Breast Augmentation (Augmentation Mammoplasty)
Breast augmentation is an operation done by plastic surgeons
where implants are used to enlarge and shape the breast. Women
desire breast augmentation surgery for a variety of reasons.
These include improvement of self-image, to bring breasts
into better proportion with the rest of the body, or to restore
breast volume that may have been lost following pregnancies,
breast-feeding, or weight loss. I have written the following
to familiarize you with the surgery, and also to inform you
of my preferences for breast augmentation. A more detailed
discussion is also possible during your consultation where
I can address your specific questions and concerns.
I prefer to do breast augmentation surgery under a general
anesthetic administered by a board certified anesthesiologist,
in an outpatient surgery setting. General anesthetic techniques
that result in minimal post-op nausea are employed. This surgery
generally takes about two hours.
The incisions can be located either in the fold under the breast (inframammary location), in the armpit area (axillary location), or at the edge of the areolar complex (periareolar location). The incision location is generally left to the patient, based on her anatomy and desires. I use the incision under the breast most frequently. With the inframammary incision there is a 3.5 cm scar that is well-hidden in the breast fold. Occasionally, when the breasts have sagged, an incision completely around the areola can be used to place the implant and remove some breast skin creating a lift of the breast when the augmentation is done. During the surgery I make a pocket for the placement of the breast implant which is either under the breast tissue or partially under the chest wall muscle (pectoralis major). Most often I prefer placement under the muscle because it results in a more natural appearance of the breast and a softer breast in most cases, particularly in women with minimal breast tissue.
Silicone and saline implants are now used for breast augmentation in the
United States. The breast implants come in different sizes
and styles. Implants are available with smooth surfaces, with
textured surfaces, and in round and anatomic shapes.
Generally, the best results are achieved with smooth, round
implants which assume a teardrop shape when you are upright
and tend to flatten as does a natural breast when you are
AFTER BREAST AUGMENTATION SURGERY
Most women are able to leave the hospital within several hours
after the surgery. A soft bra or sports bra can be worn after
the surgery if desired, but most women are more comfortable
without a bra for the first several days after their breast
augmentation surgery. You may wear or not wear a bra as desired.
Some pain and discomfort is expected after breast augmentation
surgery. The most severe pain is in the first 24 hours which
then decreases rapidly. Some discomfort and soreness can be
present for 1-2 weeks following surgery. Pain medication provides
relief from the discomfort during this time. Most patients
have stopped taking pain medicine by 3-5 days following their
breast augmentation surgery. Some swelling and bruising does
occur after surgery. Your breast will initially seem larger
and your chest will feel tight because of swelling and fluid
collection around the implants. You may be able to feel or
hear swishing as the fluid moves around your implants. This
is normal, and resolves in 1-3 weeks. A small amount of bruising
may also occur in the area beneath your breasts or on the
side of your chest wall. This subsides in 1-2 weeks. During
the first few weeks after your breast augmentation procedure,
your breasts may appear slightly full in the upper portion.
The implants may also feel a little firm during this time,
but will settle lower and soften over the next 4-6 weeks.
The incisions heal into a scar that can be red and firm initially,
but then softens and fades over a period of 3-12 months. Concerns
about the scars are unusual after the scars have matured.
However, scarring is somewhat unpredictable from individual
to individual, and a small percentage of patients make thick
You will be seen in the office about one week after your
breast augmentation surgery. Generally, I use absorbable sutures
so they do not need to be removed. Tapes are placed over the
incisions and these are changed at this visit. Further follow-up
occurs at 3-4 weeks, 3 months and 6 months. You are encouraged
to then return yearly for a brief checkup.
Return To Activity
Normal walking, use of arms, and light activity are encouraged
the day after breast augmentation. Heavy physical activity
such as running, aerobic exercise, and weight lifting are
not allowed for the fist two weeks after surgery. Two weeks
after breast augmentation, all activity can be resumed without
restrictions. You may shower the day after surgery.
Breast Augmentation and Breast Cancer
There is strong medical evidence that breast implants do not increase or decrease the chance of breast cancer. Women with implants should do breast self examinations, have mammograms, and have physician breast examinations just like women without breast implants.
Mammograms should be done after breast augmentation at the usual recommended schedule. Extra views are usually done in women with breast implants, and this can make mammograms slightly more expensive. There is a some concern that an implant can cover some breast tissue and make mammograms less effective. However, in current medical studies there is no evidence that implants hamper diagnosing breast cancer. Generally, it is felt that mammograms are more inaccurate when the implant is partially behind the pectoralis major muscle (subpectoral).
RISKS, POSSIBLE COMPLICATIONS, AND LIMITATIONS OF BREAST AUGMENTATION
Risks with breast augmentation fortunately occur infrequently. However, with any surgical procedure complications can occur, and this is meant to inform you of the risks:
No womans two breasts are exactly the same size or shape. I attempt to compensate for asymmetry in breast size and shape by the breast pocket dissection and the inflation of the implant. However, some differences in size and shape always tend to persist.
Total loss of nipple sensation after breast augmentation
surgery is unusual, but is a remote possibility. Some change
in sensation can occur, and is usually transient, lasting
several weeks to several months. About half of patients seem
to have some increase in nipple sensitivity for several weeks
following breast augmentation.
Major complications from general anesthesia are very rare. The most common problem seen our with patients is postoperative nausea. The incidence of this is now much lower using current anesthetic techniques. Medication is also available should this occur.
Bleeding which can cause a blood collection (hematoma) around the implant occurs in 2% or fewer cases. This has been very unusual in my practice, but does require a return trip to the operating room. Infection can occur following any surgical procedure. Fortunately, this occurs in less than 1% of cases in breast augmentation. However, should a serious infection occur, the implant may need to be removed and left out for several months prior to replacement. You are given antibiotics at the time of surgery to help prevent this. Antibiotics following the surgery are not necessary.
The bodys natural reaction to any medical device is to form a lining, or capsule around the medical device. This is a normal reaction and occurs in all patients. In a small percentage of patients, the capsule may contract making the implant feel firm and appear round. With todays techniques for breast augmentation, capsular contractures which require a return to the operating room have been infrequent, 2-5%. There is also new information that new asthma drugs, taken orally twice daily can help reverse this process.
On rare occasion an implant will ripple and this will be
visible through the skin. In my experience, this is much more
common with textured implants, and very rare with smooth surfaced
The life of the implant is somewhat of an unknown, although
there is a failure rate of the implants. If the implants break
or leak, the saline is absorbed by the body. However, the
breast does loose volume, and a return trip to the operating
room for a revision is needed. The implants are guaranteed
for life by the manufacturer. If an implant rupture occurs
in the first five years after the breast augmenatation surgery,
the implant company does provide some funding which covers
most of the surgical expenses. The implant company will also
extend this warranty to 10 years for $125. I do worn women
who are contemplating breast augmentation, that on average
it is reasonable to expect a revision in her lifetime.
Breast augmentation is a reliable procedure. Breast augmentation
patients are routinely some of the most satisfied plastic
surgery patients. The operation is very effective in producing
improvement in breast size and shape.
If you are in the Denver, Colorado area and would like a
consultation, feel free to visit our offices. If you are outside
the Denver, Colorado area and would like a consultation, please
use our contact page.
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