It is well known that there is a relatively simple surgical procedure called augmentation mammoplasty that almost always produces excellent results. So if you're among the growing number of women who want more beautiful breasts, this operation will be a safe and effective way to do it.

It is for this reason that breast augmentation is one of the most common operations performed by plastic surgeons today. There are an estimated 2 million American women who have had breast implants. An estimated 160,000 to 190,000 women had their breasts enlarged last year.

A breast implant is essentially an inert object that is placed into a space created surgically behind the breast. It pushes the patient's own skin and breast tissue forward thereby increasing its size. It does not go into the breast tissue itself. When properly done, it does not interfere with the breast function in any way. It does not interfere with sensation or with nipple erection. Most people believe that it does not reduce the ability to nurse a child, although there is some evidence that lactation may be slightly diminished. An implant does not interfere with breast cancer, neither causing it nor preventing it, although some statistical studies have shown that women with breast implants have less of a risk of breast cancer than the general population -- no one knows why. Since the breast tissue remains in its normal position in front of the implant, any tumor growing in the breast could still be detected on self-examination or an exam done by a doctor. Most experts believe that mammograms, when done by a skilled person, can detect breast cancer in women with implants at the same stage as in women without them, but some minimal interference may occur. And if a tumor ultimately had to be biopsied, it could be done without ever disturbing the implant.

The operation can be done in an office or hospital operating room under general or local anesthesia with intravenous sedation, the latter being preferable as there is much less bleeding with local anesthesia and little if any nausea after the surgery. It is also safer. The procedure takes an hour to an hour and a half. After a short recovery period the patient can go home with two small bandages and return one week later for suture removal. If the implants are placed above the breast there is only moderate pain after the surgery, much like muscle pain after too many pushups.

There are several types of implants, including saline, silicone gel and hydrogel; there are different size and shape implants with different types of coverings; they can be placed over or under the muscle using local or general anesthesia and there are four different incisions that could be made.

1) In the breast fold: This hides the scar well should it thicken. It provides the easiest and safest approach for the surgeon and is the one most commonly used. An excellent surgeon should be able to do the surgery through an incision measuring exactly one inch.

2) Around the nipple: This is often a very thin scar; if not, it will be very visible. The biggest risk of employing this incision is loss of sensation in the nipple that can occur up to 50% of the time.

3) In the axilla: This is a popular means of access when the implant is put under the muscle, but it can also be used for over the muscle. One of the implications of a scar in this area is that if it thickens, raising your arm on the beach or in a low cut gown will be a dead giveaway that you have implants. This incision also makes proper placement of the implant very difficult. Unfortunately, it is not uncommon to see patients with implants that were placed too high on the chest because of this approach.

4) Through the navel: The surgery is performed through a long tube called an endoscope. While the scar may be imperceptible, it is nearly impossible to dissect a large enough pocket for placement of the implant in this manner. Therefore, the method used is creation of the space by blowing a dissecting balloon that tears open the area. This does not create a large enough pocket for the implant, so that its outline can be seen, producing a very unaesthetic appearance. If bleeding should occur, stopping it can be very difficult. Furthermore, because the implant can be abraded and weakened when pushed through the endoscope, the implant manufacturers will not guarantee their products in the event of leakage.

After a short recovery period the patient can go home with two small bandages and return one week later for suture removal. If the implants are placed above the breast there is only moderate pain after the surgery, much like muscle pain after too many pushups. Mild pain medication is usually taken for the first two or three days. Most patients can have the surgery done on Friday and go back to work on Monday, still a bit sore, but perfectly able to function. Under the muscle placement is much more painful and requires at least a week of immobility. Usually, no vigorous exercise such as jogging or workouts for three weeks is recommended. After that, virtually nothing one does can injure the implants..

There are several risks associated with breast enlargement. Remember that a risk is something that the surgeon cannot control, so misplacement of the implant, for example, is not a risk. If your prospective surgeon does not describe all the risks of the surgery, do not let him operate on you. Find someone else..

1) Infection: Infection is very rare; however, should an infection occur, the implants might have to be removed. They should be replaced later on at no extra charge.

2) Bleeding: Bleeding after the surgery is also very unusual. It is not life threatening. This can happen because a small blood vessel can open up a few hours after the surgery and begin to ooze. The breast would swell a great deal and become quite painful. It would necessitate returning to the operating room to stop the bleeding. It is not a dangerous condition, only something that needs to be taken care of.

3) Hardness of the breast: The most common problem with breast augmentation is that the breasts might not feel natural. This can happen because your body makes a covering around the implant, sort of like a scar, that is referred to as a capsule. This is the way the body walls off an object that is foreign to it. If you form a thin capsule around the implant, your breasts will feel soft. Unfortunately, if your body makes a thick capsule, it can squeeze the implant and then it will feel hard. This is called capsular contracture. (Think of it as a balloon not quite filled with water that you then squeeze - it feels hard.) The problem does not cause illness; it is simply unaesthetic. It can be remedied in most cases with a procedure called a closed capsulotomy. To accomplish this, the doctor will squeeze your breast very hard to break the capsule. (It is almost impossible to break the implant.) Breaking the capsule alleviates the contracting effect and allows the space around the implant to expand making the breast feel soft again. This could recur again. Years ago a surgical procedure call open capsulotomy was performed. This entailed opening the old incision and removing the capsule. It was soon learned that this was fruitless, as the capsule almost always formed again the same way.

It is, however, strongly recommended that closed capsulotomy no longer be done on those with silicone gel because these older implants are more prone to rupture.

4) Rippling of the implant: Sometimes, when the capsule forms, it can pull the implant in such a way that it causes it to ripple. This is sometimes felt and less frequently seen. There is nothing that can be done once this occurs. Rippling is much more frequent in women who have stretch marks or very thin breast tissue after pregnancy (not small breasts, breast tissue that has thinned after having a child).

5) Deflation - Leakage: If a saline implant has a manufacturers defect, the saline would slowly leak out and be absorbed and eliminated. It is totally harmless - just like drinking salt water. The manufacturers guarantee the implants, providing a new one for no charge and reimbursing the surgeon a modest amount for replacing the implant. Gel implant leakage will be discussed further on.