Breast Augmentation Surgery
Breast augmentation surgery adds volume and shape with silicone gel implants, or with your own fat for smaller changes. At ten years, 94.2 percent of augmentation patients in a major study were satisfied with their implants. At Biruni Hospital in Istanbul, our plastic surgery team plans implant size, type and placement from your measurements, with a stay of six to seven days and video follow-up for a year.
About This Department
Breast augmentation places an implant behind the breast to add volume and shape. The right plan fits the implant to the body.
Breast augmentation surgery enlarges the breasts or restores volume lost after pregnancy, breastfeeding or weight loss, using silicone gel or saline implants, or in smaller changes a transfer of the patient's own fat. In a ten-year study of 715 women followed with regular visits and MRI scans, 94.2 percent of augmentation patients said they were satisfied or definitely satisfied with their implants, and 81.8 percent still had their original implants at ten years (Spear and Murphy, Plastic and Reconstructive Surgery, 2014). Across 14,514 women in a nationwide American study, satisfaction with the breasts and psychosocial well-being rose after surgery and stayed higher at four years. Implants do not last a lifetime, and capsular contracture remains the most common reason for another operation. This page explains who is suited, implant types, placement, incisions, choosing size, risks including lymphoma, the operation day, recovery, long-term care and how patients from abroad arrange breast augmentation at Biruni Hospital in Istanbul.
What the operation does
Augmentation adds volume and upper fullness. It does not lift a breast that has dropped well below the fold, which needs a lift as well.
Common goals
Women choose augmentation to enlarge naturally small breasts, to restore fullness after pregnancy or weight loss, and to balance breasts of different sizes.
Who is suited
| Situation | Suitability | Note |
|---|---|---|
| Small breasts, stable weight | Well suited | Most common reason |
| Volume loss after pregnancy | Well suited | Wait six months after breastfeeding ends |
| Asymmetry | Suited | Different implant sizes or shapes |
| Marked sagging | Needs a lift too | Augmentation with mastopexy |
| Planned pregnancy soon | Better to wait | Pregnancy changes the result |
| Check | Purpose | When |
|---|---|---|
| Breast ultrasound or mammogram | Exclude hidden disease | Mammogram from age 40 or with family history |
| Blood tests | Fitness for anesthesia | Before surgery |
| Smoking status | Wound healing | Stop four weeks before |
Implant types
| Feature | Options | What it means |
|---|---|---|
| Filling | Silicone gel or saline | Gel feels more natural, saline is filled after placement |
| Shape | Round or anatomical | Anatomical implants slope like a teardrop |
| Surface | Smooth or microtextured | Macrotextured implants were withdrawn in 2019 over lymphoma risk |
| Profile | Low to extra high | How far the implant projects for its width |
| Gel cohesiveness | Standard to highly cohesive | Firmer gel keeps its shape better |
In the nationwide American study of 14,514 women, silicone implants gave greater gains in satisfaction and well-being than saline implants at one and four years (Alderman and colleagues, 2016).
Proportion over volume
Bigger does not mean better.
An implant wider than the breast base sits too far to the side or crowds the cleavage, and one too heavy for thin skin stretches it and slides downward over the years, so the best measure of success comes from how well the new breast matches the chest, shoulders and hips rather than from the number of cubic centimeters. We measure the width of the breast base, the stretch of the skin, the distance from nipple to fold and the thickness of tissue at the top of the breast, and those figures narrow the choice to a small range of implants before a woman ever tries a sizer. Within that range she chooses the look she prefers.
This keeps the result stable for longer.
Implant placement
Evidence at ten years
| Advantage | Drawback | |
|---|---|---|
| Under the muscle, dual plane | Better cover in thin women, less contracture | Movement of the implant with muscle use |
| Above the muscle | Faster recovery, no animation | Edges more visible in thin women |
| Subfascial | Middle ground | Less cover than under the muscle |
In the Natrelle Core Study, capsular contracture at ten years reached 15.7 percent with implants under the muscle and 26.3 percent with implants above it (Spear and Murphy, 2014).
The pocket matters as much as the implant.
Incisions
| Site | Advantage | Consideration |
|---|---|---|
| Fold under the breast | Best control, lowest contracture in several series | Scar in the fold |
| Edge of the areola | Scar at a color border | More effect on breastfeeding and nipple feeling |
| Armpit | No scar on the breast | Less control, harder for revisions |
Fat transfer as an alternative
Fat can replace an implant for modest changes.
Liposuction takes fat from the abdomen or thighs, and after processing it is injected into the breast in small amounts. Only part of it survives. In a prospective MRI study, 57 percent of the injected volume remained at three months (Guo and colleagues, Aesthetic Surgery Journal, 2019), so fat transfer suits women who want an increase of about one cup size and have fat to spare.
It also works alongside implants to soften their edges.
Choosing size
Sizers and simulation
Risks
- Swelling, tightness and bruising in the first weeks, easing as the implants settle.
