Anesthesia: General
Location of operation: Surgery Center or hospital.
Length of surgery: 2-4 hours
Length of stay: Overnight
Discomfort: Moderate. Anticipate 3-7 days of prescription pain medication.
Swelling and Bruising: Improve in 2-4 weeks.
Bandages: Will be removed in 1-7 days.
Stitches: Will be removed in 5-7 days or will be absorbable.
Support: You will wear a sports bra or ace wrap for 1-4 weeks. Avoid an under wire bra until your surgeon approves it.
Back to work: 1-3 weeks.
Exercise: May be resumed in 2-4 weeks.
Final result: Will be seen after the scars have matured, which will be about 1-3 years.

Before you sign up for breast augmentation surgery, you and your plastic surgeon should have a long discussion about these important issues:

1. Position (under or over the muscle)
By implant position, plastic surgeons are referring to whether the breast implant should be placed above or below the pectoralis muscle. Here is an explanation of the advantages and disadvantages of both options.

The advantages of placing the breast implant above the muscle includes less discomfort post-operatively, less swelling, and less chance that the breast will appear to move when you are exercising your upper body.

Movement during exercise has been a great concern for many women. Athletic women should consider placement of the implant above the muscle (as long as they have adequate breast tissue and body fat) to avoid breast distortion during flexing. Simply put, if your breast implants are under the muscle, then when you flex your pectoralis muscles (as you often do during workouts), your breasts may appear to move. Sometimes (though not commonly) the breast motion will appear quite distorted.

One drawback is that rippling can be a significant cosmetic problem that can occur when the implant is placed over the muscle. (See Breast Implant Risks and Complications for an explanation of these things.) The advantages for placing the implants under the muscle include less interference with a mammography and less rippling in the upper half of the breast. Also, there is more cushion between the implant and skin. In general, thin and small-breasted women are probably better off with implants under the muscle.

Placement of the implants under the muscle has few drawbacks, many of which are temporary. The discomfort after surgery can be heightened along with more swelling. You may also find that your breast appears to move when you are exercising your upper body.
Thin, small-breasted, athletic women must weigh the options. You need to realize that many women who work out (and even some professional female athletes) have implants under the muscle and are very happy with their appearance. Even though working out can cause distortion of the breast, this is not too much of a problem unless you work out in the nude. So, do not automatically believe that your breast implants need to go over the muscle if you have a workout regime. An alternative for these athletic women is to have silicone breast implants.

Of course, the placement of your implants is your call. Be sure to discuss it carefully with your plastic surgeon.

2. Breast Implant surface (textured or smooth)
By implant surface, plastic surgeons are referring to whether the implant is smooth or textured. Once the implants are in place under your breasts, it is impossible to tell whether you have smooth or textured implants.

A smooth implant is just that - as smooth as the surface of a balloon.

Textured implants are rough, somewhat like sandpaper.

Textured implants were developed because plastic surgeons thought that they would be less likely to cause capsular contractures (see Risks and Complications of Breast Augmentation for an explanation of capsular contracture). Unfortunately, studies have not shown a consistent advantage of textured implants over smooth when it comes to capsular contractures.

3. Shape (round or anatomic (teardrop))
By this, plastic surgeons are referring to round or teardrop shape. Round implants are shaped like jelly donuts. Teardrop implants are shaped more like the breast.

At first, you might be thinking that (of course) teardrop implants would be better. However, most plastic surgeons disagree: they think that teardrop implants tend to become round with the forces of healing and that the teardrop implants do not necessarily give a better result. Furthermore, they find that teardrop implants may rotate, giving an unnatural appearance, and they impose restrictions in that they must be textured. Because plastic surgeons tend to recommend the techniques that work best in their hands, you should heed the advice of your plastic surgeon in this matter.

4. Volume
This is the all-important size issue. Breast implants come in all sizes with the most common sizes ranging from 200-600 cc. This is equivalent to 7-20 ounces. By the way, a cc (cubic centimeter) is the same as a ml (milliliter) - just in case you have visited other sites which refer to volumes in mls.

Although the range, 300-450cc is probably the most common, the decision is highly personal and highly individualized.
The best way to determine your size is by placing breast implant sizers (your plastic surgeon will hopefully have them) in your bra and then put a sweater, blouse, or t-shirt on (or, perhaps try all of them, as you will appear different in each). Do not allow your surgeon to dictate your size. You must have input in this decision and you must feel comfortable with your size.

5. Breast Implant projection (standard vs. high profile)
Breast implants are designed so that, as volume increases, so does diameter (the footprint of the implant) and projection (the amount it sticks out, away from your body).

Standard implants are designed so that MOST women who choose a given volume will be able to accommodate the breast implant's diameter beneath her breasts. This is so because women with narrower breast diameters often have smaller bodies and tend to choose smaller breast implants; women with wider breast diameters often have larger body frames and tend to choose larger breast implants. In other words, women tend naturally to choose an implant volume that is in proportion with body size and breast diameter, and the breast implants were designed in anticipation of that.

What if a woman wants a breast implant that has a larger volume than would be considered proportionate (by breast implant manufacturer standards) for her breast diameter, chest wall size, and body frame? In that case, placing a standard implant would risk an unnatural result, because it would be too wide for her body frame and would likely also extend too high and too low on her chest wall. In these cases, a High Profile implant is recommended.

With a high profile implant, the volume is the same, but the diameter (footprint) is narrower and the projection (the amount that it sticks out away from your body) is greater.

Most women (over 95%) are best suited to standard implants. The way to tell if you should have standard implants or high-profile is as follows: First, your surgeon should measure your breast diameter. Next, you should choose the implant volume that you want. Finally, your surgeon should compare the diameter of the desired implant size (standard implant) to the measured diameter of your breast. If the diameter of the implant size you selected is about the same or smaller than your measured breast diameter, then a standard implant is appropriate. If the diameter of the desired breast implant is larger than you breast diameter, then you should consider high profile breast implants.

6. Site of Incision
The options for site of incision are under your breast, or around your nipple. An incision under the breast is placed within or near the natural crease beneath your breast. This incision has the advantage of having the scar hidden in the shadow of the crease under the breast. It also heals well. It also is the incision you would likely get anyway if you require revision surgery later in life. Most plastic surgeons use this incision.

Around the nipple can give a good result in some women, but is riskier because it is at the focal point of the breast, so any irregularities in the scar will make it far more obvious. It also imposes a higher risk of nipple numbness and inability to breastfeed.