Breast augmentation is one of the most common cosmetic surgeries performed in the United States every year. Women typically desire this procedure to improve their breast size and shape. 

What is breast augmentation?

There is a lot to understand about the type of breast implants (silicone or saline), where they are placed (above or under the muscle), placement of scars.

Additionally, a breast augmentation can be combined with a breast lift or mastopexy. This surgery changes the shape of your breasts, but it doesn’t alter the size.

How to find a surgeon

The most important part of considering breast augmentation is choosing the right surgeon. Make sure you see a board-certified plastic surgeon. 

Ask questions about your procedure and make sure you feel comfortable with your surgeon of choice 

Surgeons website to find a board-certified plastic surgeon near you.

And while preoperative planning is important to optimize your surgery, recovery is just as essential to ensure an excellent outcome. 

How long is a full recovery?

In general, full recovery from a breast augmentation can take on average 6 weeks. Each person is different, so for specifics make sure you talk to your board-certified plastic surgeon. 

Let’s break down the recovery into a few stages so you can better understand how to prepare.

Acute Recovery:

This period is usually immediately post-operation. 

Your breast will be wrapped and you will be transported to the recovery room, where you will likely feel groggy and sore. 

At this point, your surgeon may elect to give you a local numbing pain block to improve any discomfort you are experiencing and reduce narcotic use. This typically lasts around 12 hours. 

Because you have just woken up from anesthesia, you will need someone to drive you home and stay with you overnight.

The first 3 to 5 days

The first few days after surgery are the most uncomfortable.  

Your surgeon will recommend instructions on how often to take antibiotics and muscle relaxants or pain medications for the first few days after your procedure.

Ideally, any strong narcotic medications should be discontinued within the first few days since they cause constipation and prolonged use can lead to a longer recovery.  

While some patients report pain, most patients experience tightness or muscle aching at this time. 

This can be in the breasts, shoulders, neck, and back. These symptoms are best controlled with a muscle relaxant such as Valium. For most women, this sensation resolves over the next 3 to 5 days.

You will also have instructions on how to care for your incision and what bra or garments to wear.

Bruising, swelling, and minor bleeding from the site is all normal. If something does not feel right, call your doctor.

1 week

By this time, you should have minimal discomfort that can be managed with over-the-counter medications.  

You should be seen by your surgeon within this time frame, and most women are able to resume light daily activities. Women who work at desk jobs are usually fine to return to work and drive. Many physicians encourage a few short walks 1-2 times a day. 

Next few weeks

During this time, you will start to feel like yourself again and get back into your routine. 

It’s important to note that your wound heals approximately 10% per week and so most doctors do not recommend resuming an exercise routine, especially upper extremity focused workouts, until about 4-6 weeks after surgery. 

Additionally, patients with labor-intensive jobs may have to wait 3-4 weeks after their procedure before returning.

If you have a physically demanding job, you’ll need to be out of work for 3 weeks or more. You’ll also need to avoid heavy lifting and intense physical activities, like running.

2 months

After about 2 months, your physician should assess your healing and clear you for all normal activities. 

It's vital to follow your doctor's care instructions closely so that your breast implants heal properly and there are no complications.

Possible complications  

Breast augmentation is a surgical procedure, and every procedure has potential risks. Complications can include

• Unsightly scars

• infections

• bleeding problems, like blood loss. 

• Asymmetries between your breasts

• Implant malposition

• Breast and nipple pain or numbness

• Poor cosmetic result 

• breast cellulitis

• breasts appear to merge (symmastia)

• skin dimpling or visibility of the implant 

• scarring around the implant 

• implant leak or break

• breastfeeding problems

• breast implant-associated anaplastic large cell lymphoma  

• breast implant illness 

Tips for recovery

There are things you can do in order to avoid complications and enhance your recovery experience. 

Make sure you discuss all concerns with your physician before the surgery. 

Follow instructions regarding medication frequency and duration, wear your surgical garments as instructed, and avoid activities that your physician discourages. 

Ask friends and family to help. Prepare healthy meals ahead of time and take the rest you need to heal well. 

One of the most common topics of conversation regarding breast implants is their shelf life, or “how long they last.” 

