Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:
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To enhance the body contour of a woman.
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To correct a reduction in breast volume after pregnancy.
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To balance a difference in breast size.
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As a reconstructive technique following breast surgery.
By inserting an implant behind each breast, surgeons are able to increase a woman’s bustline by one or more bra cup sizes. If you’re considering augmentation surgery, this will give you a basic understanding of the procedure–when it can help, how it’s performed, and what results you can expect.
Breast Augmentation Candidates
The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.
Types of Implants
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Saline breast implants are filled with sterile salt water, so should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.
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Structured implants are also filled with sterile salt water, but contain an inner structure which aims to make the implant feel more natural.
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Silicone breast implants are filled with silicone gel. The gel feels a bit more like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket.
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Form stable or “gummy-bear” implants are thicker than traditional silicone gel implants and maintain their shape even when the implant shell is broken.
Planning Your Surgery
In your initial consultation, Dr. Dumanian will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift. Some women also choose to undergo body contouring procedures, such as tummy tuck, at the same time as breast surgery.
Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer’s insert that comes with the implant he or she will use — just so you are fully informed about it. And, be sure to tell your surgeon if you smoke, and if you’re taking any medications, vitamins, or other drugs.
Preparing For Your Surgery
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Breast Augmentation Surgery
The method of inserting and positioning your implant will depend on your anatomy and your surgeon’s recommendation.
Working through the incision, Dr. Dumanian will lift your breast tissue and skin to create a pocket underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.
The surgery usually takes 60 to 90 minutes to complete. Stitches are used to close the incisions, which may also be taped for greater support. A gauze bandage may be applied over your breasts to help with healing.
After Your Surgery
You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.
Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.
Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.
Frequently Asked Questions about Breast Augmentation
You should be able to return to work within a few days, depending on the level of activity required for your job. Follow your surgeon’s advice on when to begin exercises and normal activities.
Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.
Incisions are made to keep scars as inconspicuous as possible. Dr. Dumanian typically uses the breast crease incision. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.
Dr. Dumanian believes the best results for breast enhancement are achieved using general anesthesia.
Routine mammograms should be continued after enhancement surgery for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading.
Implant surgery is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure including:
Capsular Contracture
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.
Excessive Bleeding
As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.
Infection
A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.
Oversensitivity or Numbness
Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.
There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.
Occasionally, implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body.
If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.
A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as “connective-tissue disorders,” but the FDA has requested further study.
While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.
While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of augmentation surgery.
Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.
More about Dr. Gregory Dumanian
Dr. Gregory Dumanian is a leading provider of plastic surgery in Chicago and has more than 20 years of experience in the field. He is proud to offer aesthetic and reconstructive procedures, such as abdominal hernia repair, rectus diastasis treatment and breast reconstruction. Schedule a consultation at his state-of-the-art practice by calling (312) 694-2428.