Exploring the Pros and Cons of Breast Augmentation Methods

  • Rajni Sarma MBBS, MD from North-Eastern Hill University, India

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Are you or someone you know considering breast augmentation and exploring the options for making an informed decision? In this article, we highlight the pros and cons of various breast augmentation techniques that will  better equip you to have meaningful discussions with your surgeon and make choices that align with your goal. 

Understanding breast augmentation

What is breast augmentation? 

It is a cosmetic procedure that enhances the size of your breasts, changes their shape, and makes them look even. It is also known as a “boob job”.

How is this different from breast reconstruction?

Breast augmentation is for a healthy person who wants to improve their appearance and confidence. As a cosmetic procedure, it is not considered medically necessary. In contrast, breast reconstruction is a surgical procedure to recreate breasts after mastectomy or after any developmental disorder1 in which the breast tissue does not develop correctly.

Five must-know facts about breast augmentation

  • A breast implant is not guaranteed to last for a lifetime. You will likely need to have them  replaced at some point.
  • On its own, breast augmentation does not correct for breast sagging, particularly if the sagging is severe.
  • In addition to its cosmetic purpose, breast implant or fat transfer (also known as fat grafting) procedures are also used for breast reconstruction.
  • The UK’s National Health Services (NHS) does not cover breast augmentation for aesthetic benefits. However, in exceptional circumstances, it might be possible to get breast enlargement on the NHS, for example, if a person has significantly uneven breasts or no breasts.
  • Routine magnetic resonance imaging (MRI) after a silicone breast implant is recommended to detect any complications such as a rupture..

Breast augmentation techniques

The two available breast augmentation methods are the placement of breast implants and the autologous transfer of fat.

When you opt for breast augmentation, there will be a range of augmentation types available to you, and your surgeon will discuss the best option based on your needs. Let's dissect each type of breast augmentation technique and its key features.

Breast implant

Breast implants are prostheses (artificial devices) that are inserted into the breasts (either behind the breasts or behind the breast muscle). There are two types of implants: silicone gel or saline (sterile salt water) solution. Both types have a silicone shell (outer layer). 

Silicone breast implant2,3Saline breast implant2,3
Is filled with silicone gelIs filled with sterile saline water
Silicone gel gives the feel and look of a natural breast.
It can be moulded and shaped.
There is a lower incidence of malposition, rippling, and rupture.
The frequency of early replacement is lower.
A higher level of safety as a rupture is harmless.
It is cheaper and cost-effective.
Smaller incisions and cosmetically less visible marks.
No long-term follow-up visit as with saline implants.
A woman as young as 18 years old can use this implant (in the US).  

The various shapes, textures, and forms of both the silicone and saline breast implants are discussed below:2,3,6

Round implant 

  • It has the same outline all over.
  • It makes breasts appear fuller.
  • It prevents rotation out of place.

Shaped implant

It helps those who:

  • Need extra volume in the upper pole of their breast.
  • Want extra projection of the breast.

Form-stable implant (i.e. implants that maintain their shape)

  • It is one of the best options for small breasts and people with thin skin.

Smooth breast implant (the outer shell of the implant is smooth)

  • Within the implant pocket, it moves naturally as if it were a natural breast.

Textured breast implants (the outer shell of the implant is coarse)

  • A textured surface aids in adhesion and prevents movement of the implant.

Autologous fat transfer breast augmentation

In this method, your surgeon will choose the sites of liposuction and lipo injection. It involves suctioning fat from the desired location, processing it, and injecting the lipo particles into the breast. In short, fat aspirated from one part of your body is injected into your breast.7

It could be the best option if you have adequate fat for liposuction and want moderate breast augmentation. Your surgeon may choose any of the following as liposuction sites:7,8

  • Belly
  • Flanks (side of the body between the rib cage and the hip)
  • Inner thigh
  • Upper arms
  • Buttock

Benefits of autologous fat transfer

The major advantages of this method of breast augmentation are:4,7

  • It appeals to anyone who does not want any foreign objects to be placed in their breast.
  • Fat transfer from your body gives breasts a natural appearance.
  • It integrates well into the breast area and has no issues related to rupture, leakage, or dislocation.
  • This procedure lasts for a lifetime, and there is no time-bound replacement or revision surgery required.
  • The incidence of scarring is minimal due to a small incision made during surgery.
  • It does not require extensive follow-up, as with a silicone implant.

