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Breast augmentation

Surgical and autologous methods to increase breast volume, including implants and fat grafting; indications, techniques, risks, recovery, and long-term considerations.

Author: Leandro Alegsa Creation date: November 13, 2022 Last updated: May 9, 2026

en.wikipedia.org · CC BY-SA 3.0

Overview

Breast augmentation is a surgical intervention intended to increase or restore breast volume, alter shape, or correct asymmetry. People seek augmentation for cosmetic reasons, reconstruction after mastectomy, correction of congenital differences, or to regain size lost after pregnancy or weight change. Outcomes depend on anatomy, implant type, surgical technique, and realistic expectations discussed during preoperative planning. For a general procedure description see procedure overview.

Approaches and materials

Two principal approaches are used: prosthetic implants and autologous fat transfer. Implants are medical devices available mainly as saline-filled or silicone gel-filled shells. Saline implants are filled with sterile salt solution and may be easier to notice if they deflate; silicone gel implants use a cohesive gel that many patients and surgeons consider to feel more like natural tissue. Autologous fat grafting uses liposuction to harvest a patient’s own adipose tissue that is purified and injected into the breast to add modest volume and smooth contour irregularities. See clinical summaries of implant types and fat transfer for differences in feel and follow-up (saline, silicone, fat grafting).

Saline implants — filled with sterile saline and often detectable if ruptured.
Silicone gel implants — filled with silicone gel; rupture can be less obvious without imaging.
Autologous fat transfer — uses the patient’s own fat for smaller augmentations or contouring; donor-site availability limits volume.

Surgical technique and placement

Surgeons choose incision location and implant pocket to balance aesthetic goals and risks. Common incisions include the inframammary fold, periareolar region, and axillary crease. Implant pockets are commonly subglandular (above the pectoral muscle) or submuscular/subpectoral (partly or fully beneath the muscle). Each choice affects support, potential visibility of rippling, interaction with mammography, and the risk of animation deformity when the muscle contracts. Anatomical (teardrop) and round implant shapes offer different profiles and contouring effects.

Risks, complications and surveillance

Surgery carries immediate risks such as bleeding, infection, and wound-healing problems. Longer-term issues include implant rupture or leakage, capsular contracture (scar tightening around an implant), malposition, and the potential need for revision surgery. Larger augmentations can alter body mechanics and may contribute to neck, shoulder, or back discomfort for some individuals. Professional guidance on complication rates and device performance is available from regulatory and specialty sources; review classic references on anatomy and complications (breast anatomy, complications).

Monitoring implant integrity may involve ultrasound or magnetic resonance imaging, particularly for silicone devices where rupture can be silent. Fat grafting carries different considerations, including variable fat survival and the potential need for staged procedures. Breastfeeding after augmentation is often possible but may be influenced by incision choice and surgical technique.

Candidates, recovery and decision factors

Appropriate candidates are adults in good health who understand risks and have realistic goals. Preoperative assessment evaluates medical history, breast examination, and discussion of size goals and lifestyle. Recovery usually includes a few days of limited activity, gradual return to exercise over weeks, and follow-up to assess healing. Many implants are not lifetime devices; replacement, revision, or removal may be necessary years after placement.

Alternatives and combined approaches

Fat grafting can be used alone for modest increases or combined with implants to refine contour and soften transitions. Candidates with low body fat may lack sufficient donor tissue for large-volume fat transfer. Non-surgical options have limited ability to increase true breast volume and are generally not replacements for surgery.

Regulation, history and patient resources

Implant design and surgical methods have evolved, and regulatory authorities monitor device safety and post-market outcomes. When researching the procedure consult board-certified surgeons and reputable clinical resources. For more detailed procedural descriptions or technique comparisons refer to specialist summaries and patient information (procedure overview, fat transfer, silicone, saline, breast anatomy).

History

Doctors have been dealing with the reconstruction of the female breast since the nineties of the 19th century. In 1895, the surgeon Vincenz Czerny was the first to transplant a fat tumour, a so-called lipoma, into a woman's breast. Prior to this, her real breast had been removed because she was suffering from breast cancer. Despite the use of the body's own fat, the blood supply remained inadequate. Experiments with materials such as ivory, bovine cartilage, wool or glass beads proved similarly fatal. Until the late 1950s, all possible uses were tried, such as paraffin injections (by Robert Gersuny), beeswax, or polyethylene, but without major success. In most cases, the use of such substances led to significant complications in the form of foreign body reactions, such as lipogranulomas. The first fixed implants were used in 1951. Ivalon sponges were initially well tolerated, but were immature in the long term. In 1961, two doctors from Houston (Texas) developed the first silicone implant on the initiative of the Dow Corning Company. In 1962 the first operation took place. In 1963 it was put on the market. 20 years later, this very company was sued by hundreds of women, as a fierce controversy had broken out in the USA that silicone implants were the cause of many autoimmune diseases and health problems. In 1992, silicone fillings were banned by the Food and Drug Administration (FDA) for cosmetic surgery in the US. After numerous studies and technical development of the implants, they were allowed again in 2006. They were never banned in Europe, but a quality seal has been in place since 2001 to ensure quality for patients. By 2011, ten million women had been operated on worldwide.

In organized crime, breast implants are used to transport drugs.

OP-Technique

During the operation, which is usually performed under general anaesthetic, a specialist (plastic, aesthetic and reconstructive surgeon) makes an incision in the skin, lifts the breast tissue and forms an implant pocket into which the breast implant can be inserted. The surgeon then either pushes the implant partially or completely under the pectoral muscle (submuscular implantation, especially in very thin women with little fat/glandular tissue) or places it under the mammary gland above the pectoral muscle (subglandular implantation, see picture), leaving the breast tissue itself largely untouched. A third option is to place the implant directly inside the muscle stocking and under the fascia layer covering the muscle (subfascial method, see picture). This method is more time-consuming, is considered more difficult and is only offered by a few surgeons.

The necessary skin incision, of which as little as possible should be visible after the operation, can be made in the newly formed underbust fold (inframammary approach), around or through the areola (transareolar approach), in the armpit (transaxillary approach) or, if saline solution is used, also in the navel. A technical specialty is the endoscopic breast augmentation through the axilla. It was already used in the early 1980s in Brazil by Ivo Pitanguy and has since been a routine operation for breast augmentation. Through a narrow incision in the natural axillary fold, a fine endoscopic instrument is inserted behind the pectoral muscle, which is initially bluntly and electrocauterically cut in the area of the muscle attachment in order to avoid deformation of the breast during arm movement. In this case, the magnification provided by the endoscopic image offers greater certainty that no sensitive nerves will be cut, but that the pocket behind the pectoral muscle will be shaped with millimetre precision. Both round and anatomical implants up to a size of 480 cm3 can be positioned safely. In the hands of the experienced surgeon, the technique is just as safe and precise as when the incision is made under or on the breast. As a rule, the operation time is shortened. This technique is not offered by all centres in Germany. So far, there is no evidence-based generally preferable method. The advantages and disadvantages of the 3 different access methods are mainly shaped against the background of the individual prerequisites and the experience of the respective surgeon with a method and are to be discussed in a consultation.

In subfascial implantation, the implant is inserted under the fascia.