BREAST AUGMENTATION

If you’re considering breast augmentation…

Breast augmentation, technically known as Augmentation Mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:

  • To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small
  • To correct a reduction in breast volume after pregnancy
  • To balance a difference in breast size
  • As a reconstructive technique following breast cancer

By inserting an implant behind the breast, surgeons are able to increase a woman’s bust line by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure – when it can help, how it’s performed, and what results you can expect. It can’t answer all your questions, since a lot depends on your individual circumstances. Please ask your surgeon if there is anything you don’t understand about your procedure.

Click here for Before and After Patient images

THE BEST CANDIDATES FOR BREAST AUGMENTATION

Breast augmentation can enhance your appearance and your self confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

DECIDING BREAST IMPLANT SIZE

Size and having breasts more proportionate with the rest of the body is why the vast majority of woman have breast augmentations. This can be very distressing because patients tend to obsess over getting the “perfect” size, which is completely understandable. Some women worry about going too big, while others worry about not going big enough. Having realistic expectations regarding size is a must. Breast implant sizers at your consultation will help you decide on your right size. Your doctor should not push the limits of your body by trying to force a too large breast implant into your body.

Trying on sizers at your consultation with your plastic surgeon is a very good idea. If you are dissatisfied with your own breast size, most any size implant seems big, but you will be amazed at how quickly you will adjust to your new larger size. It also gives you an idea of what you’d like to look like, as well as a rough idea of how many cc’s (cubic centimeters) it may take to get that result. 5 cc’s  = a teaspoon, 40 cc’s = a shot glass. You can try the Rice Test, which is a “do it yourself” sizing method. It is not 100% accurate, but it’s pretty close, to give you an idea. Do not get lost in the numbers!

HOW TO PERFORM THE RICE TEST

Use knee high hose or cut off pantyhose and, using rice, fill them with the desired amount of cc’s. Ziplock bags are not recommended due to the “pointed” corners of the bag. Once you have them filled, try them on under your sports bra.

The conversions below, which are approximate, will help you when doing the Rice Test.

  • 1 cup =  236 cc’s
  • 3/4 cup = 177 cc’s
  • 2/3 cup = 156 cc’s
  • 1/2 cup = 118 cc’s
  • 1/3 cup =   78 cc’s
  • 1/4 cup =   59 cc’s
  • 1/8 cup =   30 cc’s

The amounts above can be used in different combinations to achieve the cc amount you desire.

It’s important to remember that you should not rely solely on the cc amount. For example, if you like the way 400 cc’s look on one person, that does not mean that 400 cc’s will give you the same look. This is due to several things, including, but not limited to: amount of breast tissue, shape of your chest wall, deformities of the chest wall, your weight- to name a few. Basically, your existing breast tissue, shape, and anatomy will dictate how many cc’s you need to get the size you want. Again, this is just a rough estimate, as the Rice Test is not an exact science. Remember that breast implants increase your breast volume but cannot control your shape.

(See Mastopexy under Procedures)

Determining bra size and cup size is yet another difficulty that you can run into after surgery. Studies show that the vast majority of woman wear the wrong bra size. You may think that bra shopping will be easier after breast augmentation, but this is not always the case. Bra sizes run differently according to style and manufacturer. For example, if you buy a 34D bra from Victoria’s Secret, this does not mean that you will always wear a 34D in all of their bras. Ditto for other manufacturers.

TYPES OF IMPLANTS

A breast implant is a silicone shell filled with either silicone gel or a saltwater solution known as saline. Silicone is a product of silica (or sand), and is in the glass family, the second most common element on earth.

Saline (saltwater)- filled implants and gel-filled implants are currently available to breast augmentation patients.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

Breast augmentation is relatively straightforward. But, as with any operation, there are risks and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs when the normal scar or capsule that forms around all breast implants begins to contract or tighten. This squeezing of the soft implant can cause the implant to feel hard. Capsular contracture can be treated in several ways and sometimes requires either removal of the scar tissue, or perhaps removal and replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood in order to try and prevent future possible capsule contractures.

