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.

THE OPERATION

Anesthesia

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.

Surgical Approaches

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.

Implants

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 lying down.

AFTER BREAST AUGMENTATION SURGERY

Pain

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 scars.

Follow-up

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.

Mammography

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

Asymmetry

No woman’s 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.

Nipple Sensation

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.

Anesthesia

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

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.

Capsular Contracture

The body’s 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 today’s 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.

Rippling/Visible Implant

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 breast implants.

Implant Rupture/Failure

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.


© GRS 99