- Temporary changes in nipple feeling, returning in most women within months.
- Rippling in thin women.
| Complication | How often | Management |
|---|---|---|
| Capsular contracture | 18.9 percent at ten years in the Core Study | Capsule removal and implant exchange |
| Silent rupture of silicone implants | 7.7 percent of implants at ten years on MRI | Implant replacement |
| Hematoma | Uncommon | Drainage in the first days |
| Infection | Rare | Antibiotics, sometimes implant removal |
| Implant malposition | Uncommon | Pocket repair |
Capsular contracture
Every implant forms a thin capsule of scar tissue. In some women it thickens and tightens, making the breast firm, misshapen or painful.
Lymphoma risk in perspective
Breast implant associated anaplastic large cell lymphoma, BIA-ALCL, grows in the fluid or capsule around an implant.
A nationwide Dutch registry study found that 32 of 43 women with lymphoma of this type in the breast had implants, most of them macrotextured, and estimated that one case would arise for every 6,920 women carrying implants up to the age of 75 (de Boer and colleagues, JAMA Oncology, 2018). The disease typically shows years after surgery as sudden swelling of one breast from fluid, and when caught at that stage, removal of the implant and the whole capsule cures most women without chemotherapy. The risk relates mainly to heavily textured surfaces, and those implants left the market in 2019 for that reason.
Late swelling needs an ultrasound. It rarely means cancer.
Breastfeeding and mammograms
Breastfeeding
Screening
Can I still have mammograms with implants?
Breast implant illness
Some women with implants report fatigue, joint pain, memory problems or rashes and call this breast implant illness. Studies have not shown that implants cause a specific disease, and symptoms improve in a share of women after removal, and the question remains under research. We take these reports seriously and discuss them before surgery.
The operation day
| Step | Timing | Note |
|---|---|---|
| Admission and marking | Morning | Photographs and final check |
| Surgery | One to two hours | General anesthesia |
| Recovery room | One to two hours | Pain relief, surgical bra fitted |
| Ward | Overnight | Discharge next morning |
| Medicine | Purpose | Duration |
|---|---|---|
| Painkillers | Comfort | Five to seven days |
| Muscle relaxant if needed | Chest muscle spasm | A few days |
| Antibiotic | Prevention in selected cases | Short course |
Recovery
| Time | What happens | Activity |
|---|---|---|
| Days 1 to 3 | Tightness, swelling | Walking, arms below shoulder height |
| Week 1 | Wound check | Desk work, light daily tasks |
| Weeks 4 to 6 | Pocket healed | Gym, running, underwire bra |
| Month 3 | Implants settled | Result close to final |
| Month 12 | Scars pale | Final review |
Long-term care
Checking for rupture
Keeping your records
Keep the implant card safe, since any surgeon who operates later needs the model and size.
For patients from abroad
Long flights raise the risk of blood clots after surgery. Walk in the aisle, drink water and wear compression stockings on the journey.
One coordinator from the international patients office handles arrangements from the first message through discharge and answers the same WhatsApp number after you return. The office works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and books interpreters for other languages, and it arranges the visa invitation letter, airport transfers, daily transport and accommodation near the hospital. Halal, vegetarian and diabetic meals, a prayer room on site, and a female physician on request wherever the rota allows.
| Day | Step | Note |
|---|---|---|
| Day 1 | Consultation, tests, sizing | Implant range agreed |
| Day 2 | Surgery | One night in hospital |
| Days 3 to 5 | Rest at the hotel | Check visit on day 3 |
| Day 6 or 7 | Wound check | Cleared for travel |
Cost
| Item | Included | Priced separately |
|---|---|---|
| Surgery | Surgeon, anesthesia, operating room | Breast lift if needed |
| Implants | Two silicone implants with card | Premium implant lines if chosen |
| Hospital and aftercare | One night, surgical bra, medicines, video follow-up for a year | Later exchange or revision |
Compare quotes for the same implant brand, type and aftercare, and ask what the manufacturer warranty covers.
References
- Spear SL, Murphy DK. Natrelle round silicone breast implants. Core Study results at 10 years. Plast Reconstr Surg. 2014;133(6):1354-1361.
- Alderman A, Pusic A, Murphy DK. Prospective analysis of primary breast augmentation on body image using the BREAST-Q. Results from a nationwide study. Plast Reconstr Surg. 2016;137(6):954e-960e.
- de Boer M, van Leeuwen FE, Hauptmann M, et al. Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. 2018;4(3):335-341.
- Guo X, Mu D, Xing W, Qu Y, Luan J. Identification of the optimal recipient layer for transplanted fat. A prospective study on breast lipoaugmentation. Aesthet Surg J. 2019;39(10):1071-1081.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Assoc. Prof. Dr. Fatih CERAN, Plastic, Reconstructive and Aesthetic Surgery.
Medically reviewed by
Assoc. Prof. Dr. Fatih CERAN
Plastic, Reconstructive and Aesthetic Surgery
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