[Augmentation Mammaplasty]

Breast augmentation plastic surgery is one of the most common procedures performed annually by members of the American Society for Aesthetic Plastic Surgery. Women may choose to under go breast enlargement surgery for various reasons. These personal reasons may center around breasts that are perceived to be under developed, or because of differences in the sizes of the breasts or from changes after pregnancy or breast-feeding.

Some women may be happy with their breasts but just want them made fuller. Often after weight loss, aging or childbirth a woman's breast volume and shape may change. This too can lead to a woman to seek a breast augmentation. Breast implant surgery performed by cosmetic plastic surgeons is the most popular way to improve breast shape and size. Breast enhancement using breast implants can give a woman more proportional shape and may improve self-esteem.

Am I a good candidate for breast augmentation?

One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation:

•you are bothered by the feeling that your breasts are too small
•clothes that fit well around your hips are often too large at the bustline
•you feel self-conscious wearing a swimsuit or form-fitting top
•your breasts have become smaller and lost their firmness after having children
•weight loss has changed the size and shape of your breasts
•one of your breasts is noticeably smaller than the other

How should I prepare for breast augmentation plastic surgery?

In some instances, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast augmentation, you will still be able to perform breast self-examination.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Breast augmentation is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

What will the day of breast implant surgery be like?

Your breast augmentation surgery may be performed in a hospital or an ambulatory facility.

Medications are administered for your comfort during the surgical procedure. General anesthesia will be administered at the time of surgery. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your breasts will be wrapped in gauze dressings or a surgical bra.

You may be permitted to go home after a few hours, unless you and your plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

How will my breasts look and feel after the breast implants have been placed?

A day or two after surgery, you should be up and about. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your plastic surgeon will probably permit you to shower between three and seven days following surgery. Stitches will be removed in about a week. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

What should I expect during the recovery process?

At the conclusion of your breast augmentation procedure, you may be placed in a surgical dressing that may include a support bra or garment. You should follow your plastic surgeon’s directions as prescribed. Prior to your discharge, you and your caregiver will be given detailed instructions about your post-surgical care including drains if they have been placed, the normal symptoms you will experience, and any potential signs of complication.

Options for your recovery after undergoing breast augmentation include:

•Home: When discharged, you will be released to the care of a responsible adult with safe, licensed transportation home. The adult may be a family member, friend or hired caregiver and must be competent to understand your recovery instructions and to monitor your health. Your caregiver must commit to stay with you at all times for a minimum of 24 hours after surgery.

•Licensed Recovery Facility: You will be released to the care of a licensed post-surgical recovery facility where nurses or specially trained medical professionals will monitor your health and comfort until you are able to return home and capably care for yourself.

•Overnight Hospital Stay: An overnight hospital stay may be offered to you or may be recommended. In this case your surgery will be performed at the hospital where you will stay overnight. You will be released from the hospital to a capable caregiver to continue your recovery at home, or to a licensed recovery facility.

You should be walking under your own strength immediately after your breast augmentation surgery. It is very important that you walk a few minutes every few hours to reduce the risk of blood clot formation in your legs.

The first 2-5 days following your breast augmentation surgery you may feel stiff and sore in the chest region. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your breasts may feel tight and sensitive to the touch, and your skin may feel warm or itchy. You may experience difficulty raising your arms. You should not lift, push or pull anything, or engage in any strenuous activity or twisting of the upper body. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

It is important to follow all patient care instructions as directed.

When can I expect to resume my normal activities after my breast augmentation?

While it will take several days to return to more normal activities after your breast augmentation, it is important to your recovery that you get up and move around. After breast augmentation, it is often possible to return to work within just a few days or a week, depending on the type of activities that are required at your job.

Physical activity should be avoided for at least the first couple of weeks following surgery. After that, care must be taken to be extremely gentle with your breasts for at least the next month.

How Breast Augmentation is Performed

Individual factors and personal preferences will help you and your plastic surgeon to determine your appropriate breast size, the location of incisions, and whether the implants will be placed on top of or underneath the chest muscle.

What type of breast implants can be used for breast augmentation?

The implant is placed in a pocket either directly behind the breast tissue (right) or underneath the pectoral muscle, which is located between the breast tissue and chest wall. The size and type of breast implant recommended for you will be determined by your goals for breast enhancement, your existing body frame, and mass, your existing breast tissue, and the preferences you and your plastic surgeon discuss. All breast implants include a solid silicone rubber outer shell, called a lumen.

Breast implant options include:

•Saline breast implants: Filled with sterile salt water. Saline implants may be pre-filled to a predetermined size. Saline may also be filled at the time of surgery to allow for minor modifications in implant size.

•Silicone filled breast implants: Filled with soft, elastic gel. All silicone breast implants are pre-filled and may require a longer incision for implant placement. You must be twenty two years of age or older in order to have this type of implant. 

New scientific data on the safety of breast implants is rapidly being collected. In the future, it is possible that additional types of filler materials may become available as advancements take place. Surgical techniques for breast augmentation and breast implants themselves are continuously being refined, increasing the safety and reliability of the procedure. Your plastic surgeon will be able to provide you with the latest information.

Where are the incisions made for the placement of breast implants?

An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit. One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous.

Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit. Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle, which is located between the breast tissue and chest wall.