Breast Augmentation

What is breast augmentation?

Breast augmentation, also known as mammoplasty (augmentation), is a cosmetic surgical procedure that increases the volume and fullness of the breasts. This is typically achieved by inserting breast implants behind the chest wall tissue or beneath the breast muscle.

Reasons for Breast Augmentation:

Women consider breast augmentation for various reasons, including:

To increase breast size or fullness
To improve breast symmetry in cases where the breasts are noticeably different in size
To restore breast volume after pregnancy, breastfeeding, or significant weight loss
To achieve a more balanced and proportionate figure

Who Considers Breast Augmentation:

Women who are in good overall health, have realistic expectations about the outcome, and are done breastfeeding if they desire to breastfeed in the future might consider breast augmentation.

Types of Breast Implants:

Breast implants come in various shapes, sizes, surface textures, and fillings:

Shape: Round implants create fuller cleavage, while teardrop-shaped implants provide more upper fullness to create a more natural look.
Surface Texture: Smooth or textured surfaces are available. Textured surfaces might help reduce capsular contracture, a complication where scar tissue tightens around the implant.
Filling: Saline or silicone gel are the two main implant filling types. Saline implants are filled with sterile saltwater solution, feeling more like natural breast tissue. Silicone gel implants are filled with silicone gel, which can feel more like natural breast tissue than saline implants.

The Breast Augmentation Procedure:

Breast augmentation is typically performed under general anesthesia, meaning you’ll be asleep and feel no pain. The exact surgical approach will vary depending on the surgeon’s preference, implant type, and your desired outcome. Here’s a general overview:

An incision is made in one of several discreet locations around the breast:
- In the fold beneath the breast (inframammary fold)
- Around the areola (the pigmented area around the nipple)
- In the armpit (transaxillary)
The surgeon creates a pocket behind the chest wall tissue or beneath the breast muscle to place the implant.
The implant is inserted and precisely positioned.
The incision is closed with sutures.

How is a breast augmentation performed?

Pre-Surgical Consultation:

This is your first step. Schedule a consultation with a board-certified plastic surgeon experienced in breast augmentation.
Discuss your goals for the surgery, desired outcome (size, shape), and any questions you have about the procedure. Be open about your medical history and current medications.
The surgeon will examine your breasts, assess your tissue quality, and measure them to determine the most suitable implant type (size, shape, fill) and placement for your desired look and anatomy.

Preparation for Surgery:

Once you decide to proceed, the surgeon will provide specific instructions to prepare your body for surgery. These might include:
- Maintaining a healthy diet for optimal healing.
- Stopping smoking well in advance, as smoking hinders healing and increases complication risks.
- Managing medications as instructed by your doctor, potentially stopping certain medications that could increase bleeding.
- Stopping breastfeeding, if applicable, as determined by your doctor.
- Arranging transportation to and from the surgical facility, as you’ll likely be unable to drive yourself after anesthesia.
- Preparing a comfortable sports bra or surgical bra for post-operative support as instructed by your doctor.

The Breast Augmentation Procedure:

Breast augmentation is typically performed under general anesthesia, meaning you’ll be asleep and feel no pain. The exact surgical approach will vary depending on the surgeon’s preference, implant type, and your desired outcome. Here’s a general overview of the steps:
1. Incision: The surgeon creates an incision in one of several discreet locations around the breast:
  - Inframammary fold (the fold beneath the breast) – most common
  - Around the areola (the pigmented area around the nipple)
  - In the armpit (transaxillary) – less common
2. Pocket Creation: The surgeon meticulously dissects a pocket behind the chest wall tissue or beneath the breast muscle to accommodate the implant.
3. Implant Insertion: The chosen implant (silicone gel or saline fill, round or teardrop shape, smooth or textured surface) is carefully inserted and precisely positioned within the pocket.
4. Incision Closure: The incision is meticulously closed with sutures. Drainage tubes might be placed temporarily to drain excess fluids after surgery.

How can I select a trustworthy surgeon?

