Breast Augmentation

If You’re Considering Breast Augmentation…

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:

  • To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small
  • To restore breast volume lost due to weight loss or following pregnancy
  • To achieve better symmetry when breasts are moderately disproportionate in size and shape
  • To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
  • To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer
  • To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities

Inframammary (breast crease) Incision

Periareolar (around the areola) Incision

Transaxillary (underarm) Incision

Breast implants can be placed above or beneath the pectoral muscle.

The results of breast augmentation surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will gradually fade.

By inserting an implant behind each breast, surgeons are able to increase a woman’s bust line by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure–when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please ask your surgeon if there is anything you don’t understand about the procedure.

The Best Candidates for Breast Augmentation

Breast augmentation can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

Types of Breast Implants

The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, as well your plastic surgeon’s recommendations and sound surgical judgment are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you.

Breast implants are medical devices with a solid silicone, rubber shell. The implant shell may be filled with either saline solution (sterile salt water) or elastic silicone gel. Both saline and silicone gel breast implants are approved by the U.S. Food and Drug Administration (FDA). Approval means that an implant has been rigorously researched and tested, and reviewed by an independent panel of physicians for safety.

The size of a breast implant is measured in cubic centimeters (ccs) based on the volume of the saline or silicone filler. Breast implants vary both by filler and in size, but there are additional features to consider:

  • Texture: the implant shell may be smooth or textured
  • Shape: the implant may have a round profile or one that is anatomic (teardrop or tapered shape)
  • Profile: the implant may have a low, medium or high projection (the depth of the implant from the base to the highest point of the implant curve)
  • Diameter: the width of the implant measured across it’s base (the side of the implant that will be positioned over the chest wall)

Adult women of any age can benefit greatly from the enhancement breast implants provide. It is usually recommended, however, that a woman’s breasts are fully developed prior to placement of breast implants. Saline implants are FDA approved for augmentation in women 18 years of age and older. Silicone implants are FDA approved for augmentation in women age 22 and older. Saline or silicone implants may be recommended at a younger age if used for reconstruction purposes.

You should be aware that breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. Regular examinations for breast health and to evaluate the condition of your implants are important whether you have chosen saline or silicone breast implants.

All Surgery Carries Some Uncertainty and Risk

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

Breast implants do not generally interfere with a woman’s ability to breast feed, or present a health hazard during pregnancy to a woman or her baby. However, pregnancy and the associated changes to a woman’s body may alter the results of any breast surgery, including surgery to place breast implants. Therefore, it is important to discuss the options of breast implant surgery with your plastic surgeon if you are interested in becoming pregnant and breast feeding in the future.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak.

  • If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be absorbed and naturally expelled by the body.
  • If a silicone-gel filled implant leak or break, the elastic silicone gel may remain within the implant shell, or may escape into the breast implant pocket (a capsule of tissue that surrounds the implant). A leaking implant filled with silicone gel may not deflate and may not be noticeable except through imaging techniques such as an MRI. For this reason, a woman with silicone breast implants is advised to visit her plastic surgeon annually to assess that her implants are functioning well. An ultrasound exam or MRI screening can assess the condition of breast implants.

Following the placement of breast implants mammography is technically more difficult. Obtaining the best possible results requires specialized techniques and additional views. You must be candid about your implants when undergoing any diagnostic breast exam. In many cases, an ultrasound exam or MRI may be recommended in addition to mammography.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Planning Your Surgery

In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift.

Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer’s insert that comes with the implant he or she will use — just so you are fully informed about it. And, be sure to tell your surgeon if you smoke, and if you’re taking any medications, vitamins, or other drugs.

Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

Preparing For Your Surgery

Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. A mammogram may be recommended prior to your procedure to ensure breast health and serve as a baseline for future comparison.

In addition to explaining your surgical procedure, you plastic surgeon will discuss anesthesia, the recovery process and your obligations as a patient. You will also discuss where your procedure will be performed. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications of your surgery. There may be a waiting period of several days to weeks from the time of your consent to the day of surgery.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where Your Surgery Will Be Performed

Your surgeon may prefer to perform the operation in an office facility, a freestanding surgery center, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.

Types of Anesthesia

Breast augmentation can be performed with a general anesthesia, so you’ll sleep through the entire operation. Some surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you’ll be relaxed but awake, and may feel some discomfort.

The Surgery

The method of inserting and positioning your implant will depend on your anatomy and your surgeon’s recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. In addition, a saline implant may be placed through an incision at the navel. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (submammary or subglandular placement) or may be placed beneath the pectoral muscle and on top of the chest wall (submuscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage may be applied over your breasts to help with healing. The surgery usually takes one to two hours to complete. You’ll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure he or she recommends for you.

