Breast augmentation, or enhancement, surgery can improve the size and shape of the breasts with breast implants. There are many reasons why women may choose breast augmentation. Some choose implant surgery as a reconstructive technique following a mastectomy. Others hope to balance different sized breasts, and some simply hope to enhance the proportions of their bodies.

Breast enhancement surgery begins with an incision. This incision can be placed on the underside of the breast, the armpit, around the nipple, or around the areola. The surgeon places the implant through the incision, ensures that it is natural looking, and places sutures to close the incision.

Breast enhancement patients have their breasts wrapped in a supportive gauze bandage following surgery. They are fitted with a surgical bra that provides support for up to several weeks. Common side effects of breast augmentation include fatigue, soreness, and discomfort, though these conditions are often alleviated with the help of medication. The surgeon removes stitches within seven to ten days, and the swelling normally subsides after about a month.

Surgeons place saline implants under the muscle to avoid rippling, and generally place silicone implants in front of the muscle. Placement under the muscle compresses and hides the upper portion of the implant, giving a more natural look, avoiding the round "coconut" look and helping to hide rippling of the implant. The muscle also compresses the implant and presses it away from the breastbone, so it is more difficult to get cleavage this way.

When the implant is under the muscle, it is held down, so it is less able to fill out a breast that is sagging. If the implant is under the muscle, the breast can continue to sag down over the front of the muscle; if the implant is in front of the muscle then the scar tissue around the implant helps to suspend the breast and keep it from sagging.

Surgeons generally fill the implants to volumes within the manufacturer's recommended fill range. As an example, one size has a recommended range from 300 to 330 cc, but is designated as a "300 cc implant". Thus, filling to 330 cc, the top of this range is not actually "overfilling", but exceeding 330 cc would be. Overfilling causes the implants to feel more stiff (imagine blowing up a balloon a bit more) and does not really decrease the amount of rippling.

Possible incision locations include periareolar (around the nipple), inframammary (in the fold beneath the breast), transaxillary (in the hollow of the armpit), and transumbilical (through the belly button). *NOTE - The transumbilical approach may void the replacement policy of some implant manufacturers.

The biggest risk factor for loss of sensation is having a large implant. The nerve that goes to the nipple comes from the side of the chest, between the ribs. It usually runs through breast tissue, and is not under stretch.

When the implant is placed, the nerve has to go over and around the implant - the larger the implant the greater the "detour" and the greater the stretch on the nerve. Just as the nerve to your fingers can "go to sleep" when you bend your elbow, the nerve to the breast can "go to sleep" as it goes over the implant. Most times, it will actually grow longer and start working again, but sometimes the stretch is just too much, and the nipple area remains permanently numb.

The best way to avoid this is to choose a smaller size implant. The location of the incision does not seem to make much difference, although the incision by the nipple may.

A serious complication of any surgery is the development of blood clots in the legs as a result of inactivity. The risk of this is reduced by early movement. After two weeks you can begin more vigorous activity but you should not do any heavy lifting or vigorous jogging for at least a month.

The procedure takes between 1.5-2 hours to perform.

An estimate on breast augmentation is between $5500 for saline implants and $7500 for silicone.