Breast augmentation uses implants to increase breast size, restore volume after pregnancy or weight loss, or improve asymmetry. It’s consistently one of the most popular cosmetic procedures in the US, and for good reason — when done well, results look natural and last for years.
Surgery is typically done under anesthesia in the operating room. I make a small incision in the fold under your breast and then create a small space or “pocket” for your implant either under or on top of your chest muscle (pectoralis major). Then I use a “no-touch” technique to put the implant in, check to make sure the size and symmetry match your goals, and then I’ll close your incision in layers and put on a special dressing that will keep your incision protected for the early days after surgery.
The above-muscle versus below-muscle decision matters more than most patients realize. Above-muscle recovery is easier but works best if you have adequate breast tissue coverage. Below-muscle (submuscular) gives more natural upper pole shape, but the early post-op period can be more uncomfortable because you’re stretching the muscle.
During your consultation, we’ll talk through all of the options, pros and cons of each, and decide what fits best with your goals.
The surgery takes 1–2 hours, but it will probably feel much faster to you! You will wake up in the recovery area wearing a bra. You will probably feel tight in your chest or a sense of pressure. This is your body getting used to the size and shape of the implant, and will get better over time. You will have medications for both pain and to help relax your muscles if you need it.
You’ll feel tight, sore, and possibly wonder what you’ve done to yourself for the first 48–72 hours. This is normal. Pain is manageable with medication. Most patients describe it as intense muscle soreness rather than sharp pain.
Most people return to desk work in 5–7 days. You’ll wear a surgical bra for 4–6 weeks and sleep on your back during this time (side sleepers, I’m sorry). No lifting anything heavier than a gallon of milk for the first two weeks.
Exercise timeline: walking immediately, lower body workouts at 2 weeks, upper body and running at 6 weeks. Yes, this feels like forever when you’re used to working out regularly.
You won’t see your final result immediately. Implants start high and tight, then gradually “drop and fluff” over 3–6 months. The first few weeks, you might think they look too big, too high, or uneven. Give them time.
Swelling peaks around day 3–4, improves significantly by week 2–3, but subtle swelling persists for months. Your breasts will continue settling and softening through the first year.
Breast implants don’t “expire” at a predefined time. But for planning purposes I tell patients that they should expect to need or want a revision at around 10–15 years. It’s sometimes, but not always, because of a problem with the implant. The reality is that after 10–15 years, your body will change even if your implant doesn’t! Kids, weight gain/loss, gravity, and just plain old time can all lead to changes in how your breasts look, and the appearance of your breasts depends on your body just as much as it does on the implant.
This term seems much scarier and more dramatic than it really is. An implant rupture won’t make you sick, and with silicone implants, it’s not necessarily even something you would notice. The problem is that over time it can lead to thickening of the capsule (aka the scar that your body naturally forms around the implant) and this can potentially cause pain, hardness, and changes in appearance over months to years. The FDA recommends screening MRI or ultrasound starting 5–6 years after surgery and then every 2–3 years after that to help detect rupture. If a rupture is found, you should have surgery to exchange your implant, though this can be done on your own timeline because it is not an emergency.
Studies show that most women with breast implants who want to breastfeed are able to do so. Placing the incision in the breast fold and choosing under rather than over the muscle can help maximize your future breastfeeding potential. However you should know that pregnancy and breastfeeding can lead to major changes to your breasts with or without implants! It’s not uncommon for women who have breast augmentations when they are young to come in for a revision (usually a breast lift) after they are out of the baby zone because it changes how your breast tissue sits on top of the implant.
You can (and should!) still get mammograms. Just let the mammo tech know that you have breast implants because they may need to look at different views. If you are over 40 (or younger but with a family history of breast cancer), I will recommend that you are up to date on your mammograms prior to breast augmentation surgery.