Breast Augmentation Surgery - What you should know

Am I a good candidate for breast augmentation?

One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation:
you are bothered by the feeling that your breasts are too small
clothes that fit well around your hips are often too large at the bustline
you feel self-conscious wearing a swimsuit or form-fitting top
your breasts have become smaller and lost their firmness after having children
weight loss has changed the size and shape of your breasts
one of your breasts is noticeably smaller than the other
Your Personal Consultation

During the consultation, you will be asked about your desired breast size and anything else related to the appearance of your breasts that you feel is important.

This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

How will my ASAPS plastic surgeon evaluate me for breast augmentation surgery?

Your plastic surgeon will examine your breasts and perhaps take photographs for your medical record. He or she will consider such factors as the size and shape of your breasts, the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging, a breast lift may be recommended in conjunction with augmentation.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. You will be asked whether you have a family history of breast cancer and about results of any mammograms. It is important for you to provide complete information.

There is no scientific evidence that breast augmentation increases the risk of breast cancer. The presence of breast implants, however, makes it more technically difficult to take and read mammograms. This may be a special consideration for women who perhaps are at higher risk for breast cancer because of their family history or other reasons. Placement of the implant underneath the pectoral muscle may interfere less with mammographic examination, but other factors may also need to be considered with regard to implant placement. Your plastic surgeon will discuss this with you.

If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. He or she may recommend that you stabilize your weight prior to undergoing surgery.

If you think that you may want to become pregnant in the future, you should mention this to your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your breast augmentation. There is no evidence that breast implants will affect pregnancy or your ability to breast-feed, but if you have questions about these matters, you should ask your plastic surgeon.

Your Surgical Experience

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

How should I prepare for breast augmentation plastic surgery?

In some instances, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast augmentation, you will still be able to perform breast self-examination.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Breast augmentation is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

What will the day of breast implant surgery be like?

Your breast augmentation surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite.

Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing breast augmentation, although general anesthesia may be desirable in some instances.

When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your breasts will be wrapped in gauze dressings or a surgical bra.

You may be permitted to go home after a few hours, unless you and your plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

How will my breasts look and feel after the breast implants have been placed?

A day or two after surgery, you should be up and about. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your plastic surgeon will probably permit you to shower between three and seven days following surgery. Stitches will be removed in about a week.

Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

What should I expect during the recovery process?

Recovery
At the conclusion of your breast augmentation procedure, you may be placed in a surgical dressing that may include a support bra or garment. You should follow your plastic surgeon's directions as prescribed. Prior to your discharge, you and your caregiver will be given detailed instructions about your post-surgical care including drains if they have been placed, the normal symptoms you will experience, and any potential signs of complication.

Options for your recovery after undergoing breast augmentation include:

Home: When discharged, you will be released to the care of a responsible adult with safe, licensed transportation home. The adult may be a family member, friend or hired caregiver and must be competent to understand your recovery instructions and to monitor your health. Your caregiver must commit to stay with you at all times for a minimum of 24 hours after surgery.
Licensed Recovery Facility: You will be released to the care of a licensed post-surgical recovery facility where nurses or specially trained medical professionals will monitor your health and comfort until you are able to return home and capably care for yourself.
Hotel or spa: You may wish to recover at a hotel or spa location, where licensed healthcare professionals will monitor your recovery around the clock as recommended by your plastic surgeon.
Overnight Hospital Stay: An overnight hospital stay may be offered to you or may be recommended. In this case your surgery will be performed at the hospital where you will stay overnight. You will be released from the hospital to a capable caregiver to continue your recovery at home, or to a licensed recovery facility.
You should be walking under your own strength immediately after your breast augmentation surgery. It is very important that you walk a few minutes every few hours to reduce the risk of blood clot formation in your legs.

The first 2-5 days following your breast augmentation surgery you may feel stiff and sore in the chest region. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your breasts may feel tight and sensitive to the touch, and your skin may feel warm or itchy. You may experience difficulty raising your arms. You should not lift, push or pull anything, or engage in any strenuous activity or twisting of the upper body. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

It is important to follow all patient care instructions as directed.

When can I expect to resume my normal activities after my breast augmentation?

While it will take several days to return to more normal activities after your breast augmentation, it is important to your recovery that you get up and move around. After breast augmentation, it is often possible to return to work within just a few days or a week, depending on the type of activities that are required at your job.