For women considering a removal and possible implant replacement, there are several important things to understand in order to make an informed decision.

What is the average duration of implants?

Breast implants are one of the most studied medical devices in history. Over the past fifty years, there have been concerns about implant safety and so much so that they have been taken on and off the market in order to conduct thorough medical research. 

The first medical-grade silicone gel implants consisted of a thin shell and gooey gel, and patients were concerned that high rates of rupture and leaking implant material were leading to silicone infiltrating the bloodstream and lymph nodes and contributing to connective tissue diseases and autoimmune conditions. 

 So, in 1992, the Food and Drug Administration (FDA) pulled silicone gel implants off the market, amid a sea of concerns about their safety. 

After 14 years of research in cooperation with the American Society of Plastic Surgeons, silicone implants were reintroduced to the market in 2006 and the FDA issued a warning that breast implants are not life-long devices and may require removal and replacement. Additionally, In the case of silicone implants, the FDA recommends having an MRI every three years or so, but not many women do that because it is often an out-of-pocket expense and not covered by your insurance.

However, there is no allotted amount of time (i.e. 20 years) that we as plastic surgeons recommend removal and replacement of implants. Rather, we recommend proper self-breast exams and consultation with your physician should you feel a change in your breasts.  On average, most breast implants last anywhere from 10 – 20 years. 

How do I know if my implants need to be removed or replaced?

The following issues may necessitate evaluation and possible breast implant removal.

Hardening (Capsular Contracture):

Some women may experience tightness and hardening of the scar, or breast capsule, around their implant. This may cause the breast to migrate up and toward the armpit and be uncomfortable.  

Capsular contracture can occur almost immediately after surgery, or it can develop years and years later. The condition can occur on just one or on both breasts.

Implant Rupture: 

In women with saline implants, an implant leak would result in the deflation of the implant as the body absorbs the saline, or saltwater, in approximately 24-48hours after deflation. The breast will look dramatically different. 

Women with silicone gel implant rupture may not recognize a change in their breasts. The silicone gel in implants today is much thicker than it had previously been and has a consistency similar to taffy or a gummy bear. These cohesive gels make it difficult to detect a rupture because they tend to stay in place within the breast capsule. Additionally, most women do not experience symptoms with a silent rupture. 

However, symptoms that you may have a leak include: 

• change in breast size and/or shape

• pain or tenderness

• swelling

• changes in the sensation of the breast. 

Change in Position:

The effects of time and gravity, as well as fluctuations in weight, may cause stretching and sagging of the breasts. 

If you’re bothered by these changes, getting a revision with a mastopexy (breast lift) or breast augmentation replacement may help return your breasts to their previous appearance.

Rippling or Palpability:

Rippling occurs when the implant develops wrinkles or ripples. This is more common with saline implants and may worsen with time.

Palpability refers to the ability to feel the ripples when you touch your breast. 

If you see or feel wrinkling in your implant, you may want to consider replacing or removing it.

What about Breast Implant Illness? Breast-Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)? Can implants make you ill?

Breast Implant Illness (BII) is a combination of various systemic symptoms that women have been reporting and believe to be related to their breast implants. 

To date, these symptoms have been reported in women with saline, silicone, smooth and textured implants. 

I have recently written an article all about BIA-ALCL and encourage you to learn more.

Deciding to remove your implants:

If you are experiencing changes in your breasts or simply desire to have your implants removed, make sure to see a board-certified plastic surgeon in consultation to discuss your surgical options.

It is important to talk to your doctor about what your breast may look like after implant removal. Some women may experience deflation, sagging, or asymmetries of their breast

Because of this, your doctor may recommend a breast revision by replacing your implants with a different type of implant, different size or shape, or in combination with a breast lift. 

Additionally, the scar tissue, or breast capsule, may be removed in addition to the removal of your breast implants.

What are the surgery and recovery like?

Most patients have this surgery performed and go home the same day. Recovery time will be dependent on the extent of surgery that is being performed. 

Most women are back to light activities 3-5 days after surgery and the gym at about 1 month. 

The Bottom Line

Implants are some of the most studied medical devices on the market. At this time, research has continued to argue for their safety. 

