Initially, you'll consult with a plastic surgeon about your preferences for size, feel and overall appearance of your breasts. The surgeon will describe specific types of implants — smooth or textured, round or shaped like a teardrop, saline or silicone — as well as options for surgical techniques.

Review any documentation carefully and keep copies of all pertinent information for your records.

Before you decide to go ahead with surgery, consider some important factors about breast augmentation:

• Breast implants won't prevent your breasts from sagging. To correct sagging breasts, you might need a breast lift in addition to breast augmentation.
• Breast implants aren't guaranteed to last a lifetime. Implant rupture is a possibility. Also, your breasts will continue to age after augmentation — and factors such as weight gain or weight loss might further change the way your breasts look. Any of these issues might lead to additional surgery.
• Mammograms might be more complicated. If you have breast implants, routine mammograms might require additional, specialized views.
• You might need routine MRI scans. The Food and Drug Administration recommends monitoring silicone breast implants with routine MRI scans every two years, starting three years after the initial implant surgery. Debate continues, however, on whether the benefit of routine MRI scans justifies the cost. There's also a concern that routine MRI scans have the potential to lead to unnecessary surgery.
• Breast implants might hamper breast-feeding. Some women are able to successfully breast-feed after breast augmentation. For others, however, breast-feeding is a challenge.
• Insurance might not cover breast implants. Unless it's medically necessary — such as the need for implant reconstruction after a mastectomy — breast augmentation isn't covered by insurance. Be prepared to handle any expenses that accompany breast augmentation, including related surgeries or future imaging tests.
• You might need additional surgery after breast implant removal. If you decide to have your implants removed, you might need a breast lift or other corrective surgery to help your breasts maintain an aesthetically pleasing appearance.

If you decide to have the surgery, you might need lab tests or a baseline mammogram ahead of time. Your doctor might adjust certain medications before the surgery as well. For example, it's important to avoid aspirin or other medications that can increase bleeding.

If you smoke, your surgeon will ask you to stop smoking for a certain period of time before the surgery.

Arrange for someone to drive you home after the surgery and to stay with you for at least the first night.

What you can expect

Breast augmentation can be done in a surgical center or hospital outpatient facility. You'll probably go home the same day. Rarely, the procedure requires a hospital stay.

In select cases, breast augmentation is done with local anesthesia — in which you're awake and only your breast area is numbed. In most cases, though, breast augmentation is done under general anesthesia — in which you're asleep for the surgery.

During the procedure

To insert the breast implant, your surgeon will make a single cut (incision) in one of three places:

• In the crease under your breast (inframammary)
• Under your arm (axillary)
• Around your nipple (periareolar)

After making an incision, the surgeon will separate your breast tissue from the muscles and connective tissue of your chest. This creates a pocket either behind or in front of the outermost muscle of the chest wall (pectoral muscle). The surgeon will insert the implant into this pocket and center it behind your nipple.

Saline implants are inserted empty, and then filled with sterile salt water once they're in place. Silicone implants are pre-filled with silicone gel.

When the implant is in place, the incision will be closed — typically with stitches (sutures) — and bandaged with skin adhesive and surgical tape.

After the procedure

Soreness and swelling are likely for a few weeks after surgery. Bruising is possible, too. Expect your scars to fade gradually over time, although they won't disappear completely.

While you're healing, it might help to wear a compression bandage or sports bra for extra support and positioning of the breast implants. Your surgeon might prescribe pain medication as well.

Follow your surgeon's instructions about returning to regular activities. If you don't have a physically demanding job, you might be able to return to work within a few days to a week. Avoid strenuous activities — anything that could raise your pulse or blood pressure — for at least two weeks. While you're healing, remember that your breasts will be sensitive to physical contact or jarring movements.

If your surgeon used sutures that don't absorb on their own or placed drainage tubes near your breasts, you'll need to have them removed at a follow-up appointment.

If you notice warmth and redness in your breast or you run a fever, you might have an infection. Contact your surgeon as soon as possible. Also contact your surgeon if you experience shortness of breath or chest pain.