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Modern breast enlargement 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. (see In The Media)
Implant 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 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 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 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 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.
View our Photo Gallery on Breast Augmentation
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?
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