What is Breast Augmentation?
Breast Enhancement or Augmentation Mammaplasty is one of
the most popular surgical procedures requested by women of
all ages. It involves the placement of an implant behind
the breast tissue of each breast or the underlying chest
wall muscle. Breast Augmentation gives patients a larger,
fuller figure that they desire.
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Effects of Breast Augmentation
Breast Augmentation produces pleasing and satisfying
results through enhancing the size and shape of breasts that
women wish to have. It gives women a more flattering bust
line, improving their appearance and boosting their
self-confidence with regards to their figure.
Those who would benefit the most in this procedure are the
women having realistic expectations of improvement, not
perfection, in the way they look.
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Candidates for Breast Augmentation
Each person has her own opinion on what is beautiful in a
breast. Normal breast size, for some, might not be enough,
and this procedure offers that change you might want. It is
solely your choice if you want to undergo this procedure,
and the doctors will be happy to discuss the change in the
size and shape of your breasts.
Women who are good candidates for Breast Augmentation have
at least one of following characteristics:
• You think your breasts are too small or underdeveloped.
• The upper part of the breasts seems “empty”.
• Your breasts do not have the same size or shape.
• One or both breasts failed to develop normally or have an
unnatural shape.
• You previously had breast implants and are having
problems with them.
• Your breasts have lost volume due to pregnancy, weight
loss or aging.
• For breast reconstruction following mastectomy for breast
cancer.
Breast Augmentation has been performed since 1962 to over 3
million women. The surgical techniques and breast implants
have been continuously refined throughout the years,
increasing the safety and reliability of said procedure.
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Your
Consultation
Prior to your breast surgery, the BHMG’s Board Certified
Surgeon will carefully evaluate your general health status
and any pre-existing health conditions that could compromise
the outcome of surgery or bring risk to your health. Also,
the BHMG’s Board Certified Surgeon will get detailed
measurements of the physical parameters of your breasts and
the quality and quantity of your existing breast tissue to
determine the proper choice of breast implant and technique.
The BHMG’s Board Certified Surgeon may suggest a breast
lift or Mastopexy in addition to Breast Augmentation in
situations where there is excessive laxity or drooping of
the breasts. If this is the case, Breast Augmentation alone
would be insufficient to solve and correct this condition.
A mammogram six months before surgery is required, and
photos of your breasts will be taken before and after
surgery.
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The Breast Augmentation
Procedure
Breast Augmentation is done on an outpatient basis in an
Ambulatory Surgery Center
, and usually under general
anesthesia.
A couple of options with regards to the location of the
incision will be relayed to you, which would be dependent on
the individual variables of your breast anatomy and the type
and size of implant that will be used. Not all options are
available to every patient. The implant type, pocket
placement and incision approach all have relative advantages
and disadvantages.
The following are the different type of incisions:
Infra-mammary
Incision is made in the fold under the breast.
Peri-areolar
Incision is made around the nipple.
Trans-axillary
with endoscopic assist
Incision is made under the arm.
All incisions are kept short and inconspicuous. The BHMG’s
Board Certified Surgeon will choose the surgical technique
as well as the size and type of implant that will produce
the result each individual desires.
Implants can be inserted either under the breast tissue
(sub-glandular) or partially under the pectoral muscle
(sub-pectoral or sub-muscular). When implants are placed in
a sub-muscular position (under the breast tissue and the
pectoral muscle), there is less chance of capsular
contracture, which is the shrinkage of the tissue capsule
surrounding the implant that causes both implant and breast
to feel unnaturally firm. Placing implants in a
sub-glandular position (directly under the breast tissue)
may be advisable in some cases, depending on the thickness
and laxity of the breast tissue, and also the ability of the
breast tissue to decently cover the implant.
Once the desired pocket has been created, a temporary
“sizer” implant is placed to determine the proper shape and
size of the final implant. In this stage, the BHMG’s Board
Certified Surgeon will evaluate your pre-operative photos
and your desired results based on your previous discussions
with the surgeon, as well as the photos you may have shown
for comparison. The final implant is then chosen, inserted,
and properly positioned within the pocket, and checked to
insure that your breasts have the shape and size you
expected before surgery. Although, take note that there
can be no guarantee as to the final cup size of your breasts
after the operation.
