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Breast Augmentation Surgery

Written By: Dr Kristie McNealy                                   Reviewed: 06 July 2010

Breast augmentation, or breast enlargement, is a surgical procedure that enlarges and reshapes the breasts using implants. Women choose to have breast augmentation because they feel their breasts are too small, or they are unhappy with how their breasts have changed after pregnancy or weight loss. Breast implants can also be used to reconstruct the breast after surgery for breast cancer, or to correct size differences in women with asymmetrical breasts.

Breast Augmentation Overview

Breast implants are made from an outer silicone shell, which is filled with either silicone or saline (salt water). In the past, there have been breast implants available with other fillers, including soy oil and hydrogel, but these have been taken off the market.

Breast implants come in a variety of profiles, shapes and textures. The breast implant which will work best for you depends a lot on your own anatomy. For example, high profile implants work well for women with a narrow breast base, while moderate profile implants are better for women with wider breasts.

Breast implants can be either round, or have an anatomical teardrop shape. While many people assume that round implants look less natural, they actually assume the same shape as anatomical implants when held in a vertical position. Round implants have the advantage of looking the same regardless of how they turn within the breast. Anatomical implants on the other hand, must stay in one position. For that reason, they are always textured to help them stay in the correct orientation.

All breast implants on the market today should last for at least ten years, but can last longer.

Breast Implant Placement

Breast implants can be placed either over or under the pectoral muscles of the chest. Each location has its own advantages and disadvantages.

Over the Muscle:

  • Easier surgery and recovery
  • Larger implants can be placed
  • Easier to see ripples
  • More risk of certain complications like capsular contractions
  • More risk that the implants will drop lower on the chest and "bottom out"

Under the Muscle:

  • Easier to visualize the breast tissue in mammograms
  • Edges of implant and ripples are camouflaged by the muscle
  • Less risk of the implant sinking too low on the chest
  • More painful surgical recovery
  • Implants sit higher until the muscle relaxes
  • Contracting the chest muscles can distort the appearance of the implant

Incision Placement

The incision used to insert a breast implant can be made in a variety of locations. Location can usually be chosen based on personal preference, but if you feel strongly about one incision site over another, it's best to find a surgeon who is comfortable with that surgical approach.

There are four incisions your surgeon can use when placing your breast implants. They are:

  • Areola - incision around the bottom half of the areola
  • Transaxillary - incision placed in the armpit.
  • Inframammary - incision made in the crease under the breast
  • Transumbilical breast augmentation (TUBA) - incision is made in the belly button

While most surgeons are skilled at using both areola and inframammary incisions, transaxillary and TUBA incisions are less common. Transaxillary incisions are good for under the muscle implants because they allow the muscles and fascia to be left intact.

What to Expect with Breast Augmentation Surgery

Consultation

Before having breast augmentation surgery, you'll need to attend a consultation with your surgeon. During the consultation, you'll discuss your reasons and expectations for breast enhancement, as well as the look you're trying to achieve. Your surgeon will examine your breasts, and recommend the shape, size and type of implant they think will work best with your body type, as well as the type of placement and incision site.
Your doctor will discuss the potential risks and complications of breast augmentation surgery, and have you sign a consent form. Then, they will give you instructions for any special things you'll need to do before your surgery, and explain what to expect during recovery.

Before Breast Augmentation Surgery

Your surgeon will give you specific instructions for the things you need to do before surgery. If you smoke, they will advise you to stop, because smoking can interfere with healing. They may also advise you to stop taking certain medications which could cause problems with bleeding during surgery or healing after surgery.

You may need to buy a supportive bra without an underwire to wear after surgery.

Since breast augmentation is done under general anesthesia, you will need to stop eating between 6 and 12 hours before surgery. You may be able to drink water or other clear liquids until closer to surgery time, but you surgeon will provide you with specific instructions.

You may need certain blood or urine tests performed before surgery to make sure that you are healthy, and not pregnant. You will probably also have your blood pressure, heart rate and breathing rate checked by a nurse.

Shortly before your operation, your surgeon will examine your breasts again. They may take measurements, or mark on your skin with a marker to help guide them during surgery.

During Breast Augmentation Surgery

Breast augmentation surgery typically lasts about 1 to 2 hours. Once you are in the operating theatre, the anesthesiologist will use special medications to put you to sleep. Then your surgeon will clean the skin around your incision sites and begin the surgery. Once the surgeon makes the incision, they will make a space for the implant, and then insert it.

Small plastic tubes called drains may be placed in your breasts and left in place for a few days. Stitches will be used to close your incisions, and your breasts will be bandaged with a supportive dressing or bra.

At this point, the anesthesiologist will wake you up, and you'll be moved to a recovery room.

After Breast Augmentation Surgery

Because breast augmentation is surgery, you'll experience pain once your anesthesia wears off. You'll be given pain killers to help you feel comfortable. Once you are fully awake, you'll be given something to drink.

You may stay in the hospital overnight, or g home the same day as your surgery. Either way, you'll need someone to drive you home, because anesthesia can cause problems with coordination and reasoning skills.

You'll need to wear a supportive bra day and night. If drains have been left in place, they'll be removed after a few days. After 7 to 14 days, any stitches that need to be removed will be taken out.

Risks of Breast Augmentation

Certain things, like infection, bleeding, scarring and pain are risks of any surgery. After breast augmentation you will also have hardness, swelling and bruising of the breasts. Depending on placement, it can take a few months for your breast implants to settle into place.

Complications of breast enhancement include:

  • Implant rupture – The outer shell of the implant may split or tear. Depending on what the implant is filled with, the contents of the implant may leak into surrounding tissue causing lumps or tender spots. Rupture does not always cause medical problems, but sometimes implants need to be removed and replaced.

  • Capsular contracture – Sometimes, the scar tissue that naturally forms around the breast implant shrinks causing the implant to harden and sometimes deform. This is more common in textured implants, and occurs in about 1 in 10 women who have breast implants. Surgery is needed to remove and replace the implant.

  • Implant moving out of place – Breast implants can bottom out, making the nipple appear too high. Anatomic implants can also rotate out of position giving the breast a distorted shape. Either of these situations can require further surgery to resolve.

Next: Is Breast Augmentation Right For Me?

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