When choosing an aesthetic plastic surgeon, it’s essential to consider the following factors:

Qualifications: Does the surgeon possess the necessary education, training, and certification?
Experience: Does the surgeon have extensive experience performing ear surgery?
Pediatric Experience: If the patient is a child, does the surgeon have experience operating on pediatric patients?
Results: Do you find the surgeon’s before-and-after photos satisfactory?
Comfort Level: Are you comfortable with the surgeon and their approach to your procedure?
Membership: Is the surgeon a member of The Aesthetic Society?

After finding a board-certified plastic surgeon with significant experience in ear surgery, you’ll need to schedule a consultation.

What to expect during a consultation?

Typically, there may be a consultation fee due to the comprehensive nature of the appointment. During the consultation, you’ll have the opportunity to discuss your aesthetic goals. The surgeon will assess your suitability for ear surgery and evaluate the shape, size, and position of your ears. They may also take photographs for further analysis. Be prepared to provide your complete medical history, including past surgeries, medical conditions, allergies, and current medications.

Questions to ask your surgeon: It’s crucial to be proactive during your consultation. Here are some questions to consider asking:

Am I a suitable candidate for ear surgery?
Are my desired outcomes realistic?
Can I see before-and-after photos of previous ear surgeries?
How many ear surgeries have you performed?
Which surgical approach is best suited to my needs?
Where will the incisions be made, and will they be visible?
What type of anesthesia do you recommend?
What is the expected cost of the procedure?
What can I do to ensure optimal results?
What is the anticipated recovery period?
What are the potential risks and complications?

After the consultation: Following the consultation, your surgeon will provide personalized recommendations and information, including:

Proposed surgical approach
Expected outcomes
Financial considerations
Risks and complications
Anesthesia options
Preoperative preparation
Postoperative care instructions
Similar case studies
Answers to any additional questions

With thorough research and consultation, you’ll be equipped to make an informed decision regarding your surgery and surgeon. If uncertainties persist, don’t hesitate to seek further clarification or explore consultations with other surgeons.

How do I prepare for a breast augmentation?

Pre-Operative Instructions:

Once you decide to proceed, the surgeon will provide specific instructions to prepare your body for surgery. These might include:
- Healthy Diet: Maintaining a balanced diet rich in fruits, vegetables, and lean protein in the weeks leading up to surgery is recommended. This ensures your body has the necessary nutrients to heal effectively.
- Smoking Cessation: Stopping smoking ideally weeks or months before surgery is crucial. Smoking hinders healing and increases complication risks.
- Medication Management: You might need to stop taking certain medications or supplements that could increase bleeding risk. Discuss any medications with your doctor for specific guidance.
- Stopping Breastfeeding: If you’re breastfeeding, you’ll need to stop well in advance of surgery, as determined by your doctor.
- Weight Management: Maintaining a stable weight within a healthy range is recommended. Significant weight fluctuations can affect the results of the breast augmentation.
- Logistics: Arrange transportation to and from the surgical facility, as you’ll likely be unable to drive yourself after anesthesia. Prepare a comfortable sports bra or surgical bra for post-operative support as instructed by your doctor.

Additional Tips:

Hydration: Staying well-hydrated is vital before any surgery. Increase your water intake in the days leading up to your breast augmentation.
Lab Tests: Your doctor might order blood tests or other lab tests to assess your overall health and suitability for surgery.
Psychological Preparation: Discuss your expectations with your doctor and be prepared for some post-surgical discomfort and swelling. A positive mindset and realistic expectations can aid recovery.

How long does it take to recover from a breast augmentation?

Immediately After Surgery:

You’ll likely experience some swelling, bruising, and tenderness in the breasts. Pain medication will be prescribed to manage discomfort.
Depending on the extent of the surgery, you might stay overnight at the surgical facility or recover at home on the same day.

First Weeks (1-2):

Discomfort gradually lessens.
Swelling and bruising will be most prominent during this initial phase.
Wearing a surgical bra for support and compression is crucial throughout the day and night as instructed by your doctor.
Limited movement and activity, especially those that strain the chest muscles (lifting objects, strenuous exercise), are recommended for the initial recovery phase.

Weeks 3-6:

Swelling and bruising progressively subside.
You can gradually increase activity levels, but strenuous exercise should still be avoided.
Discomfort should be significantly reduced by this point.
Sutures might be removed during follow-up appointments with your doctor.