A local, long-acting anesthetic will be used in the space
around the implants to insure minimal pain or discomfort
when you wake from surgery. Incisions are carefully closed
with multiple layers of hidden sutures and surgical tape.
However, in the case of revision surgery on the breast for
encapsulation or other problems, drains are never placed.
You will then be placed in a soft surgical bra with a
supportive wrapping around the chest. You will wake up in
the recovery room with minimal pain, or mild to moderate
muscular soreness that is similar to a strenuous workout,
after the implants have been placed partially behind the
muscle.
The BHMG’s Board Certified Surgeon will help you in
deciding which incision, pocket placement, and type of
implant you should have to get your desired results. They
will utilize the most advanced techniques in order to
minimize your risks, optimize your results, and return you
to your normal, unrestricted activities as quickly and
comfortably as possible.
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Recovery
After the procedure, patients are placed in a soft surgical
bra with a supportive wrapping around the chest. Do make
sure someone is able to assist and drive you home and be
available to care for you continuously for the first 24
hours. Since no drains are required except in the case of
re-operative breast implant surgery, our patients are
allowed to shower the day after surgery. Some pain or
discomfort might be experienced the first day or two which
is easily controlled with analgesic medications. But there
should be minimal bruising. Also, tightness in the breast
area is normal as your body adjusts to the implants. There
is somewhat more discomfort and spasm when the implants are
placed below the pectoral muscle. If this occurs, the
BHMG’s Board Certified Surgeon may prescribe a muscle
relaxing medication to control the spasms.
Patients would be able to return to normal daily activities
like washing the hair and driving, about 2 to 4 days after
the surgery. In the first 2 weeks after the procedure, a
bra should be worn at all times, except when showering.
Moderate exercises like walking are allowed after the first
week. Patients should avoid heavy lifting, tub bathing and
Jacuzzi, or swimming for the next 2 to 3 weeks. While
vigorous exercises like jogging and aerobics should be
resumed in 3 to 4 weeks time. You may return to work in a
day or two, but do avoid any strenuous activities for a
couple of weeks after surgery.
Your breasts may be appear somewhat swollen after surgery,
but within a few weeks, the actual shape and size of your
breasts will be apparent so you can begin to wear bras and
clothes that you prefer.
BHMG suggests for you to get breast examinations at no cost
from our office every 6 to 12 months. Continue breast
self-examinations monthly, and have mammograms as
recommended by your gynecologist or personal physician,
which is generally yearly after age 40. We do request that
you forward copies of all your mammography results to our
office.
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Risks
Every operation has potential complications, like adverse
reactions to anesthesia, bleeding, infection, poor healing
of the surgical scar and pain. Post-operative bleeding or
formation of a seroma (a collection of the watery portion of
the blood around the implant) may require re-operation and
drainage, and may be associated with an increased incidence
of infection or capsular contracture.
Although rare, infection of a breast implant may occur that
will require the removal of the implant for up to several
months until the infection is completely cleared, and only
then can the implant be re-inserted. The formation of a
fibrous tissue capsule around a breast implant after surgery
is a body's normal response to the placement of a foreign
object in the soft tissue.
Capsular contracture is a process of gradual but aggressive
shrinkage of this tissue capsule surrounding the implant.
This causes the breast and implant to feel unnaturally firm
and often times painful. Capsular contracture is usually
progressive, worsening with time, over the course of several
months to years. This situation may result in asymmetry of
the breasts. The occurrence or severity of this condition
varies with each individual. There is no reliable data as
to how often it occurs. Asymmetry may also occur as a
result of unexpected problems with early healing after
implant placement.
When the saline solution of a saline breast implant leaks
either through the valve or through a puncture or defect of
the outer shell of the implant, it would cause deflation and
would require surgical replacement. Most implants are
covered by a manufacturer’s warranty against deflation.
