BREAST AUGMENTATION AND ALL YOU HAVE TO KNOW BEFORE GOING UNDER –THE-KNIFE
By Dr. Patrick Hsu
Breast augmentation, or augmentation mammaplasty, is a surgical procedure that may be done to improve the size, shape or fullness of a woman’s breast for various reasons. One reason being is that most women who undergo breast enlargement often see a sizable boost in self-esteem and positive feelings about their sexuality. Some women who feel that their breasts are too small find it the only hope to improve their physical shortcoming. Others just wish to balance a difference in their breast size. Mothers often choose to have breast augmentation in order to regain the breast size they had prior to pregnancy. There are also women who, after having had mastectomy, choose implants as a reconstructive technique following breast cancer surgery. The procedure basically involves the insertion of a silicone or saline implant either behind the muscle wall or within the breast itself in order to improve or restore the bust line by one or more cup sizes.
Any healthy woman is suited to undergo breast augmentation especially if they are interested in improving their overall appearance. This is because this procedure can greatly improve a woman’s self-image and self-confidence. This creates a generally positive satisfaction with their body. Some body types are just way too disproportionate to the small size of their breasts, hence breast augmentation. By balancing the top half of the body with the bottom half, patients will feel happier and secure about themselves. The surgery usually takes an hour and is associated with very few risks. Though surgery is not a cure-all and there are risks associated with any type of surgery, most women feel the benefits outweigh these potentially low risks. Before going under the knife, make sure that the operating surgeon highlights these risks and discuss the reasonable expectations before agreeing to surgery.
There are two types of breast implants–silicone vs. saline. Silicone implants are filled with a viscous silicone gel which is held within an elastomeric silicone shell. If a silicone-filled implant leaks, the gel will either stay in the shell or escape into the breast implant pocket. A leaking silicone-filled implant might not collapse. Patients choosing this type of implant should carry out more regular checks with their doctor compared to those on saline solution implants. The condition of the implants can be determined with an MRI or ultrasound scan. Although the US FDA recommends regular follow-up MRI scans for women with silicone implants, a study published in Plastic and Reconstructive Surgery (March 2011 issue) says there are significant flaws supporting this recommendation. The authors wonder how effective MRI screening is for women with silicone implants. There are five generations of this type of implant. The latest one is made of a semi-solid gel that has virtually completely eliminated silicone gel bleed (filler leakage) and silicone migration from the breast to other parts of the body, according to manufacturers.
Saline implants, on the other hand, are filled with a sterile saline solution (biological-concentration salt water 0.90% w/v of NaCl, ca. 300 mOsm/L.) which is held within an elastomer silicone shell. These implants can be filled with different amounts of saline solution, which may affect the feel, firmness and shape of the breast. If this type of implant leaks, the solution will be absorbed and expelled by the body naturally.
Both of these implants come in a variety of shapes, sizes and profiles. The different sizes will be determined by how much saline or silicone is filled into each implant, which is referred to as cc or ml (millilitres). You may hear a friend say they have 400 cc implants. That means that they are filled with 400 millilitres. As the volume goes up, the implant gets bigger. Lastly, there are generally four different profiles that mostly translate into how much projection you get. Each implant company has a different name for each profile. In general, silicone implants are softer and associated with less rippling. They feel more like breast tissue and tend to have a more natural feel when compared to saline implants. Saline implants are filled with salt water, the same salt water composition that our bodies are made of. Because they are filled with saline, they are stiffer and can have more rippling. Silicone implants will usually require a longer incision when compared to saline implants and will also have a higher capsular contracture rate.
Just like any operation, breast augmentation involves risks and complications. These risks could include bleeding, infection, poor scarring, capsular contracture, and nipple sensation changes.
Prepared patients are the best patients. Before jumping under the knife, your doctor should evaluate your overall health condition and recommend the surgical techniques that are best for your breast type and skin tone. A detailed medical history will be required, including information on what types of medications and/or supplements you take in addition to whether or not you smoke. It would also help to make personal arrangements on the day of the surgery.
- If you smoke, it is essential that you reduce or stop smoking before your procedure and for some time afterward. Be sure to discuss this openly with your doctor.
- Make sure your physician is aware of any medications, supplements, and herbs you are currently taking. For instance, certain medications such as aspirin or ibuprofen can cause bleeding problems during and after the procedure. Carefully follow your physician’s instructions and do not take these medications for a few weeks prior to your procedure. Eat a healthy diet and avoid drinking alcohol a few days prior to your procedure.
- Exercise is generally good for your overall health; however, refrain from extremely vigorous exercise the day before your breast augmentation procedure. Do not eat or drink anything, including water, after midnight the night before the procedure.
- The night before your procedure, shower and wash your surgical areas with antimicrobial soap. After your shower do not wear any makeup, moisturizers, oils, creams, or lotions — including deodorant.
- Remove nail polish from at least one fingernail and toenail to help the anesthesia person monitor your blood circulation during your procedure.
- The morning of your breast augmentation procedure you may brush your teeth, but do not swallow more than a sip of water. If your physician allows you to take any prescribed medication, swallow it with a minimal amount of water. When you go to your physician’s office, wear loose-fitting clothes that open in the front and comfortable flat shoes that slip on.
