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Modern breast augmentation employs implants that are made of a silicone shell that contains either saline (salt water) or silicone gel. The FDA has re-approved silicone gel breast implants for general use in patients over the age of 22. These silicone implants may be a better choice for some patients, especially very thin patients with little breast tissue.
Breast mplant shells can be smooth or textured. Textured shells were developed to help control the problem of capsular contracture. Contracture is a scar which forms around the breast implant and balls it up into a hard and undesirable shape. Contracture was more common with older style silicone breast implants and may play less of a role in modern saline and silicone implants.
Two basic implant shapes exist: round and anatomic (teardrop). The vast majority of patients will do well with a round implant. If additional lower breast projection is needed, an anatomic implant can be used.
The breast implants can be inserted though several incisions. The most common route is an inframamary incision placed at the bottom of the breast. This provides a straightforward route for implant insertion and its scar usually fades well. Another method places the incision along the areola. This is a good incision to use when the areola is darker than the surrounding skin so that the scar is well hidden. A third incision is in the armpit area. This technique requires the use of an endoscopic camera to properly place the implant. Silicone implants cannot be placed through this incision. A fourth technique, places the implants through a belly button incision. Again, silicone breast implants cannot be placed through this incision. All of these techniques can provide an excellent result and, once properly performed, their main difference lies in the location of the scar.
Another choice to be made is the implant location relative to the pectoralis muscle - above or below. Placement of the implant below the muscle further decreases the contracture rate. It also blunts the upper aspect of the implant to allow for a more natural appearance in small-breasted and thin-skinned patients. Placing the breast implant under the muscle usually entails cutting the muscle and causes more post-operative pain and possible implant motion when the pectoralis muscle is exercised. Placing the implant above the muscle (below the breast gland) is the best way to fill a sagging breast and the preferred method in cases of moderate and severe breast droop (ptosis). In many cases a Dual-Plane augmentation works best. This technique allows the lower portion of the implant to stay above the muscle to fill the skin more fully and more naturally, but keeps the upper part of the implant covered with muscle to provide a more natural contour.
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Once the decisions have been made, routine laboratory testing to rule out anemia or unknown pregnancy is often performed, and photographs are taken to assess post-operative effectiveness. Mammograms are ordered in all patients over 30 years of age in order to detect any possible abnormalities and to serve as a baseline for postoperative comparison.
No aspirin, ibuprofen, or similar drugs should be taken within two weeks of surgery. These medications can cause serious excess bleeding during and after the operation. If you have any questions about drugs you are taking, including over-the-counter preparations and natural herbs, please call the office.
Do not eat or drink anything after midnight of the night before your surgery. This prohibition includes coffee and juice in the morning. Oral medications can be taken with a sip of water.
The Operation for Breast Augmentation
You should be at the office surgicenter or hospital at least 90 minutes prior to your scheduled surgical start time. Bring all paperwork from the office with you, as many of these papers will save time on the day of surgery.
You will be seen pre-operatively and a few marks will be drawn on your chest to help guide the surgery. You will then be brought into the operating room and given anesthesia. The operation will proceed as discussed pre-operatively in most cases, though some intra-operative changes in plan are sometimes required to give the best result possible.
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Incisions will be made and pockets opened into which the implants are placed. In most cases saline implants are used and they are filled and adjusted to provide an even result. In some cases (mastopexy, prior implants) silicone filled implants can be used.
Once the implants are in place, the wounds are closed and a dressing is applied. The dressing will stay in place for 1-2 days until changed in the office.
Most patients will go home several hours after the surgery.
Breast Augmentation Post-Operative Care
Keep the dressing on until your office visit. Take the pain medication and antibiotics as prescribed. Your pain should steadily decrease with time. If the pain increases significantly there may be bleeding around the implant and you should call the office immediately.
Over the past year, post operative pain pumps have become more common. Originally their use was limited due to fears of infection, but their safety has been shown and they are very effective in minimizing pain over the first 2-4 days.
At the first office visit you will be placed into a new dressing. In many below-the-muscle cases an upper breast bandage is placed to help push the implant down against the action of the pectoralis muscle. In above-the-muscle cases, a sport bra is usually fitted for support.
