Article

Breast Augmentation

Breast augmentation (augmentation mammoplasty) is a surgical procedure to increase breast size, restore lost volume, alter projection, or modify shape and symmetry. It most often uses breast implants (saline, silicone, structured) or autologous fat transfer, and may be part of cosmetic enhancement, post‑mastectomy reconstruction, correction of congenital asymmetry (e.g. tuberous breasts), or gender-affirming chest surgery. See also breasts, breast implants, body_confidence, and plastic_surgery.

Indications & Contexts

  • Cosmetic enlargement: Desire for greater volume, upper pole fullness, projection, or aesthetic balance (waist–hip–bust harmony).
  • Post-pregnancy or weight loss changes: Restoring deflated volume, correcting ptosis (sometimes combined with a lift—mastopexy).
  • Reconstruction: Following mastectomy or trauma using expanders then permanent implants or fat grafting.
  • Congenital / Developmental: Tuberous breast deformity, Poland syndrome, asymmetry.
  • Gender-affirming care: Creating or enhancing feminine chest contour in transfeminine individuals after hormone therapy plateaus.

Methods

  • Implants: Saline, silicone gel, structured (internal baffles), less common composite (historical/obsolete fillers: hydrogel, soy oil—rare today). See breast_implants.
  • Autologous Fat Transfer: Liposuction harvest, processing, multi-layer micro‑injection. Typically modest increase (≈ 1 cup size); multiple sessions may be needed. Advantages: no foreign device, natural feel. Limitations: partial resorption, calcifications affecting imaging, donor site morbidity.
  • Hybrid Augmentation: Combining moderate implant with fat grafting to smooth edges, improve cleavage, or correct rippling.
  • Tissue Expansion: Temporary expander gradually filled with saline to create pocket before definitive implant (common in reconstruction).

Implant Placement (Pocket Planes)

  • Subglandular (over muscle): More pronounced upper pole, easier surgery, quicker recovery; higher risk of visible rippling in thin patients and potentially higher capsular contracture rate.
  • Subfascial: Under pectoral fascia; aims for some coverage with potentially less animation deformity vs full submuscular.
  • Dual Plane (partial submuscular): Upper implant under pectoralis major, lower pole released for natural slope; balances coverage and aesthetics.
  • Submuscular / Total muscular: More soft tissue coverage, potentially reduced capsular contracture, but risk of animation (movement with muscle contraction) and longer recovery.
  • Prepectoral vs retropectoral in reconstruction: Prepectoral (above muscle with mesh/ADM support) avoids animation; retropectoral provides more coverage.

Incision Approaches

  • Inframammary fold (IMF): Most common; good control and pocket visibility; small scar hidden in fold.
  • Periareolar: Around areolar border; can reduce contrast of scar but higher potential impact on nipple_sensitivity and breastfeeding.
  • Transaxillary: Armpit incision; no breast scar; technically demanding revisions.
  • Transumbilical (TUBA): Rare; limited to saline; long subcutaneous tunnel; higher complication/revision rates.
  • Transareolar / vertical mastopexy combinations: Used when combined with lifts.

Sizing & Aesthetics

  • Projection & Base Width: Implant chosen to match thoracic width and desired profile (low, moderate, high, extra‑high).
  • Cleavage & Upper Pole Fullness: Influenced by implant width and placement plane; excessive medial dissection risks symmastia.
  • Soft Tissue Envelope: Skin elasticity and thickness affect risk of visible edges or rippling.

Complications & Risks

See also implant_risks and (new) capsular_contracture.

  • Early: Hematoma, infection, seroma, delayed wound healing.
  • Device-specific: Rupture (silent gel rupture detectable on MRI), saline deflation, gel bleed (older generations), rippling.
  • Capsular Contracture: Fibrous capsule tightening—Baker grades I–IV. Risk factors: bacterial biofilm, hematoma, subglandular placement. (See capsular_contracture).
  • Malposition: High, low (“bottoming out”), lateral displacement, rotation (anatomic implants).
  • Symmastia: Loss of intermammary cleft due to over‑dissection medially (see symmastia).
  • Animation Deformity: Distortion with pectoral contraction in submuscular placements.
  • BIA‑ALCL: Rare lymphoma associated mainly with certain textured implants (see bia_alcl).
  • BII (Breast Implant Illness): Patient‑reported constellation (fatigue, brain fog, arthralgia); mechanism unproven, subject of ongoing research.
  • Sensory Changes: Altered nipple or skin sensation (see nipple_sensitivity).
  • Psychological: Dissatisfaction, anxiety, body image shifts (see self_image, body_confidence).

Imaging & Surveillance

  • MRI / Ultrasound: Recommended intervals for silent rupture detection (varies by regulatory guidance). Fat grafting requires distinguishing oil cysts/calcifications from pathology.
  • Mammography Adjustments: Eklund (implant displacement) views to visualize more tissue.

Longevity & Revision

Implants are not “lifetime” devices. Revisions for size change, rupture, capsular contracture, ptosis progression, or aesthetic preference are common over decades. Discuss expectation management and future costs.

Psychological & Cultural Dimensions

Augmentation can enhance perceived femininity, sexual agency, and alignment with cultural ideals (cultural_ideals). It may also expose individuals to objectification or internal conflict if expectations are unrealistic or external validation dominates motivation. Preoperative counseling screens for body_dysmorphic_disorder and clarifies goals.

Writing Tips

  • Contrast pre‑ and post‑op embodiment: posture changes, clothing fit (see bras).
  • Use tactile contrasts: preoperative softness vs postoperative firmness, temperature, movement (link to implant_feel).
  • Integrate tension from risks (capsular tightness, fear of rupture) to heighten intimacy scenes.
  • Show partner adaptation (see partner_perception).
  • Employ clinical realism (incision location, recovery soreness, compression garments) to ground erotic or emotional narrative.

Example

"Weeks after surgery she noticed how her silhouette commanded space—upper pole fullness rounding each breath. His fingers traced the still‑firm edges where swelling lingered, curiosity mingling with her nervous pride."

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