The nature of breast augmentation procedure will require you to be under anaesthesia to minimize discomfort. The method of insertion and placement of your implant is basically determined by the configuration of your breasts, your desired results, and varying other factors. The placement of your incision will be determined by what type of implant you receive. The surgeon and patient should discuss incision options. Dr. Patrick Hsu can explain which are most suitable for the patient and her desired outcome.
There are three common incision sites:
• Infra-mammary incision – in the crease under the breast: The infra-mammary fold incision is a small incision along the base of the breast. It is perhaps the easiest to perform however scars in this area can be particularly good or particularly bad depending on the shape and size of the breast. Breastfeeding is generally unaffected and the scar is well concealed if the patient has enough breast tissue to drop over the incision. The surgery usually takes one hour to complete.
• Trans-axillary incision – in the armpit (axilla): This type of incision is used for both saline and silicone implants and allows for the most remote and hidden scar possible. Scars often appear to blend into the natural creases of the armpit and fade at 6 months to a year. The advantage to this incision is that there are no scars on the breast itself. Surgery will usually take an hour longer because of the increased expertise needed to perform this surgery.
• Peri-areolar incision – around the nipple: One of the most common incision sites, this method creates a circular cut around the natural edge of the areola. Scars are concealed by the natural lines and ridges of the nipple, so are far less noticeable. Breast feeding can be hindered by this type of incision so be sure to ask your surgeon about this incision.
The choice of which incision to use depends on several factors, including the degree of enlargement, the patient’s anatomy, the type of implant, and surgeon-patient preference.
The surgeon closes the incisions with layered sutures (stitches) in the breast tissue, and with skin adhesives, sutures and surgical tape to close the skin and keep it closed.
Initially, there will be evident incision lines. These will fade with time.
Though there are different methods of implantation, all procedures involve lifting the skin and breast tissue to create a pocket centered under the nipple, which is where the implant will ultimately be placed. Surgery lengths and recovery times depend on the incision and placement method, so consider carefully.
Inserting and placing the implant
1. Breast after subglandular augmentation.
2. Breast after submuscular augmentation.
A sub-muscular placement: Under the pectoral muscle. When placed here the patient may take slightly longer to recover, compared to sub-glandular placement, and may also experience a little more post-operative pain. Women preferring a more “natural” look to their breast augmentation should consider sub-muscular placement, especially smaller breasted patients. This procedure places the implant behind the pectoral muscle rather than within the breast tissue. There is a longer surgery and recovery associated with this type of surgery, but most women appreciate the benefits of a more natural look. Patients who have more breast tissue can have the implant placed above or below the muscle with little difference. Your needs and desired results will determine if this is the procedure for you.
Before and After for Breast Augmentation
A sub-mammary (sub-glandular) placement: Behind the breast tissue, over the pectoral muscle. Sub-glandular means the implant is placed above the muscle just under the breast tissue. Since only skin and fat are disturbed during the procedure, there is less recovery time and pain associated with it. There is higher likelihood that the implants will be palpable and edges more visible, and there is an increased risk of capsular contracture (thick scarring around the implant). Your surgeon should discuss with you the pros and cons of the two possible implant placement sites, and recommend the site that best meets your needs. Also, you should be aware that breast implants don’t last forever. They often require a future operation to remove and replace the original implant.
After Breast Augmentation Surgery
After your surgery is complete, you will begin the recovery process. It’s important that you take good care of yourself during this time to ensure that your body has time to heal and look its best. Read on to learn what to expect in the days and weeks following your surgery.
You will probably feel fatigued and sore for several days after the breast augmentation surgery, so rest is essential. It’s normal to experience a feeling of tightness in the breast area as your skin adjusts to your new breast size and your breast implants. You may also notice diminished feeling in your breasts and nipples during immediate recovery. Your plastic surgeon may recommend breast massage or other exercises to speed recovery and help alleviate any discomfort. Your doctor may ask you to wear a postoperative bra, compression bandage, or jog bra for extra support and positioning while you heal. Some surgeons may not want you to wear a bra at all for a period of time following your surgery. Most patients are able to return to work within a few days after their procedure.
Your breasts may remain swollen and sensitive to physical contact for a month or longer. Your surgeon will be able to provide you with more specific details about the recovery process. Contact your surgeon should any problems occur after your surgery.
Important note: If you experience a fever, or noticeable swelling and/or redness in your implanted breast(s), you should contact your surgeon immediately.
It is highly recommended that any patient avoid contact with their breasts for the first few weeks, as they are extremely sensitive. Once that sensitivity fades, normal contact may be resumed. Heavy lifting should also be avoided for 4 weeks. In general, nothing heavier than 10 pounds. Mammograms should be continued after breast augmentation surgery for women who are in the appropriate age group. Your mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
The amount of noticeable scar tissue will depend on the placement of your incision. Though scars will never fade entirely, they will eventually become less noticeable. Depending on your ethnicity, firm, pink scars are expected usually around the first year and will begin to fade in around one year. You will be aggressively started on scar therapy at two to three weeks after surgery.