However, implants are not life-long devices and you may need to have them removed or replaced for a variety of reasons.

The best way to ensure the best cosmetic outcome is to consult with a board-certified plastic surgeon and follow all postoperative instructions.

Interested in trying Botox? A Juvéderm filler? A laser resurfacing procedure? 

You may want to see a Board-Certified Plastic Surgeon for that.

Individuals seeking out a cosmetic procedure often assume that cosmetic surgeons and plastic surgeons have the same training and that the word plastic and cosmetic are interchangeable. 

This is misleading, confusing, and can even be dangerous. 

As a board-certified Plastic surgeon, I often refer to my practice as a mix of reconstructive (i.e. breast reconstruction) and cosmetic, because I’ve had extensive training in both. 

However, properly Board-Certified Plastic Surgeons do not refer to themselves as “cosmetic surgeons.”

What is Plastic Surgery?

The goal of plastic surgery is to restore the form (appearance) and function to a damaged area of the body. 

Plastic surgeons use a variety of techniques to move healthy tissue to an area affected by a birth defect, burn, traumatic injury, tumor, or other condition. Some plastic surgeons may focus on congenital defects (cleft lips), hand trauma, breast reconstruction, as well as cosmetic surgery.

What is Cosmetic Surgery?

Cosmetic Surgery is a combination of nonsurgical and surgical techniques to enhance appearance. Examples include facelifts, abdominoplasty (tummy tuck), liposuction, and Botox or Juvéderm fillers. 

What’s the difference between a Plastic Surgeon vs a Cosmetic Surgeon?

Legally, any physician with a valid medical license can perform cosmetic procedures, regardless of their training. I know, this is unbelievable. However, because of a number of factors - including declining insurance reimbursement and stress of keeping a practice financially secure - many physicians are looking towards elective cash-based procedures to survive.  

Several organizations have established “cliffs notes-type” courses with the goal of training these physicians in the same procedures that I, as a Plastic Surgeon, was trained to due over 6 years in my residency. 

Think about it: an emergency room physician with no surgical training goes to take a 2 week “crash course” on breast augmentation and is now ready to advertise as a cosmetic surgeon. 

And while your OB/GYN is offering you Botox or filler after a weekend training in cosmetic surgery, he or she may not be offering the best treatment, nor be able to handle complications (because OB/GYNs did not have focused training in facial anatomy). Scary, right?

On the flip side, a board-certified plastic surgeon would be able to offer the full scope of cosmetic options and let you know what works best for your body and your desires because we have been specifically trained to do so, without any shortcuts. Expertise cannot be achieved with a quick weekend course.

What does it take to become a board-certified plastic surgeon?

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In order to become a board-certified plastic surgeon, an individual must complete 

1. Four years of medical education and obtain a medical degree (MD or DO) 

2. A minimum of 6 years of accredited surgical residency training with at least 3 years of education dedicated to cosmetic and reconstructive surgery

3. Pass both written and oral examinations. At this point, he/she is board-certified by the American Board of Plastic Surgery (ABPS).

4. Remain in good ethical standing within their community and the board, as well as routinely participate in continuing medical education (CME) on the latest innovations and abide by up-to-date patient safety recommendations.

What if my doctor says he/she is Board Certified in Cosmetic Surgery?

At this time, there is no formal certification in Cosmetic Surgery and so anyone claiming to be board certified in this area is actually recognized only by a self-created organization (American Board of Cosmetic Surgery) and not an official licensing board by the American Board of Medical Specialties (ABMS).

In this situation, I encourage you to ask him or her a few more questions.  Ask about his/her background training (what is he really certified in), ask him/her how many of these specific procedures he has performed, and ask him/her how many years he/she has been practicing.  You might be surprised at what he/she says…and even more by what he/she does not.

How do I know if my surgeon is board-certified in plastic surgery?

Check online, and if in doubt, as your potential surgeon which board they are certified in. 

How do I find a Board-Certified Plastic Surgeon? 

You can easily find a list of local board-certified plastic surgeons by visiting the American Board of Plastic Surgery website.

