Breast Augmentation Surgery

woman talking to doctor about breast implants
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Breast augmentation (aka augmentation mammaplasty) is one of the most popular cosmetic procedures performed in the U.S. today. Despite controversy over the use of silicone breast implants, women have shown a continuing and growing eagerness to surgically enhance the size and shape of their breasts.

If you are healthy, non-smoking women who are at or near their ideal weight, with enough of their own breast tissue to cover and support an implant adequately, then you are a good candidate for breast augmentation surgery.

When considering breast augmentation surgery, know that it isn't as simple as saying, "I'd like my 34As turned into 34Ds." There are choices about materials, incisions, and whether you're up for future surgeries to think about.

The Decisions: Implant Type and Placement, and Incision

Breast augmentation surgery requires that you and your plastic surgeon become partners in the process since there are a few choices that need to be made about the procedure before it occurs. Determining the type of implants, where they are placed, and how the doctor makes the incisions, will be choices you will have to make.

Choosing an Implant. When you are deciding on the type of implant you want, you will need to decide its texture, shape, and what it is made of.

  • Texture: Implants may be smooth or have a rougher, textured surface, which many surgeons believe may reduce the risk of capsular contracture. On the other hand, the textured implants are harder to remove if needed.
  • Shape: Implants can be round or anatomical (tear-drop) shaped. Some people prefer the shape provided by the anatomical implants. However, the risk of malrotation — the implant rotating in the breast — is a concern.
  • Composition: Silicone implants feel more natural. However, though no adverse effect on health has ever been proven, some women opt for saline because they are still concerned about the safety of silicone implants. For a head-to-head comparison of the two, see Silicone Implants v. Saline Implants.

Where to Place It: Deciding whether you put the implant on top of the chest muscles or underneath, is mostly determined on the amount of breast tissue you have.

  • Over the muscle (sub-glandular) - Implants are placed on top of the pectoral muscle, under the fatty tissue of the natural breast. This option usually provides more projection and is suitable for women who have a sufficient amount of natural breast tissue to cover the edges of the implant.
  • Under the muscle (sub-pectoral/sub-muscular) - Implants are placed underneath the pectoral muscle. This option is better for women who do not have very much natural breast tissue to cover the edges of the implant. Sub-muscular placement also can help decrease the risk of capsular contracture.

Incision Options: Discuss each of these with your doctor as they can affect feeling in the breast and nipple.

  • Periareolar Incision - an incision made on the lower border of the areola (the darker colored area surrounding the nipple)
  • Inframammary Crease Incision - an incision made in the natural fold or crease underneath the breast
  • Transaxillary Incision - an incision made in the armpit
  • Transumbilical Incision - an incision made in the navel

There are advantages and disadvantages to each of these options, and they are all useful for meeting different needs in different situations. Be sure to find out what your surgeon recommends as the best option for your particular case.

What Happens During Breast Augmentation Surgery

  1. You're marked for surgery. Your surgeon will make markings on your breasts and the surrounding areas. These marks include incision marks, as well as general measurements that will be used by your surgeon as a visual guide during surgery.
  2. Anesthesia is administered and you're prepped for surgery. You will be given general anesthesia or in some cases, intravenous sedation (aka "twilight sleep"). The surgery site will be prepared by a thorough cleaning and disinfecting of the area, followed by the application of a topical antibiotic solution.
  3. Incisions are made. An incision will be made either in the crease underneath the breast mound (called the inframammary fold), around the bottom half of the areola (the colored area of skin surrounding the nipple), under the arm, or through the navel. Usually, electric cautery is used to minimize bleeding at the incision sites.
  4. A “pocket” is created and shaped to receive the implant. The surgeon dissects tissue to create a space for the implant to occupy. Proper placement and shaping of the pocket are crucial to the quality of the end result. The pocket may be created underneath or on top of the pectoral muscle.
  5. The implants are placed into the pockets which have been created. If the implants are to be filled with saline, they are rolled up before being placed, and filled with saline once in place, up to the desired fill amount. The surgeon may decide to fill one implant more or less than the other, in order to achieve the most symmetrical result. (If silicone implants are being used, the implant shell comes to the surgeon pre-filled. If this is the case, all size decisions must have been made prior to surgery.)
  6. The surgeon checks the result for symmetry and proper placement. The patient is positioned in an upright posture on the operating table so that the surgeon can better judge implant placement before closing the incisions. If needed, adjustments to the pocket placement or fill amount can be made at this point.
  7. Incisions are closed. Once the surgeon is happy with the placement and symmetry of the breasts, he or she will suture the incisions closed. In some cases, drains are put in place at the incision site before the last suture is put in. These drains are used to prevent fluid build-up and are usually removed at the patient’s first pre-op visit.

Recovery & Downtime

Because there are several options regarding incision and implant placement, recovery time can vary widely. In general, though, you will need at least 2 days of rest following the procedure, followed by a period of several days of reduced activity. Most patients can return to work after several days to one week. However, swelling and soreness may be present for 3-4 weeks.

Risks & Complications

Although complication rates are low, the most common risks include infection, excessive bleeding, bruising, tissue death, loss or increase of sensation, asymmetry, implant rupture, and capsular contracture (a hardening of the breasts due to the formation of scar tissue around the implant).

In surgeries where tear-drop shaped implants are used, another risk is malrotation of the implant, which can cause the breast to appear misshapen. It is also worth noting that the presence of breast implants can make breast tissue abnormalities harder to detect. Your surgeon will explain any additional risks specific to your case.

The Cost of Breast Augmentation 

Total costs for breast augmentation surgery can vary widely, from around $2000-$12000. The average cost of breast augmentation surgery is $3,822, according to 2015 statistics from the American Society of Plastic Surgeons.

The total cost may include many separate categories of fees, including the surgeon's fee, operating facility fees, anesthesia fees, lab fees for pre-op tests, the cost of the implants themselves, the cost of prescription medications, and possibly the cost of post-op compression garments.

Breast Implants Aren't Forever

Most breast implants will need to be replaced at some point in the patient's life, especially saline implants, due to the likelihood of implant rupture or deflation with older implants. It is suggested that implants are removed every 10 years and the average cost for removal of breast implants was $2,380 in 2015. 

Also, you should keep in mind that extreme weight fluctuations (including those associated with pregnancy) can affect the appearance of the breasts over time. It is possible that, in the future, you may desire to address drooping or other cosmetic concerns with breast revision surgery.

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Article Sources

  • American Society For Aesthetic Plastic Surgery.
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