Upper body exercise should be minimized and no reaching-type motions should be performed for 2-3 weeks. Massage of the implants may help decrease capsular contracture.
Patients can return to non-strenuous work in 3-7 days in most cases.
Frequently Asked Questions
- What is a breast augmentation?
- What are the benefits of this surgery?
- What are the risks associated with this surgery?
- What do I need to do before surgery?
- Where is the surgery performed?
- What happens on the day of surgery?
- What type of anesthesia will be used?
- What happens during the surgery, and how is the surgery performed?
- How long will I be in the hospital/surgery center?
- How will I look and feel after surgery?
- Will there be scars?
- When can I expect to return to work and resume normal activities?
What is a breast augmentation? |
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A breast augmentation or augmentation mammoplasty is a surgical procedure that enhances a woman's breast size and shape. |
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What are the benefits of this surgery? |
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Breast augmentation can enhance your appearance and increase your self-confidence. |
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What are the risks associated with this surgery? |
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As with any surgery, there are risks such as infection, bleeding, and scarring. Scarring around the implant (capsular contracture) is a special type of scarring possible in implant surgery and Dr. Moskovitz will inform you of this, and other risks of breast augmentation surgery at your consultation. |
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What do I need to do before surgery? |
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Please confirm your preoperative appointment with our office. At this visit, you will undergo a history and physical examination and Dr. Moskovitz will answer any questions you may have regarding your surgical procedure. The surgical fee will also be collected at this visit. Laboratory (blood work) will be needed prior to surgery. These tests may be covered by your insurance as part of your annual physical examination. Diagnostic examinations (mammogram) may also be performed as needed. You may not take aspirin within 2 weeks of your surgery and you should also avoid smoking for two weeks before and after the operation. |
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Where is the surgery performed? |
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Most breast augmentations are done in the office surgery center. If a hospital setting is needed for safety's sake, your surgery can be performed there. |
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What happens on the day of surgery? |
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You will report to the office and will be asked to change into a hospital gown. A nurse will review your chart and confirm that all of the paperwork is in order. You will be taken to a preoperative holding area and the anesthesiologist will start an intravenous line in one of your arms. Before any medications are administered, Dr. Moskovitz will verify your name and the type of procedure you are having. He will also answer any questions that you may have. You will then be taken to the operating room where the appropriate anesthesia will be administered and the surgery will be performed. Once the surgery is complete, you will be taken to a post-operative recovery unit where you will be monitored closely during your recovery. |
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What type of anesthesia will be used? |
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There are several types of anesthesia but the most common forms are general, local and monitored anesthesia care (MAC). With a general anesthetic, you will be asleep during your surgery. With a local anesthetic, you will be alert during the surgery and only the incision location will be anesthetized. With monitored anesthesia care or MAC, you will be given medications to relax you and the incision location will be anesthetized. General anesthesia is often used in the hospital, while MAC is usually used in the hospital. |
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What happens during the surgery, and how is the surgery performed? |
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Before the operation, you and Dr. Moskovitz will determine the best method for inserting and positioning the implant based on your anatomy. The incision location can be made in the armpit, around the areola (dark skin around the nipple), or most commonly in the crease between the breast and chest. During surgery, Dr. Moskovitz will position the implants by lifting breast tissue and skin to create a pocket located behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The surgery normally takes two hours to complete. |
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How long will I be in the hospital/surgery center? |
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You are usually allowed to go home within two to three hours after surgery, but you may stay longer for safety reasons. |
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How will I look and feel after surgery? |
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The first few days after your surgery you will feel sore, but you are expected to be up and about within 24 hours. You will have a prescription for pain medication, which should alleviate most pain and discomfort. There will always be some pain after surgery, especially for the first few days. Should your pain suddenly increase, please call the office immediately. |
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Will there be scars? |
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Your scars will be hidden as carefully as possible. They will be pink for several months then fade over time and in most cases will become almost imperceptible. The scars may, however, will never disappear completely and will be affected by your genetic ability to heal. |
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When can I expect to return to work and resume normal activities? |
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Within a few days of your surgery, you should be able to return to desk type work. For the first two to three weeks, your breasts may be sensitive to direct stimulation. Once the soreness goes away, breast contact is allowed. Stitches will usually dissolve on their own over a few weeks. |
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