Factors that influence your choice of breast augmentation

Choosing the breast augmentation technique that suits you best depends on many factors, including the following:2,3,4

  • Look and feel of the implant or filler.
  • Safety and outcome of the surgery.
  • Extent of surgical intervention.
  • Frequency of follow-up. 
  • The durability of an implant.
  • The expense of the procedure and its maintenance.

Who should avoid breast augmentation?

It is a highly personal choice; anyone who is physically and emotionally healthy can seek breast augmentation. However, you may not be a perfect candidate for this type of surgery if you have the following:1

  • An underlying medical condition that interferes with implants
  • Abnormal breast findings
  • Pregnant or breastfeeding
  • Presence of active cancer
  • Has active infections
  • History of autoimmune disease
  • Radiation therapy for any illness
  • If you have any unrealistic expectations and are unprepared for post-surgery potential events

Cons of breast augmentation

Breast implant-related risk and side-effects

  • Hematoma (a collection of blood that has started to clot outside of the blood vessels)
  • Fluid collection under the skin (seroma)
  • Infection and inflammation of the breast
  • Rupture or deflation of breast implants
  • Breast pain
  • Hardening of the breast
  • Delay in wound healing
  • Rash in and around the breast
  • Toxic shock syndrome, in some rare cases

Autologous fat transfer-associated complications

Unlike breast implants, the frequency of major complications such as hematoma, infections, and seroma is lower. The common complications in the breasts are:4,7

  • Bruising
  • Cysts or nodules
  • Fat necrosis (death of fat tissue due to injury and loss of blood supply)
  • Benign calcification (calcium deposits)
  • Rarely, an infection can progress to septic shock.

Risk of cancer

Breast implants of textured silicone are associated with anaplastic large-cell lymphoma (a rare type of blood cancer).1 There is no evidence that fat transfer increases breast cancer risk, but long-term inflammation may do so.4

Impact on mammography

The fibrosis (thickening or scarring of tissue) or granulomatous (a small area of inflammation) reaction after fat transfer can interfere with the findings from ultrasound imaging. It may delay the diagnosis of underlying breast cancer or any breast changes that may require immediate attention.7 Therefore, always discuss any underlying breast-related issues with your surgeon..

The burden of additional surgeries

You may require further breast surgeries, such as

  • Revision surgery (i.e. corrective surgery) for implant removal or scar tissue removal.
  • Hematoma drainage.
  • Surgical repositioning of the implant.

Post-surgical follow-up

Routine follow-up is a standard practice after breast augmentation. However, silicone breast implants require regular follow-ups with MRI or ultrasonography for at least 3 to 5 years.2,3

Again, after the first 5 years, follow-up every 2 to 3 years is recommended.3 Sometimes, it is frustrating, and patients avoid going for this long-term follow-up.

Impact on lactation

Having a boob job does not affect your ability to breastfeed. However, in some cases, while undergoing surgery, there is a possibility of injuring the nerves or ducts within the breast, thus affecting lactation.

It is frequently reported with incisions in and around the breast's areola. If you're thinking of conceiving soon, it might be wise to defer getting a breast augmentation.

Financial issues

There may be financial constraints if you are unaware of expenses related to frequent follow-up, implant surveillance, additional surgeries, and revision procedures.

A lack of insurance coverage in the US makes breast augmentation a significant financial investment.2. You can also experience long-term career and employment consequences if you take time off due to related complications.

Emotional aspects

Around 70-80% of people are satisfied with the outcome of their breast augmentation surgery.1 Despite satisfactory results, many fail to get the desired aesthetic satisfaction after the surgery.

Imagine you do not achieve your aesthetic goals, experience complications during breast augmentation, or need to attend regular follow-up appointments. All these can affect your mental well-being.

FAQs

Is breast augmentation available on the NHS?

The UK’s NHS may offer breast augmentation only when breasts are considerably or no breast tissue is present. Your general practitioner (GP) can guide you on whether you are eligible for breast augmentation under the NHS.

How long does it take for recovery after breast augmentation?

It depends upon the type of surgery and any associated side effects you had. Typically, it takes a few weeks to recover after the procedure. After 6 weeks, you should be fully recovered and your breasts will look and feel natural within a few months.

