Breast augmentation is a surgical procedure involving the use of breast implants or fat, referred to as fat transfer breast augmentation, to increase breast size, change the shape and alter the texture of the breasts of a woman. Clinically referred to as augmentation mammaplasty, this type of surgery will increase fullness and projection of your breasts, enhance your self-image and confidence and will improve the balance of your figure.
As a primary reconstruction, it is applied to effect a post-mastectomy breast reconstruction and it is used to repair the chest wound resulted from the removal of a cancerous breast, to correct congenital defects of the breast and chest wall.
Types of Breast Implants
There are 2 main types of breast implants available: saline and silicone breast implants. FDA- approved for augmentation in women age 18 or older, saline implants are filled with sterile salt water, providing a uniform shape, firmness and feel. In the event of implant shell leakage, the saline implant will collapse and the fill will be absorbed and naturally expelled by the body.
Silicone breast implants are filled with silicone gel, as their name suggests, with the advantage of providing a more natural feel. As for leaking, if this happens, the gel may either remain within the implant shell, or might escape into the breast implant pocket. Unlike the saline breast implants, leaking silicone implants will not collapse. Also FDA-approved, these implants are recommended or augmentation in women age 22 or older. You will need to visit your plastic surgeon regularly to ensure the silicone implants are functioning properly.
Gummy bear breast implants are form-stable implants, which maintain their shape even when the implant shell is broken. They are filled with a thicker silicone gel, are firmer than traditional implants, less likely to break, but require a longer incision in the skin. They are shaped rather than round and can cause an unusual appearance of the breast if it rotates.
Other breast implants include round breast implants, smooth and textured implants.
Another type of surgery includes fat transfer, which basically uses liposuction to take fat from other parts of your body and inject it into your breasts. This procedure is an option for women who are looking for natural results and wish for a relatively small increase in breast size.
Breast Augmentation Procedure Steps
Breast augmentation procedures are done under general anesthesia and medications are administered for your comfort during the surgical procedures. The surgery lasts approximately 1.5-2 hours and includes a number of steps:
1. The Incision
Incisions are made in areas where they are minimally visible and vary based on the type of breast implant, particular anatomy, degree of desired enlargement and patient-surgeon preference. There are 3 types of incisions to choose from:
- periareolar
- inframammary
- transaxillary
Periareolar Incision
The incision is made along the areolar border and provides an optimal approach in the event of needed infra-mammary fold (IMF) position adjustments, or when a breast lift is also included in the procedure. The scars will be less visible, as they are at the areola’s border. As for disadvantages, periareolar incisions sever the milk ducts and the nerves to the nipple, also producing a greater incidence of capsular contracture.
Inframammary Incision
Made below the breast in the IMF, this incision affords maximal access for dissection and positioning of the implant device. Although it is a preferred technique for emplacing silicone-gel implants because of the longer incisions required, IMF implantation can result in thicker and more visible surgical scars.
Transaxillary Incision
This incision is made to the axilla or armpit, from which the dissection tunnels medially. The implants can be emplaced without producing visible scars on the breast, but as a disadvantage, they can produce inferior asymmetry of the implant-device position.
2. Inserting and Placing the Breast Implant
There are 4 surgical approaches to positioning a breast implant in the implant pocket:
- subglandular – between the breast tissue and the pectoral muscle
- subfascial – beneath the fascia of the pectoral muscle
- subpectoral – beneath the pectoral muscle
- submuscular – beneath the pectoral muscle, without releasing the inferior origin of the muscle proper
3. Closing the Incisions
After the procedure is finalized, the incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin. A surgical bra needs to be worn 24 hours a day for the next few weeks and vigorous activity should be avoided for at least a few weeks. Women often feel tired and sore after the surgery, but these feelings usually disappear in a day or two.
4. The Results
Results will be nevertheless immediately visible and will continue to be noticed as the post-operative swelling goes down and scars heal. For proper healing, women should follow all post-operative instructions provided by their surgeon. Breast implants are not designed to last a lifetime and may need to be replaced later on. An annual examination by your plastic surgeon is recommended to evaluate your breast health and implant integrity. As breasts change due to a number of factors such as hormone levels, gravity, aging and weight fluctuations, you may wish to undergo an implant change or breast lift in order to achieve a more youthful appearance.
Risks and Safety concerning Breast Augmentation
Before deciding to continue with breast augmentation surgery, your surgeon will ask you to sign consent forms to ensure that you fully understand the procedure, risks and potential complications that may arise. Prior to your consent, all possible risks and complications are fully discussed. Breast augmentation risks may include:
- infection
- implant leakage/rupture
- anesthesia risks
- bleeding
- changes in nipple or breast sensation
- faulty position of the implant
- persistent pain
- fluid accumulation (seroma)
- formation of tight scar tissue around the implant (capsular contracture)
It is highly important to address all your questions directly to your surgeon for a better understanding of the procedure. As for safety, breast implants do not impair breast health and no links have been found between them and autoimmune or other systemic diseases.
Preparing for the Consultation
During your consultation, you will need to be prepared to answer a few questions and share health-related information. You will need to explain why you want breast augmentation surgery, what are your expectations and the desired outcome. It is very important to talk to your surgeon about your medical conditions, drug allergies and previous medical treatments, current medications, herbal supplements or vitamins and alcohol, tobacco or drug use. Another important part of the consultation is sharing your family history of breast cancer and results of any mammograms or previous biopsies if the case.
These details will help your surgeon determine if breast augmentation surgery is a viable solution for you. Your surgeon will evaluate your general health status and risk factors. Next, a breast examination is needed, where the doctor will examine and measure your breasts, including detailed measurements of their shape, size, skin quality and placement of your nipples and areolas. Furthermore, the surgeon will take photographs and will discuss your options, likely outcomes of the surgery and any risks or potential complications. After everything has been understood and agreed on, a course of treatment will be recommended.
Make sure you ask questions when the situation is unclear, so you can understand all aspects of your surgery. Anxiety and preoperative stress is something normal, so do not be afraid to discuss these feelings with your surgeon.
Am I a Candidate?
Candidates for breast augmentation surgery should meet a few conditions for a successful procedure:
- candidates should be physically healthy
- breasts must be fully developed
- breasts are asymmetrical
- one or both breasts failed to develop normally or have an elongated shape
- candidates have realistic expectations
- candidates are bothered by the feeling that the breasts are too small
- candidates are unhappy with the upper part of their body
When preparing for breast augmentation surgery, you may be asked to get a blood test, take certain medications or adjust your current medications, stop smoking, avoid aspiring and certain anti-inflammatory drugs. After your surgery, arrange for someone to drive you home if the surgery is performed on an outpatient basis and ask somebody to stay with you for at least the first night following surgery.