Physical activity should be avoided for at least the first couple of weeks following surgery. After that, care must be taken to be extremely gentle with your breasts for at least the next month.

How Breast Augmentation is Performed

Individual factors and personal preferences will help you and your plastic surgeon to determine your appropriate breast size, the location of incisions, and whether the implants will be placed on top of or underneath the chest muscle.

Breast Implant Options for the 21st Century

Breast augmentation is designed to increase the size of small or underdeveloped breasts. Breast surgery can also restore and enhance your breast volume if it has decreased as a result of pregnancy and breast feeding. In addition, breast implants can serve one or more of a number of purposes; breast cancer victims can use breast implants for reconstructive purposes after mastectomy, or women with asymmetrical breasts may use a single breast implant to balance the difference in size.

The availability of FDA-approved silicone gel implants will create new options for women considering breast surgery for the first time and for those who have had previous surgeries but are seeking new replacements or revision. Now, all women over 22 years old seeking cosmetic breast augmentation and women seeking breast reconstruction surgery will be able to select silicone breast implants.

What type of breast implants can be used for breast augmentation?

The size and type of breast implant recommended for you will be determined by your goals for breast enhancement, your existing body frame, and mass, your existing breast tissue, and the preferences you and your plastic surgeon discuss. All breast implants include a solid silicone rubber outer shell, called a lumen.

Breast implant options include:

Saline breast implants: Filled with sterile salt water. Saline implants may be pre-filled to a predetermined size. Saline may also be filled at the time of surgery to allow for minor modifications in implant size.
Silicone filled breast implants: Filled with soft, elastic gel. All silicone breast implants are pre-filled and may require a longer incision for implant placement.
The implant is placed in a pocket either directly behind the breast tissue (right) or underneath the pectoral muscle which is located between the breast tissue and chest wall.

New scientific data on the safety of breast implants is rapidly being collected. In the future, it is possible that additional types of filler materials may become available as advancements take place. Surgical techniques for breast augmentation and breast implants themselves are continuously being refined, increasing the safety and reliability of the procedure. Your plastic surgeon will be able to provide you with the latest information.

Where are the incisions made for the placement of breast implants?

One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous.

Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit.

An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit.

Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle which is located between the breast tissue and chest wall.

Understanding Risks

Every year, many thousands of women undergo successful breast augmentation surgery; however, anyone considering surgery should be aware of both the benefits and risks.

I understand that every plastic surgical procedure has risks, but how will I learn more so that I can make an informed decision?

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your plastic surgeon, or with a staff member in your surgeon's office.

Some of the potential complications that may be discussed with you include reactions to anesthesia, blood accumulation that may need to be drained surgically and infection. Although rare, an infection that does not subside with appropriate treatment may require temporary removal of the implant. Changes in nipple or breast sensation may result from breast augmentation surgery, although they usually are temporary.

When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may sometimes tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in the breast's appearance. In such cases, more surgery may be needed to modify or remove the scar tissue, or perhaps remove or replace the implant.

Breast implants are not lifetime devices and cannot be expected to last forever. If a saline-filled implant breaks, its contents are harmlessly absorbed by the body within hours. A definite change in the size of the breast is clearly noticed. Rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause. Surgery will be required to replace the implant, if desired.

If you are at an age when mammographic examinations should be conducted on a periodic basis, it will be important for you to select a radiology technician who is experienced in taking x-rays of augmented breasts. Additional views of your breasts will be required. Your plastic surgeon, in some instances, may recommend other types of examinations such as ultrasound or magnetic resonance imaging. It is possible that the presence of breast implants could delay or hinder the early detection of breast cancer.

Some women with breast implants have reported problems including certain connective tissue and immune-related diseases. Women without implants also have these disorders, so the key question is whether breast implants increase the risk of developing the conditions. Several large studies have been completed that provide reassurance that women with breast implants do not have a significantly increased risk for these diseases.

Results of Breast Augmentation

Breast augmentation will make your breasts fuller and enhance their shape. You will find it easier to wear certain styles of clothing. Like many women who have had breast augmentation, you may have a boost in self-confidence.

How long will the results last after a breast augmentation?

Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long-lasting. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" to restore their more youthful contour.

Maintaining a Relationship with Your Plastic Surgeon

You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Your surgeon will encourage you to schedule routine mammographic evaluations at the frequency recommended for your age group. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room.