What should I avoid immediately after breast augmentation?

After your procedure, avoid the following:

  • Strenuous exercise or lifting any heavy objects for at least a month.
  • Driving for at least a week or until the suture heals.

Your medical team can advise you on how to recover early and what to avoid.

Does breast augmentation help in breast lifting?

Breast augmentation does not guarantee a breast lift. A breast uplift addresses the issue of saggy and droopy breasts and loose skin, whereas breast augmentation helps achieve enlarged and firm breasts. You can have both procedures simultaneously to get the desired result.9

What is the ideal revision period for breast augmentation?

There is no fixed recommended revision period. Ideally, implants are removed or replaced after ten years of their placement. In the fat transfer method, revision surgery is not required unless associated complications exist.

Summary

Weighing the risks and benefits of the various options available is essential before getting breast augmentation. Whether you receive breast implants or autologous fat transfer, no single procedure is devoid of adverse effects. Feel free to discuss the options available with your surgeon. Choose the type of breast augmentation based on your need, your ability to bear potential expenses for future maintenance, and your physical as well as mental strength to deal with unanticipated outcomes.

References

  1. Fardo D, Sequeira Campos M, Pensler JM. Breast Augmentation. [Updated 2023 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482206/
  2. Spear SL, Jespersen MR. Breast implants: Saline or silicone? Aesthet Surg J [Internet]. 2010;30(4):557–70. Available from: http://dx.doi.org/10.1177/1090820x10380401
  3. Schrager S, Lyon SM, Poore SO. Breast implants: common questions and answers. afp [Internet]. 2021 Nov [cited 2023 Dec 15];104(5):500–8. Available from: https://www.aafp.org/pubs/afp/issues/2021/1100/p500.html
  4. Ørholt M, Larsen A, Hemmingsen MN, Mirian C, Zocchi ML, Vester-Glowinski PV, et al. Complications after breast augmentation with fat grafting: A systematic review. Plast Reconstr Surg [Internet]. 2020;145(3):530e–7e. Available from: http://dx.doi.org/10.1097/prs.0000000000006569
  5. Öztürk G, Beyazyüz E, Albayrak Y, Beyazyüz M. Favorable personality traits in women who have undergone cosmetic breast augmentation surgery. Eur J Breast Health [Internet]. 2021;17(4):308–14. Available from: http://dx.doi.org/10.4274/ejbh.galenos.2020.6276
  6. Nahabedian MY. Shaped versus round implants for breast reconstruction: Indications and outcomes. Plast Reconstr Surg Glob Open [Internet]. 2014;2(3):e116. Available from: http://dx.doi.org/10.1097/gox.0000000000000068
  7.  Li F-C, Chen B, Cheng L. Breast augmentation with autologous fat injection: A report of 105 cases. Ann Plast Surg [Internet]. 2014;73(Supplement 1):S37–42. Available from: http://dx.doi.org/10.1097/sap.0000000000000271
  8.  Sakai S, Ishii N, Nakamura Y, Matsuzaki K, Sakai S, Kishi K. Complications and surgical treatment of breast augmentation using autologous fat transfer and fillers. Plast Reconstr Surg Glob Open [Internet]. 2021;9(8):e3734. Available from: http://dx.doi.org/10.1097/gox.0000000000003734
  9. Spring MA, Hartmann EC, Stevens WG. Strategies and challenges in simultaneous augmentation mastopexy. Clin Plast Surg [Internet]. 2015;42(4):505–18. Available from: http://dx.doi.org/10.1016/j.cps.2015.06.008

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Rajni Sarma

MBBS, MD from North-Eastern Hill University, India
MSc in Molecular Pathology of Cancer, Queen's University, Belfast, UK

I worked as a medical doctor for almost eight years before applying to Queen’s University Belfast for MSc in Molecular Pathology of Cancer. My outstanding verbal and demonstrative skills have helped me to get distinction in my master’s program.

However, I found my true passion in medical writing. Therefore, after I graduated from Queen’s University, I decided not to join any laboratory but to restart my career as a medical writer.

The topics that intrigue me are haematology, oncology, rare diseases, immunology, gynaecology, molecular pathology, targeted therapy, and precision medicine. I am currently an intern at Klarity and a volunteer medical writer for a health and wellness website.

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