After Your Surgery

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.

Getting Back to Normal

You should be able to return to work within a few days, depending on the level of activity required for your job.

Follow your surgeon’s advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammography technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

Your New Look

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Even if you believe your implants are functioning well, it is important that you follow-up as directed with your plastic surgeon to assess the condition of your breast implants. In addition, whether you choose to have breast implants or not, it is essential to your health that you practice a monthly breast self-exam and schedule regular diagnostic breast screenings.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.

FAQ

How long is my recovery?

You may have bruising on or near your breasts lasting a week or two. Swelling of the breasts may persist for several weeks; you can expect them to go down in size about 10-20%. You should be able to resume normal activity within a day or two of surgery. Strenuous exercise and heavy lifting should be avoided for 2-3 weeks following surgery.

How long will I be in pain?

You will be sore for a few days and may even experience some muscle spasms/twinges in your chest. Tightness in the chest may persist for several days. You will be given a prescription for pain medication to use immediately post-op, and can switch to Ibuprofen or other over the counter medication after a few days.

How often will I need to come to the office for follow-up visits?

Your first post-op visit will typically be within three days after surgery. We will then monitor your recovery and progress on a weekly basis for a few weeks.

When can I go back to work?

In a few days you should be able to return to work. If your job requires physical labor, you may have lifting restrictions for three weeks.

When can I drive?

You can drive as soon as you are off of the narcotic pain medication and feel alert enough and physically able to do so.

What medications will I be on after surgery?

You will be given prescriptions for pain medication: usually Percocet and Vicodin. You may take one or the other to control your pain. You will also be given a prescription for Valium, to help with muscle spasms. A prescription for Zofran is also given; you can have this filled if you need to. This can be used to control post-operative nausea and vomiting that some patients experience after anesthesia. We may also give you a prescription for an antibiotic to prevent infection.

Can I go home the same day?

Most patients are able to go home following surgery. You will need someone to drive you home and stay with you the first night.

When can I have sex?

You may have sex when you feel comfortable enough. However, anything other than gentle manipulation of the breasts immediately post-op could harm the incision.

Will I have scars?

Yes. Scars can be around the areola, under the breast, in the armpit, or belly button. If a mastopexy (lift procedure) is also performed, you may have an incision around your areola, down your breast and under your breast.

When can I shower?

You may shower the day following surgery. You will have Dermabond, an adhesive glue covering your incisions. Your incisions can get wet. Do not apply any ointment or scar products until discussed with our office.

Do I have to wear a special garment?

We recommend wearing a sports bra after surgery for 2-3 weeks. Choose a sports bra with no underwire that fastens in the front. We suggest getting at least two. You will need to bring one with you to the hospital on the day of your surgery. These can be found at a department store, Target, Wal-Mart or a sports store. Occasionally, we recommend an underwire bra after surgery for certain procedures, we will let you know after surgery if that is needed.

When will I see the results?

You will immediately notice the results. However, you can expect about 10-20% of swelling to diminish over 3-6 weeks.

You will see the final result in 2-3 months.

Will I be able to breast feed after my augmentation?

Implants should not interfere with your ability to breast feed.

Will implants interfere with a mammogram?

Breast implants should not interfere with a mammogram. Dr. Spear usually places the implants partially underneath the pectoralis muscle. This position of the implant is best for mammography. You should have a mammogram at a facility that is familiar with patients who have implants.

What about implant massage?

We recommend that you massage your breasts to keep the implants soft. As you are healing, we will show you how to gently manipulate your breasts to help keep the scar tissue soft. After you are completely healed, we will show you how to massage your breasts more aggressively. We suggest you massage your implants on a daily basis, twice daily for at least two minutes, for as long as you have your implants.

How do I prevent constipation?

Narcotic pain medication can cause constipation. We recommend taking Colace or Pericolace. This medication is available over the counter at the pharmacy. You should begin taking this medication when you get home, and continue as long as you are on the narcotic pain medication. Increasing your fiber intake, eating fruits and vegetables and drinking plenty of fluids also helps. If constipation becomes a serious problem, we suggest either a Dulcolax suppository or drinking Milk-of-Magnesia.

How can I reach someone, after office hours if I have a problem?

If you have a problem and the office is closed, you may contact the Plastic Surgery fellow or chief resident. You will be given their pager number after surgery.

What if I cannot urinate?

Following anesthesia, some patients have difficulty urinating. If you go home and are unable to urinate within six hours, you may need to be catheterized. Go to the Emergency Room—either Georgetown or one that is closer to your home. Patients are usually able to urinate after the medication leaves their system.