Breast Augmentation

Enlarges or restores breast size with silicone or saline implants, or with fat transfer, and remains the most common cosmetic operation in the United States.

What is breast augmentation?

Breast augmentation (augmentation mammaplasty) increases breast size or restores volume lost after pregnancy, weight change, or asymmetry. Most augmentations use silicone or saline implants; a smaller number use fat transferred from another part of the body. Surgery is usually outpatient, under general anesthesia, and takes about one to two hours.

Augmentation changes size and shape, not lift: if the breast already sags significantly, an implant alone will not raise the nipple to a youthful position, and a lift is often discussed at the same operation. Sizing is planned from tissue measurements — chest width, existing breast tissue, and skin elasticity — rather than from a requested cup size alone, because the same implant looks different on different frames.

How is breast augmentation done?

The surgeon makes an incision, most commonly in the crease under the breast, and less commonly around the areola, in the armpit, or, for saline only, near the navel. A pocket is created either over the chest muscle or under it, the implant is placed, and the incisions are closed. Silicone implants arrive pre-filled; saline implants are filled after placement. Patients leave wearing a surgical bra, and drainage tubes are occasionally used for a short time.

For fat-transfer augmentation, fat is harvested by liposuction from the abdomen, thighs, or flanks, processed, and injected into the breasts in small amounts. It avoids an implant but gives a more modest increase, and some of the transferred fat is naturally reabsorbed, so the final volume is less than the volume injected.

What are the options for breast augmentation?

Saline vs. silicone. Saline implants are filled with sterile salt water during surgery, which allows a smaller incision and fine-tuning of volume, but they ripple more visibly and a rupture shows as visible deflation. Silicone gel implants are pre-filled, feel closer to natural breast tissue, and ripple less; a rupture may not be obvious and is usually found on imaging.

Shape and profile. Round implants add fullness up top; anatomical (teardrop) implants mimic a natural slope. Profile describes how far the implant projects from the chest, from moderate to ultra high.

Placement. Over the muscle or under it. Placement affects look and feel over time, recovery intensity, and long-term complication rates, and the choice depends on existing tissue and goals.

Surface. Smooth implants are the standard in the United States today. Textured surfaces are rarely used now, in part because of their link to a rare lymphoma described under risks.

Fat transfer. An implant-free option for a modest increase, sometimes combined with a small implant. It cannot match the volume or projection of an implant, and results depend on how much transferred fat survives.

What is internal bra support?

Internal bra support means adding a layer of supportive material inside the breast during augmentation or a lift, intended to help hold the implant or breast tissue in position and reduce sagging or implant movement over time. The material is placed as an internal sling or hammock, most often along the lower portion of the breast, and is meant to reinforce the body's own tissue rather than replace it.

State this plainly: no mesh is FDA-approved or FDA-cleared specifically for breast use. GalaFLEX, made from P4HB (poly-4-hydroxybutyrate), is cleared under a 510(k) clearance for general soft-tissue reinforcement only, not for breast surgery. In a letter dated November 2023, the FDA stated its position that no mesh device is cleared or approved for breast surgery, including for use as an internal bra. Any use of mesh in the breast is therefore off-label, and a surgeon who offers it should explain that status openly, along with what evidence supports it, how long the material lasts in the body, and what happens if it needs to be removed or revised.

Questions worth asking include: what exact material would you use, and is it cleared for breast use or used off-label; what benefit do you expect it to add in my case compared with no internal support; what are the added risks, including infection, extrusion, or palpability; how does it change the cost and the revision plan; and what happens to the material over time as it absorbs or remains in place. See also the dedicated Internal Bra page in this guide for a fuller explanation.

What affects the cost of breast augmentation?

There is no single fixed charge for breast augmentation, and this guide does not publish prices: the written quote you receive at consultation is the binding figure.

Factors that commonly move the total include the surgeon's experience, the facility type (office procedure suite, ambulatory surgery center, or hospital), the type and length of anesthesia, the complexity of the surgical plan, whether other procedures are combined in the same operation, garments and follow-up visits, and the revision terms. Implant type matters as well: silicone and saline devices are priced differently, and a lift added to the same operation is a second procedure with its own fee. Fat transfer adds liposuction time and cost. Ask for an itemized written quote that states exactly what is included, and what would cost extra if a revision or an overnight stay became necessary.

What is recovery like after breast augmentation?

Expect swelling, bruising, and tenderness in the first days, with moderate discomfort for the first couple of days managed with prescribed pain medication. Many patients return to desk work and driving within about a week, and to most normal activities within one to two weeks; strenuous activity is usually avoided for about three weeks. A surgical bra is worn during healing.

Implants drop and settle over roughly three to six months before the final look emerges, and follow-up visits monitor healing throughout. In Florida's climate, plan sun protection for healing incisions and avoid pools, hot tubs, and ocean swimming until the surgeon clears water exposure, since soaking incisions early raises infection risk.

What are the risks of breast augmentation?

Capsular contracture is the most common long-term complication: the scar capsule every body forms around an implant tightens, causing firmness, distortion, or discomfort. Other risks include rupture or leak, infection, bleeding, scarring, asymmetry, rippling, and temporary changes in sensation, which usually resolve within a year. Implants are not lifetime devices and may need replacement or revision.

BIA-ALCL, a rare lymphoma of the immune system (not breast cancer), is linked to textured surfaces; no confirmed cases have occurred in patients with smooth implants only, and preventive removal without symptoms is not recommended. Some patients report a range of symptoms attributed to implants; the causes are still being studied, so raise any symptoms with your surgeon rather than assuming a cause.

What should I ask at a breast augmentation consultation?

• Which implant type, profile, and placement do you recommend for my tissue and goals, and why?
• Do I need a lift as well, or will implants alone meet my goal?
• Would you use any internal support material, and is it cleared for breast use or used off-label?
• What is the total quote, broken down, and what are the revision terms?
• How are rupture and capsular contracture detected and handled, and what is your revision policy?
• Can you confirm your board certification? (Check the badge on each profile in this directory.)

Sources: American Society of Plastic Surgeons patient information and procedure guidance; U.S. Food and Drug Administration guidance where applicable. General information only, not medical advice. Confirm details with a board-certified surgeon at consultation.