Whether you chose breast augmentation to enhance your appearance or correct a problem, the results are often exhilarating for most women. An improved self-image is only one of the benefits of this amazing procedure. Routine mammograms at intervals is advised throughout the recovery process and afterward to ensure complications (if any) are caught and corrected early.
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 is a success.
What are some breast augmentation complications that could arise?
There are not many complications that could arise from breast augmentation surgery. In general, the most common complications with any type of surgery include bleeding, infection, and scarring. However, infection and bleeding are extremely rare because of the precautions that your surgeon takes inside the operating room. Amongst other things, all implants are soaked in a solution that contains three different antibiotics while the pockets where the implants will be placed are likewise washed out with the same solutions.
How to pick from the best breast augmentation incision types?
There are many factors that come into play when deciding on incision sites. Make sure your surgeon is adeptly skilled in utilizing all three incision sites (armpit, nipple, fold) to personally evaluate each patient before recommending the most suitable location in-line with the patient’s body type and desired final look. Please consult with Dr. Patrick Hsu to determine which incision is best for you.
Are there breast augmentation restrictions after surgery?
For the first four weeks, it is recommended that patients avoid any heavy lifting of objects weighing more than 10 pounds, which can result in bleeding or additional pain in the early postoperative period. Patients can start easing back into their normal activities and routine gym exercises starting the second month. As a test, patients should start with a lighter weight the first few days and if no pain and/or discomfort is experienced, the can slowly increase the weight and intensity.
Eventually, implants should naturally become a part of a patient’s body. You could personally avoid isolated chest exercises since these exercises focus on the pectoralis muscle and can lead to chronic pain and soreness. Additionally, they may also push your implants down and outward, causing a disfigured or abnormal shape. Isolated chest exercises include pushups, bench presses, dumbbell fly exercises, etc.
Will skin color affect how obvious a scar’s color is?
Scarring as a result of breast augmentation varies from individual to individual. All scars look red and raised for the first year before they mature. Scars will usually start to fade after the first year and improve in appearance as the years pass. Darker skinned patients usually scar worse than lighter skinned patients.
Is there a specific body type/breast type that is prescribed for saline or silicone implants?
No, saline and silicone implants can be placed in everyone. They are filled with different materials and therefore result in a different feel. Any body type can get a saline or silicone implant.
Breastfeeding after breast augmentation?
Most patients will be able to breast feed after breast augmentation surgery because not much of the breast tissue is disturbed, especially if the implant is placed under the muscle.However, incisions around the nipple may slightly lower your risk of being able to breastfeed. Ability to breast feed post-breast augmentation will vary from patient to patient so it is recommended that patients ready questions they can ask the doctor during the initial consultation.
How long should I wait after breastfeeding before I can have breast augmentation surgery?
If a patient has just had a child, it is recommended that she wait at least 3-6 months before undergoing breast augmentation surgery to ensure lactation is complete. This will help reduce the risk of infection and also produce a more accurate final result.
What are the implications of a ruptured silicone implant and how does that differ from saline implants?
Ruptured saline implants will just deflate and the body will absorb the water the implant was filled with. There are no complications when saline implants rupture except for cosmetic deformity. Silicone implants are harder to detect because the majority of the silicone will typically stay within the shell because of its cohesive bear (sort of like a gummy bear’s consistency). When ruptured, the silicone gel is first contained in the implant shell and if it travels outside the shell, it is usually contained in the capsule or scar tissue surrounding the implant. Although silicone is a relatively inert substance in your body, it is always recommended that it be removed immediately to minimize the risk of infection, capsular contracture or additional migration of silicone into the breast tissue itself.
What causes breast implants to rupture?
The most common cause of an implant bursting is usually from trauma. This is usually associated with high impacts such as car accidents. Normal trauma that is usually experienced from falling or tripping should not, under normal circumstances, cause implants to rupture. As a manufacturer’s note, implants should be replaced every 10-15 years. This is necessary because, even if the implants are made with stronger shells, they are not designed to last forever.
Do I have to pay for fees if my implants burst?
If the implants are ruptured, the manufacturing company of said implants will usually cover the required operation costs. There are criteria that the manufacturers have put into place to warranty the device and each incident is evaluated on a case-by-case basis. If the rupture is deemed a manufacturer’s defect, the implants and associated breast augmentation repair fees for replacement are typically covered.
Will an implant move after surgery?
If the implant is designed and dissected out correctly, the implants should not move around too much and should sit evenly on the chest. Implants will begin to drop into place once the skin and soft tissues slowly stretch out. It usually takes 2-3 months before an implant is finally settled.
How will I know what size implants to get?
The best way for a patient to gauge how large they want to go while still remaining proportional to their body is to have their measurements as well as to have various implants tested. Proportionality is an important factor to consider in order to avoid further complications. Desired size should be discussed and Dr. Hsu during the initial consultation to ensure that your implants are suited for your body type and lifestyle.
Will having breast implants affect an active lifestyle?
Implants should not affect an active lifestyle. There are considerations for placing the implant above the muscle in patients who are competitive athletes. Let your surgeon know what specific lifestyle you live so he can guide you through the process.