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Breast Enlargement (Augmentation Mammaplasty)

Breast augmentation, technically known as augmentation mammaplasty, is a surgical procedure that utilizes synthetic implants to enhance the size and shape of a woman's breast creating a desired appearance.

Women who desire larger or fuller breasts elect to have this surgical procedure. Breasts that never developed to a desirable size appear disproportionate to the rest of the body, creating a figure imbalance. Women who feel as if their breasts are unusual or tubular; unequally developed; or have lost volume and shape after pregnancy would benefit from this type of procedure.

• How is breast augmentation performed?
• How long does breast augmentation take?
• What type of anesthesia is used?
• Where is the procedure performed?
• When can I return home and resume normal activities?
• How do I prepare for breast augmentation?
• What precautions are necessary during recovery?
• What are the possible complications after breast augmentation?
• What results can I expect after breast augmentation?
• Choosing the right surgeon

How is breast augmentation performed?

The three different ways to place the incision are either; just below the dark skin of the areola, below the breast where it meets the chest wall (inframammary) or hidden in the armpit (auxiliary). During your initial consultation, your surgeon will thoroughly discuss the placement of your incision, the risks and benefits, and your personal goals.

A salt water (saline) filled implant is placed either under or above the chest (pectoral) muscle, depending on your breast tissue, body formation, and amount of sagging (ptosis) of the breast. If the implant is placed under the pectoral muscle, simple movement of the arms automatically moves the implant around in its pocket. In some patients, these muscles are extremely active and can distort the implant so it is important to discuss with your surgeon the right implant placement for you. Your surgeon's goal is to achieve the most natural appearance possible of the breasts. The incision is closed with stitches beneath the skin (subcuticular sutures). The incisions may also be taped for greater support and a gauze bandage applied to help with healing.

Frequently breast augmentations are performed in conjunction with other procedures such as liposuction.

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How long does breast augmentation take?

Breast implants usually take about one to three hours to complete. The length of the procedure varies according to the technique used, the placement of the implants, the patients' anatomy.

What type of anesthesia is used?

Breast augmentations are usually performed using local anesthesia along with a light sedative to make you feel drowsy and relaxed. General anesthesia may also be used, causing you to be asleep during the whole procedure.

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Where is the procedure performed?

Most breast augmentations are performed on an outpatient basis, in the surgeon's office-based surgical suite, or outpatient surgery center.

When can I return home and resume normal activities?

You'll be able to return home within a few hours of the surgery. Most women return to their usual activities in one week. However, it is necessary that you have someone take you home after the procedure and stay with you for at least 24 hours. You must not lift anything for the first two weeks and do no heavy lifting for the first four weeks.

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How do I prepare for breast augmentation?

During your initial consultation, your surgeon will discuss the changes that you would like to make to your appearance. Since the appearance of your breasts is a matter of personal perception and preference, you will need to discuss your concerns in detail so your surgeon can determine the appropriate alternatives. You should have pictures of your desired breast size available for your surgeon. He/she will be able to determine which size implants will achieve your preferred size. He/she will also explain the different options available to you, including incision type, location of the implant, type of implant, and whether a breast lift might also be beneficial. You should also make arrangements ahead of time for someone to drive you to and from your procedure and to assist you with your daily activities during your recovery period.

Prior to your surgical procedure, the surgeon will perform a complete health history and physical. Knowledge of your allergies, medications and previous surgeries should be brought to your surgeon's attention at this time. Specific instructions to assist you in preparing for this procedure will be given to you after the health history and physical is complete. Depending on your individual health status, the instructions may include guidelines regarding your diet, alcohol intake, smoking and which medications to take or avoid. Your experience will be much smoother if you remain compliant with your surgeon's instructions.

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What precautions are necessary during recovery?

You will be placed in a surgical bra immediately after your procedure. You will wear this continuously for approximately two days. You will receive specific instructions to follow during your recovery including rest and sleeping positions, raising your arms, bathing and showering techniques, breast manipulation and deep breathing exercises.

Your surgeon will want to examine you at regular intervals during the first 90 days following your breast enlargement. Sometime after the third day, your surgeon will remove any bandages and check your incision area. You will need your new bra to support your breasts from this time forward. Your breasts may be swollen and bruised for approximately one to two weeks.
With most patients, the scars from the incisions will be pink for about six months and gradually fade thereafter. The scars are usually unnoticeable. It is important to know that all scars are permanent and their height, width and final color are never completely predictable.

As with any surgical procedure, small nerves to the skin are interrupted during surgery. Portions of the nipple area may feel numb or have less than full feeling. Sensitivity usually returns over several weeks, but some diminished feeling may last indefinitely.

You have to avoid sun exposure or use of a tanning bed until the numbness of the breasts has subsided. Thereafter be sure to protect the incision site with a sunscreen of at least SPF 15 or more for at least six months.

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What are the possible complications after breast augmentation?

Even though the implant is well tolerated, your body's natural reaction to a foreign material is to surround it with a thin membrane called a "capsule" in order to stay in the desired pocket. The formation of this capsule is not a problem and occurs in every patient. In some cases, for reasons that are as yet not completely understood, this capsule can shrink around one or both implants, compressing the implant and making it round and firm. This is called capsular contracture and can occur in varying degrees. Although some women may consider some firmness desirable, the capsule can cause the breast to become unnaturally firm, misshapen or uncomfortable.

Capsular contracture may occur from a few weeks to several years after the initial procedure. There is no way to predict your body's reaction and if you will develop capsular contracture. Placing the implant under the muscle, in some cases, can reduce the incidence of this condition. If a patient does develop capsular contracture, surgical intervention may be required.

The opposite of capsular contracture can also occur when breast implants are in a satisfactory position but several months later there is spontaneous expansion of the capsule. This is described medically as an inferior and lateral migration of the implants. If this happens, the patient will require closure of the breast pocket to reposition the implant either through the original incision or through a small inframammary incision.

While there is no evidence that the saline breast implant causes breast cancer, it is recommended that the patient have a preoperative mammogram as a baseline. Thereafter, when having a mammogram be sure to go to a radiology center where the radiologist is experienced in the (Eklund) special technique required for an accurate x-ray of a patient with breast implants.
It is emphasized that regular breast examination and mammograms are the best way to detect early cancers. It is always important to be informed about the possible complications before any surgery. Be sure to discuss any concerns you may have with your surgeon.

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What results can I expect after breast augmentation?

Your breasts will appear firmer and fuller immediately following your procedure. As with any surgical procedure, some swelling or bruising can be expected. Your breasts may not attain their final feel or shape for three to four months. In generally most woman are very pleased with their results after this procedure.