When meeting with your surgeon, ask which board (i.e. Internal Medicine vs. Plastic Surgery) she or he is certified in

Lastly, If the surgeon routinely does procedures within an office operating room, as them where they have privileges. A reputable hospital will only accredit a board-certified plastic surgeon.

At the end of the day, it’s your body. And when it comes to your time, energy, and money, you should do the proper background research to ensure you are in the best hands. 

What is Breast Implant Illness (BII):

Breast Implant Illness (BII) is a combination of various systemic symptoms that women have been reporting and believe to be related to their breast implants.

To date, these symptoms have been reported in women with saline, silicone, smooth and textured implants:

These symptoms include (but are not limited to):

-fatigue

-chest pain

-hair loss

-headaches

-chills

-photosensitivity

-chronic pain

-rash

-body odor

-anxiety

-brain fog

-sleep disturbance

-depression

-neurologic issues

-hormonal issues

At this time, breast implant illness (BII) is not an official medical diagnosis.

Many patients are reporting their symptoms on social media and state their symptoms have been improved and resolved with the removal of their implants.

Common Questions:

1.    Is there a link between BII and silicone?

Silicone is an element that exists in nature as crystalline silica. The silicone used in breast implants is different as it has had antioxidants, dyes, and plasticizers removed during processing.

Silicone gel implants have been studied by the FDA for many years and to date have not been proven to cause any disease.

2.    Can you diagnose Breast implant illness with a test?

Currently, there is no diagnostic test for BII.

Many different organizations in Plastic Surgery, such as the American Society for Plastic Surgeons and the American Society of Aesthetic Plastic Surgery, are funding research to further understand this potential disease process.

There are tests for autoimmune diseases that your plastic surgeon may recommend. However, patients who self-identify as having BII have tested both positively and negatively on laboratory tests for autoimmune disease. So, at this time, there is no causal relationship between BII and autoimmune disease. 

3.    Does implant removal improve BII symptoms or cure patients?

At this time, there is no definitive epidemiological evidence to support a direct link between breast implants and any disease.

However, some women have reported different degrees of improvement in symptoms after implant removal. Improvement may be temporary or permanent. It is unclear what specific symptoms may or may not improve with implant and capsule removal.

4.    what is the difference between BII and capsular contracture?

When a foreign object is placed into the body (hip implant, breast implant, catheter), the body’s response is to form scar tissue around it.

In women with breast implants, the scar layer around the implant is called the breast capsule, and it usually takes 4-6 weeks to form.

In a small percentage of women, the scar capsule can become irritated and can contract tightly around the implant, pushing it up and out and causing pain or discomfort. This is known as capsular contracture. There are many theories as to why this occurs, and there are strategies to decrease the risk of this contracture.

The treatment for this contracture is the removal of the breast implant and the capsule.

In women with BII, there has been no association with capsular contracture. Women do not usually complain about pain and tightness around their implants. Rather, they have systemic symptoms such as fatigue and malaise. However, the treatment is the same – removal of the implant and the capsule (scar layer) surrounding the implant.

5.    What is the risk of developing BII

At this time, because there is no definitive link between symptoms and breast implants, there is no “known risk.”

6.    What should I do if I think I have BII?

There are legitimate concerns about a potential link between breast implants and symptoms of BII.

If you are concerned you may be experiencing these symptoms and feel they are attributed to your breast implants, see your Board-Certified Plastic Surgeon.

Just remember, breast implant surgery is elective surgery, and you can always elect to have your implants and overlying breast capsule removed if you believe doing this will improve your symptoms.

9. How much do the removal of breast implants and capsulectomy cost?

Each patient is different, and your needs are unique. The cost of this procedure will depend on the conversation between you and Dr. Parcells during your one-on-one consultation.

After reviewing your medical history, Dr. Parcells will perform a physical exam to evaluate your breasts as well as skin tone, laxity, nipple position.

She will then provide her expert advice and discuss your surgical options.  She will also address all risks and benefits of the procedures you are interested in.

At the end of your consultation with Dr. Parcells, you will meet with our surgical coordinator who will address the logistics and finances of the procedure you are best suited for.

Dr. Parcells is board certified by the American Board of Plastic Surgery.