Months 3-12:

Daily activities can be resumed with minimal discomfort in the breasts.
Light exercise that doesn’t strain the chest muscles might be gradually incorporated as approved by your doctor. The final results of the breast augmentation become progressively more evident during this period.

Up to 1 Year:

Significant improvement in the appearance of the breasts should be evident by 6 months to a year after surgery.
By this time, most swelling will have resolved, and the implants will feel more settled in their final position.

How long will my breast augmentation results last?

Generally Expected Longevity:

With a healthy lifestyle, you can expect to enjoy significant improvements in the appearance of your breasts for 5 to 10 years after a breast augmentation.

What type of breast augmentation incisions are there?

Desired implant size and placement: Different incisions provide access to different areas of the breast tissue for implant placement.
Your anatomy: Factors like skin elasticity and breast shape can influence incision choice.
Surgeon’s preference and experience: Surgeons may have experience and expertise with specific incision techniques.

Here’s a breakdown of the four main types of breast augmentation incisions:

Inframammary fold incision (most common):

This incision is made in the fold beneath the breast, where the breast meets the chest wall.
It offers good access for implant placement and results in a well-hidden scar.
This is the most commonly used incision due to its versatility and ability to accommodate various implant sizes and placements.

Periareolar incision (around the areola):

This incision is made around the lower half of the areola, the pigmented area surrounding the nipple.
It results in a scar that blends in with the natural pigmentation of the areola, making it less noticeable.
This incision is typically used for smaller implants or when combined with a breast lift for minimal breast tissue laxity.

Transaxillary incision (through the armpit):

This incision is made in the armpit.
It leaves no visible scars on the breast itself but requires special techniques and equipment to ensure proper implant placement.
This incision might be preferred by some patients who desire minimal scarring on the breasts, but it’s less common due to the technical challenges.

Transumbilical incision (through belly button) (least common):

This least common incision is made through the belly button.
It leaves no visible scar on the breast but is typically only used for saline implants due to limitations in implant manipulation through this access point.

Here’s a table summarizing the incision types:

Incision Type	Location	Advantages	Disadvantages
Inframammary fold	Beneath the breast fold	Versatile, good access, well-hidden scar	Can be slightly visible in low-cut clothing
Periareolar	Around the areola	Less noticeable scar	Limited access for larger implants, not suitable for significant sagging
Transaxillary	Through armpit	No scar on breast	Technically challenging, requires specialized equipment
Transumbilical	Through belly button	No scar on breast	Limited to saline implants, more technical challenges

What are the risks associated with breast augmentation?

General Surgical Risks:

Anesthesia Risks: Reactions to anesthesia can occur, though uncommon with modern medicine.
Bleeding: Bleeding is a potential risk during and after surgery, but controlled with surgical techniques and medications.
Infection: Infection is a risk after any surgery, but proper sterile technique and antibiotics help minimize this risk.

Potential Complications Specific to Breast Augmentation:

Scarring: While some permanent scarring is inevitable from any incision, techniques are used to minimize their appearance. Scars typically fade over time with proper care.
Swelling and Bruising: Swelling and bruising are common after surgery and resolve gradually over weeks.
Fluid Accumulation (Seromas): Fluid pockets can form under the skin after surgery, typically addressed with aspiration by your doctor.
Numbness or Changes in Skin Sensation: Temporary numbness or altered sensation around the incision sites can occur, usually improving over time.
Asymmetry: Minor asymmetry in appearance between the two breasts is possible, but a skilled surgeon works to minimize this risk.

Serious but Rare Risks:

Deep Vein Thrombosis (DVT): Blood clots can develop in the deep veins of the legs, potentially leading to serious complications. Preventive measures like compression garments and blood thinners help mitigate this risk.
Fat Necrosis: Fat cells can die after liposuction, sometimes leading to firm, tender lumps under the skin. This risk is less common in breast augmentation if liposuction isn’t part of the procedure.
Implant Rupture or Leakage: Implants can rupture or leak over time, potentially requiring additional surgery. Silicone gel implants can rupture silently, while saline implants feel deflation when ruptured.
Capsular Contracture: Scar tissue tightens around the implant, causing the breast to feel firm and potentially distorted. This can necessitate revision surgery.

Source: Information adapted from theaestheticsociety.org

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