A very small percentage of women can develop infection around an implant. This may occur at any time, but is most often seen within a week after surgery. Today, this is a rare event. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants can affect fertility, pregnancy, or your ability to nurse. Your implants are behind your breasts, pushing your breasts forward. If you have nursed a baby within a year prior to augmentation, you may produce milk for a few days due to the breast stimulation of the operation. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, the breast implants may fail due to what is called material fatigue. Disruption can occur as a result of injury or even from the normal compression and movements of your breast and implant over the years, causing the shell to fail. If a saline-filled implant fails, the implant will deflate and the salt water will be harmlessly absorbed by the body.

If failure occurs in a gel-filled implant, one of two things may occur. The scar capsule around the implant will contain the gel and you may not detect any change. If the scar capsule tears, the high viscosity, modern silicone implants will not migrate or invade your body. Hence, the term for modern implants “Gummy Bear Implants”.

In the 1990’s, a few women with breast implants reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. Research has found no link between silicone breast implants and the symptoms of what doctors refer to as connective tissue disorders. The present breast implants have been in use for nearly 70 years. I recommend reading the book “Silicone on Trial” by Jack Fisher for more information.

While there is absolutely no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable xray of a breast with an implant. Additional views may be required. Ultrasound examinations may be of benefit to some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience any of these complications, you should discuss each of them with your physician to make sure you understand the consequences of a breast augmentation.

PLANNING YOUR SURGERY

At your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you based on aesthetics and the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend that a breast lift is done at the same time as your augmentation. (See Mastopexy under Procedures)

Be sure to discuss your expectations frankly with your surgeon who should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer’s insert that comes with the implant that is recommended so that you are fully informed. And, be sure to tell your surgeon if you smoke, or are taking any medications, vitamins, or other drugs.

The surgery is performed in an outpatient surgery center.

TYPES OF ANESTHESIA

Breast augmentation is performed with general anesthesia, so you’ll sleep through the entire operation.

THE SURGERY

The method of inserting and positioning your implant will depend on your anatomy and your surgeon’s recommendation. The incision can be made either in the crease where the breast meets the chest (inframammary), around the areola, the dark skin surrounding the nipple, (periareolar), or in the armpit (axillary). Every effort will be made to ensure that the incision is placed so that resulting scars will be as inconspicuous as possible. You will be shown close up photographs of post-operative patients.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (pectoral muscle). The implants are then centered beneath your nipples.

Some surgeons believe that putting the implants behind your chest muscle may reduce the potential for capsular contracture. The placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle, however, is more painful for a few days after surgery than placement directly under the breast tissue. Also keep in mind that any physical activity will cause breast movement if the implants are placed behind your chest pectoralis muscles.

You’ll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure recommended for you.

The surgery usually takes one to two hours to complete. Stitches used to close the incisions are under the skin and dissolve. The incision is then taped for greater support. A gauze bandage is applied over your breast for protection and an Ace bandage placed over the gauze to help stabilize your breasts as they heal.

AFTER YOUR SURGERY

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by the medication prescribed by your doctor and ice bags.

The next day, your dressings will be removed. You may experience a burning sensation in your nipples for a week or two due to nerve irritation. A support bra may be suggested for continuous support. Your stitches are under the skin and will dissolve over the next 2-3 weeks.

GETTING BACK TO NORMAL

You should be able to return to work within a few days, depending on the level of activity required for your job.  Do not perform any strenuous activity as this may cause internal bleeding that can result in a future scar contracture.

Follow your surgeon’s advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation. Breast contact is fine once your breasts are no longer sore, usually two to three weeks after surgery.

Your scars may be pink for about six weeks or longer. Protect them with paper tape under your bathing suit. After several months, your scars will begin to fade, although they will never disappear completely.

YOUR NEW LOOK

For many women, the result of breast augmentation will be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications can be detected early and treated.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery was a success.

Breast augmentation is usually done to balance a difference in breast size, to improve body contour, or as a reconstructive technique following surgery.
Incisions are made to keep scars as inconspicuous as possible, in the breast crease, around the nipple, or in the armpit. Breast tissue and skin is lifted to create a pocket for each implant.
The breast implant may be inserted directly under the breast tissue or beneath the chest wall muscle.
Underlying fat, along with excess skin and muscle, can be removed during the operation.
After surgery, breasts appear fuller and more natural in tone and contour. Scars will fade with time.