Breast enlargement (augmentation) may be incorporated into the reconstruction process, whether you plan to add more volume at the outset or your surgeon suggests it as a tool to enhance the symmetry and appearance of your breasts.
While each situation is unique, you can talk with your plastic surgeon ahead of time to determine the most promising cosmetic options for enlargement. If you plan to have natural tissue reconstruction and you want a larger breast, you will discuss which transplant procedures will offer you the most tissue and fat. Procedures in which tissue is harvested from your abdomen, such as the DIEP flap procedure, might be the most promising. The “stacked” variation of DIEP involves taking two flaps of tissue from the abdomen and connecting them to form one breast when more fullness is desired.
Implants also offer opportunities to go up in cup size. There are two types of breast implants – silicone and saline (salt water). Saline implants do not sit like normal breasts and tend to have a rippling effect. Someone who undergoes a cosmetic breast augmentation has natural breast tissue that will cover saline implants and mask those problems. In contrast, breast cancer patients have little to no remaining breast tissue following a mastectomy. They can expect better cosmetic results with silicone gel implants, which hang more naturally and are more cohesive with less chance of rippling.
Well-known concerns about silicone implants resulted in them being taken off the market for several years, but the FDA thoroughly examined the evidence and declared them safe in 2006, allowing them to be used again. Currently, an average implant lasts for 13.5 years, and even though it will eventually rupture, it’s not dangerous. Because today’s silicone implants are made of a cohesive gel, the inner material does not “leak” and the capsule of scar tissue around the implant keeps it secure. Most people don’t notice that their silicone implant has ruptured. This usually has to be determined by an MRI. But when a saline implant ruptures, the saline leaks out and the implant goes noticeably flat.
Breast augmentation surgery lasts about 30 minutes per breast and can be done on an outpatient basis with general anesthesia. There will be temporary swelling, numbness and bruising during recovery. You may be able to return to work as early as five to seven days after surgery and resume normal activities in six weeks.
Risks include bleeding, scarring, infection, loss of sensation in breasts and nipples, hardening of the implant (capsular contraction) and the need for additional procedures.