After surgery, breasts appear fuller and more natural in tone and contour. Scars will fade with time.

After your surgery

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

You will wear a supportive bra around the clock for the first 6 weeks after surgery.  You may also be given a bandeau to help hold the breasts in position.   It takes several weeks for the swelling to disappear.  It takes even longer for the breasts to assume their final shape and softness.

Getting back to normal

You should be able to return to work within 3-7 days, depending on the level of activity required for your job.

Follow your surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.  Most patients can resume exercise, such as walking, treadmill, stairclimbers, at one week after surgery.  Running and weight lifting can be resumed approximately 6 weeks after surgery.

Your scars will be firm and pink initially and then gradually fade and flatten for up to a year after surgery.  You will be provided with a cream to help your scars heal and fade quickly 

Your new look

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success.

Breast reduction (reduction mammaplasty) and breast lift (mastopexy)

Breast Reduction is a procedure designed to reduce the size of a woman's breasts. This is done for both medical and cosmetic reasons. What is Breast Lift?

Breast lift surgery removes the excess skin of sagging breasts without greatly reducing the size of the breast. It is usually done as a cosmetic procedure.

You should expect that your breasts will be reduced to the size and shape that you discussed with your surgeon prior to surgery. They will be smaller, lighter and firmer. You should expect to be more comfortable and have fewer problems related to large breasts after the surgery.

The scars of breast lift or reduction are noticeable and the fold of fat that is often present under the arm will not be removed during the surgery. Scars are easily hidden under a bra or bathing suit.

Breast reduction is suitable for women who feel that their breasts are too large and/or pendulous or they are suffering physical symptoms related to the weight of large breasts. For example back, neck and shoulder pain, indented bra straps, breathing or skeletal problems or skin disease under the fold of large breasts.

This can be performed in healthy women of any age. This procedure may lead to an improvement in posture, greater range of physical activity, reduce hormonally related breast pain, reduce skin irritation under breast folds and increase self-confidence in women who are sensitive about their large breast size.

Breast lift is suitable for women who are happy with the size of their breasts but are dissatisfied with the sagging and loss of firmness that occurs with age.

This also can be performed in healthy women of any age however, it is more common in older women. It can be performed on women with any sized breasts but results are longer lasting in smaller breasted women.

Mastopexy can be performed in conjunction with breast enlargement using implants to lift and enlarge a woman's breasts. It may also raise the position of downward facing nipples and reduce the size of large areolae.

In certain circumstances, breast lift and/or reduction can be used to balance asymmetry of breasts or to match a healthy breast to one that has been operated on for breast cancer.

Surgical Technique

The basic techniques for both breast reduction and breast lift are similar however, breast reduction involves removing more of the breast tissue and breast lift involves removing mostly skin.

In almost all cases, the nipple and areola remain joined to their blood and nerve supply when they are re-positioned. In cases, where the breasts are very large, occasionally the nipple and areola need to be removed completely and replaced as a graft when being re-positioned. When this is necessary, all sensation to the nipple and ability to breast feed are lost.

The site of the incisions is dependent on your breast size and shape, your surgeon's preferences and the amount of tissue to be removed. There are 3 main methods of breast reduction/lift.

Inferior pedicle (Robbins) Method - This is the most commonly performed technique. It involves incisions around the areola, under the breast in the infra-mammary fold and a vertical line between the two. Excess skin, fat and breast tissue are removed and weighed. This tissue is sent to the pathologist to be examined for any abnormality or evidence of breast cancer.

The breast is then re-shaped and stitched into place. A drainage tube is usually required and this is placed at the end of the infra-mammary incision under the arm. It is usually removed 1-2 days after surgery.

The other side is then done in the same manner, aiming for as symmetrical result as possible.

Lejour Method - This method is similar to the Robbins technique but the horizontal incision along the infra-mammary fold is not used. The vertical (or sometimes oblique) incision is puckered and takes some weeks to become smooth.

Benelli (Peri-areola) Method - This method involves two circular incisions around the areola. Excess skin, fat and breast tissue are removed between the two. The wounds are then sutured closed. It can lead to flat looking breasts and is not commonly used.

Liposuction may in some case be performed in conjunction with breast lift or reduction surgery to give an improved contour. Breast reduction surgery usually takes 1-4 hours. Breast lift usually takes 1-3 hours.

The most important thing to remember with this type of surgery is that it will leave permanent scarring. Although these scars fade with time, they will always be noticeable without a bra on. It is important to be mentally prepared for this surgery and understand that the aim is an improvement, not perfection.

Breast reduction and breast lift surgery is usually performed under a general anaesthetic but in certain cases, breast lift surgery may be done under local anaesthetic with heavy sedation in a day surgical facility.