Breast Augmentation

Overview:

Breast augmentation — also known as augmentation mammoplasty — is surgery to increase breast size. Breast augmentation may be done by insertion of a silicone bag (prosthesis) under the breast (submammary) or under the breast and chest muscle (subpectoral), after which the bag is filled with saline solution. This prosthesis expands the breast area to give the appearance of a fuller breast (increased cup size).

For some women, breast augmentation is a way to feel more confident. For others, it’s part of rebuilding the breast for various conditions.

Generally, Breast augmentation is done to:

• Enlarge breasts that are naturally small
• Restore breast size and shape after pregnancy, weight loss or breastfeeding
• Restore symmetry when the breasts are asymmetrical
• Restore the breast or breasts after surgery

Plastic surgery includes reconstructive surgery and cosmetic surgery.

Reconstructive breast surgery may be done as a part of the treatment for breast cancer. Cosmetic breast surgery is done for aesthetic purposes.

Who is a good candidate for breast augmentation?

Breast augmentation is a deeply personal procedure, and it’s important that you’re doing it for yourself and not for someone else, even if that person has offered to pay for it. Patient satisfaction is high, specifically when they want the procedure themselves.

You may be a candidate for breast augmentation if:

• You are physically healthy and you aren’t pregnant or breastfeeding
• You have realistic expectations
• Your breasts are fully developed
• You are bothered by the feeling that your breasts are too small
• You are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss or with aging
• You are unhappy with the upper part of your breast appearing “empty”
• Your breasts are asymmetrical
• One or both breasts failed to develop normally or have an elongated shape

Important Things to know:

Before you decide to have surgery, consider the following:

• 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. The average life span of an implant is 10 years. Implant rupture is a possibility. Also, your breasts will continue to age, and factors such as weight gain or weight loss might change the way your breasts look. These issues will likely lead to more surgery.
• Mammograms might be more complicated. If you have breast implants, in addition to routine mammograms, you’ll require additional, specialized views.
• 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 does not cover breast implants. Unless it’s medically necessary — such as after a mastectomy — breast augmentation isn’t covered by insurance. Be prepared to handle the expenses, 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 restore your breasts’ appearance.
• You might need an MRI scan. The FDA recommends routine monitoring with MRI after three years. However, recent studies show that there’s little data to support routine screening unless you have symptoms.

Procedures:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). A belly-button approach is associated with a higher complication rate.

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting and placing the breast implant

After the incision is made, a breast implant is inserted into a pocket either:

1. Under the pectoral muscle (a submuscular placement)
2. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.

Step 4 – Closing the incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin.

Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

Preparation and Recovery:

Preparation:

you may be asked to:

• Get a blood test
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin and certain anti-inflammatory drugs as they can increase bleeding
• Stop taking recreational drugs, such as cocaine

Breast augmentation surgery should be performed in an accredited outpatient or ambulatory surgical center or a hospital. This is for your safety.

Recovery:

During your breast augmentation recovery, your breasts will be wrapped in gauze dressings and an elastic bandage or support bra will minimize swelling and support the breasts as they heal.

Immediately after surgery, you will be taken into a recovery area for close monitoring. You may be permitted to go home when you are stable for discharge, typically after an hour or so.

Before leaving, you will be given specific postoperative instructions for your breast implant recovery and a follow-up appointment with your plastic surgeon. You may also receive medications or a prescription, but many plastic surgeons prescribe postoperative medications in advance. Your prescribed medications may include pain pills and an antibiotic to prevent infection.

Wear your support garment (a bra or elastic band, called a bandeau) around the clock as instructed by your plastic surgeon. Some surgeons may ask patients cleanse the incision sites and apply ointment, while others will ask their patients to keep tape or a bandage on. Instructions vary, so it’s important to follow all your plastic surgeon’s directions carefully.

Because it is possible to bleed into the pockets around the breast implants for the first several days, take it easy until you have permission to increase your activity level. Acute pain typically subsides after one to five days, but you may experience soreness and swelling for a few weeks. Resume exercise and normal activity according to your plastic surgeon’s directions.

Further information:

It is also worth to know:

Breast Implant Choices:

There’s never been a better time to have breast augmentation, as today you have more choices than ever to help you customize your new look. Whether you’d like more dramatic curves or a modest boost in cleavage, there’s an option for you. Here are some choices you can expect to go over during your consultation process:

• Filling type: Saline, Silicone Gel, or Highly Cohesive Silicone “Gummy Bear” Implants. Neither is “best,” but there are some differences in cost, feel, and incision requirements that you need to consider. Your cosmetic surgeon will help you find the right implant type for you.
• Shape: Saline & Silicone Gel implants are typically round, while gummy bear implants come in shaped and round options. Round implants will typically achieve a fuller upper pole (the top portion of your breast), while shaped implants lend a gently sloping look to your breast profile. Both can look very natural with a skilled cosmetic surgeon’s help.
• Profile: Your cosmetic surgeon will help you choose this based on your existing proportions and your goals. Generally, patients with a more petite frame will require a higher profile implant to achieve the desired size increase while ensuring the implants are not too wide at the base.
• Size: Breast implants range in size from about 150cc to 800cc or larger. Many patients require a different sized breast implant for each breast; this helps to achieve the best possible symmetry. The size you choose depends on your existing breast size, your personal goals, and your cosmetic surgeon’s recommendations.

Of course, all of these options make it even more important to choose a cosmetic surgeon who is well-qualified and has experience using a variety of breast implants.

Incision Options for Breast Augmentation

One common question that patients have before breast augmentation is, “What will my scars look like?” You’ll be glad to learn that an experienced, qualified cosmetic surgeon will use a surgical technique that places breast augmentation incisions so the resulting scars are easily hidden and inconspicuous, even to the patient herself. Depending on your anatomy and your desired outcome, your cosmetic surgeon will use one of the following incision techniques to place your breast implants:

• Inframammary: This involves a short incision made in the crease underneath the breast, called the inframammary fold. This leaves a thin, 1 to 2 inch scar that is easily concealed within the crease. Advantages of this incision type include a wider access point, allowing a cosmetic surgeon to place larger silicone implants or gummy bear implants with precision.
• Peri-areolar: The incision is made around the outer edge of the areola, so the resulting scar is located within this natural transition in pigmentation. Cosmetic surgeons will often use this incision type if they are also performing a mild to moderate breast lift at the same time.
• Trans-axillary: This involves a small incision made within the armpit, through which your cosmetic surgeon will place the breast implant using a specialized camera and instruments to ensure optimal placement. This leaves a small scar within the armpit but achieves a breast augmentation with no scar on the breast itself.
• Transumbilical: This technique involves an incision just above the belly button. Each breast implant is inserted through this incision and then brought up to the breast. Advantages of the transumbilical technique include a single scar with no scarrring on the breast itself.

Risks and Complications:

Every surgical procedure has risks. Possible breast augmentation surgery risks include:

• Anesthesia risks
• Bleeding
• Hematoma
• Infection
• Changes in nipple or breast sensation
• Poor scarring
• Wrong or faulty position of the implant
• Implant leakage or rupture
• The formation of tight scar tissue around the implant (capsular contracture)
• Fluid accumulation (seroma)
• Wrinkling of the skin over the implant
• Persistent pain
• Possibility of revision surgery

These risks and others will be fully discussed prior to your operation. It is important that you address all your questions directly with us.

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