Patients are reminded that sensory changes may occur in the
nipples or outer breasts. Also, patients with a very small
volume of breast tissue or thin skin before surgery may
notice visible wrinkling or rippling of the implants,
especially saline, and more commonly when larger size
implants are chosen. Another reminder is that there may be
delayed wound healing for patients with diabetes, a history
of radiation, autoimmune disease, or for smokers. Surgical
scars may be unsightly. In order to avoid these problems,
a thorough medical evaluation should be done before the
surgery.
Breast implants do not affect fertility, pregnancy, or a
woman’s future ability to nurse, there are no evidences
found to prove otherwise. It is a fact that not all women
may be able to breastfeed even without the implants. If the
peri-areolar (nipple) incision is used for the procedure,
there may be a greater risk of scarring within the breast or
alteration in the ability to breastfeed as compared to the
axillary (under-arm) or inframammary (breast fold)
incisions, but there is no evidence gathered for it to be
scientifically proven.
Breast Augmentation may not be a one-time surgery. It is
very likely that additional surgeries and doctor visits will
be necessary over the course of your lifetime to maintain
the appearance of your breasts after the procedure. This
might be because of problems related to the implants
themselves, like deflation, capsular contracture, rupture,
etc., or because of aging changes, like pregnancies, weight
gain, loss of breast tissue, etc., that affect the
appearance of the breasts over time.
Health
insurance does not cover Breast Augmentation, except in rare
cases of congenital deformity or some types of
reconstruction. Insurance may not also cover re-operation
or additional future surgeries or additional doctor visits
if complications arise.
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Frequently Asked
Questions
Q: How
much increase in cup size can I expect?
A:
The size of your breasts after Breast Augmentation will
depend on the implant used and the ability of your breast
tissues and chest wall muscles to expand with the implant.
In general, women with relatively large breasts can go
larger than women who have very little breast tissue to
begin with, also petite women cannot go as large as women
with a larger physique. There is no guarantee as to the
final cup size.
Q: Are
silicone breast implants dangerous?
A:
To date, silicone breast implants are safe devices that do
not pose any greater risk of causing disease than saline
implants. If there is evidence showing that silicone breast
implants could lead to systemic disease, BHMG would never
use them. As for now, we would not hesitate to recommend
silicone breast implants to a patient if the circumstances
dictate that this would be the best choice of implant.
Q: When
will the sutures be removed?
A:
Sutures will be removed after a week to 10 days.
Q: Do I
need to massage my breasts and for how long?
A:
Smooth implants, whether saline or silicone, above or below
the muscle, must be massaged immediately after surgery to
maintain the softness of the breasts. Maintaining a large
space around these implants prevents or delays the
encapsulation process. Textured implants do not require
massage. We will give you detailed instructions if massage
is required after the surgery.
Q: When
can I bathe?
A:
You
may shower 24 hours after surgery. Do not immerse your
breasts under water or take baths in the tub, pool or ocean
3 weeks after surgery.
Q: When
can I resume exercise?
A:
You may do walking and treadmill or riding a stationary
recumbent bicycle within 2 days. No strenuous upper-body
exercises for 2 to 3 weeks following surgery. Avoid any
activity that may cause any discomfort.
Q: When
can I wear my preferred bras or clothes?
A:
The swelling will settle in 2 to 4 weeks. The breasts are
not likely to change much in size at that time, but may
continue to soften and improve in shape. You can now wear
your bras and preferred clothes at this point. You should
wear the post-surgical bra given by our office for the first
2 weeks at least.
Q: Will I
need additional operations on my breasts in the future?
A:
It is likely that you will be required to have future
surgeries on your breasts in order to maintain its
appearance.
Q: How
long will my implants last?
A:
Most implants last for 10 to 15 years. Any type of breast
implant is subject to wear and tear and deterioration due to
aging over time. Like a heart valve or artificial joint
replacement, they are not to be expected to last forever.
The implants are covered by a manufacturer's warranty
against manufacturing defects, and most companies provide
financial assistance for re-operation, and implant
replacement at no charge, in the event of implant failure.
However, you may incur other financial costs which are not
covered.
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