Breast Augmentation SurgeryBy
Sarah Lewis, PharmD
What is breast augmentation surgery?
Breast augmentation surgery is the surgical reshaping of the breast in order to make it larger. Breast augmentation is also called breast enlargement and augmentation mammaplasty. It uses breast implants to increase breast size. Most people seek breast augmentation for cosmetic or aesthetic reasons. Your doctor may also recommend the procedure to reconstruct your breast following breast surgery.
Breast augmentation surgery is a common but major surgery with significant risks and potential complications. You may have less invasive options to enhance breast size or shape. Consider getting a second opinion about all your treatment choices before having breast augmentation surgery.
Types of breast augmentation surgery
The types of breast augmentation surgery procedures include:
Inframammary surgery involves making an incision in the natural fold on the underside of your breast. Your surgeon will insert the implant through this opening. You will have a scar on the underside of your breast.
Periareolar surgery involves making an incision around the dark area that surrounds your nipple. Your surgeon will insert the implant through this opening. This technique may lead to the inability to breastfeed or loss of nipple sensation.
Transaxillary approach is a minimally invasive procedure. Your surgeon will make a small incision in your underarm and insert the implant through the opening.
Transumbilical approach is a newer, minimally invasive technique. Your surgeon will make an incision near your belly button and feed the implant up to your breast. He or she will then fill the implant.
Types of breast implants
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The types of breast implants include:
Saline implants are filled with sterile salt water. If this type of implant leaks, it will collapse. Your body will absorb the salt water and eliminate it.
Silicone implants are filled with a gel that feels more like natural breast tissue. If this type of implant leaks, it may not collapse. Your doctor may require regular follow-up visits with ultrasound imaging to verify the condition and function of these implants.
Types of implant placements
The types of breast implant placements include:
Subglandular or submammary placement involves positioning the implant in a pocket your surgeon makes under your breast tissue and on top of your pectoral muscle.
Submuscular placement involves placing the implant in a pocket your surgeon makes under your pectoral muscle.
Other procedures that may be performed
Your doctor may perform other procedures in addition to breast augmentation surgery. The most common combination is a breast augmentation with a breast lift (mastopexy). A breast lift is a procedure to lift, or boost, sagging or loose breasts.
Why is breast augmentation surgery performed?
Your doctor may recommend breast augmentation surgery if you want larger or more shapely breasts for cosmetic reasons. It is also used to reconstruct breasts following breast surgery, such as mastectomy.
Not everyone is a good candidate for breast augmentation surgery. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on breast augmentation surgery.
Your doctor may recommend breast augmentation surgery for you if:
One breast varies in size or shape from the other one.
One or both breasts did not develop normally.
You are bothered by the feeling that your breasts are too small.
You are dissatisfied with the size, shape or firmness of your breasts after weight loss, pregnancy, or as a result of aging.
You are physically healthy and have realistic expectations of improvement, not perfection.
Your breasts are fully developed.
Who performs breast augmentation surgery?
A plastic surgeon or a cosmetic surgeon performs breast augmentation surgery. A plastic surgeon is a specialist in aesthetic and reconstructive surgery. A cosmetic surgeon focuses on aesthetic surgery—most procedures are elective and not medical necessary. A cosmetic surgeon performs some of the same surgeries as a plastic surgeon, including breast augmentation, but the surgeons’ education and training are different.
How is breast augmentation surgery performed?
Your breast augmentation surgery will be performed in a hospital or outpatient surgical center.
Surgical approaches to breast augmentation surgery
Breast augmentation surgery is performed using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an endoscope through small incisions in your underarm or near your belly button. An endoscope is a thin, lighted instrument with a small camera. The camera sends pictures of the inside of your body to a video screen viewed by your surgeon while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision(s) instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Open surgery involves making a larger incision under your breast or around your areola. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different breast augmentation procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform breast augmentation surgery using general anesthesia or regional anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your breast augmentation surgery
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have. The surgeon provides anesthesia in some cases.
A surgical team member will start an IV.
The surgeon, anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of breast augmentation surgery?
As with all surgeries, a breast augmentation involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
A anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of breast augmentation surgery
Complications of breast augmentation surgery include:
Capsule contracture or thickening. Your body normally forms a capsule of scar tissue around the implant. This capsule may become abnormally tight, thick or large causing shape changes, hardening or pain.
Change in breast appearance due to pregnancy, weight loss, or menopause
Change in nipple or breast sensation, which may be permanent
More difficulty reading mammograms and finding breast lumps with a manual exam
Need for implant replacement surgery because they may not last your entire lifetime
Rippling of the implant that may be visible
Rupture and leakage of the implant
Uneven nipple positions
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Informing your doctor or radiologist if you are nursing or if there is any possibility that you may be pregnant. It is also important to tell your doctor if you plan on becoming pregnant, breastfeeding, or losing weight in the future.
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
Wearing a post-surgical support bra as directed by your healthcare provider
How do I prepare for my breast augmentation surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for breast augmentation surgery by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a breast exam, mammograms, chest X-rays, blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Am I a good candidate for breast augmentation surgery? Are there any other options for me?
Which type of breast augmentation surgery procedure will I have?
What results can I expect?
What options do I have if I am not satisfied with the results?
What other implant-related surgery should I expect to have over my lifetime?
What should I expect if I have the implants removed?
How long will the surgery take? When will I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
How do I care for the incisions? When can I bathe or shower?
How do I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my breast augmentation surgery?
Knowing what to expect can help make your road to recovery after breast augmentation surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have tubes attached to your breasts to drain fluids. Your surgeon will usually remove them within three days. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Patients often go home on the same day if they are recovering well. In other cases, a hospital stay of one day is required. Your surgeon may recommend private nursing care to help you recover safely.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. You may need to wear a surgical support bra for several weeks after your surgery. Full recovery takes a couple of weeks to a month.
Will I feel pain?
Pain control is important to healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after breast augmentation surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, palpitations, or uneven heart beats
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication
Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Sudden change in size or shape of your breast or breasts
Unexpected drainage, pus, redness or swelling of your incision
How might breast augmentation surgery affect my everyday life?
Breast augmentation surgery may improve satisfaction with your appearance and boost your self-confidence. Surgeons caution that it is important to be realistic about how much breast augmentation may improve your self-image.
Be aware of what cosmetic breast augmentation surgery can and cannot do for your overall appearance. Time, gravity and aging will eventually affect the size and shape of your breast implants, just as it does natural breasts.
It is important to tell all your healthcare providers about your breast augmentation surgery. It can make it more difficult to feel a breast lump or see one on a mammogram. Breast augmentation can also complicate breastfeeding.
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