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Breast Augmentation

Breast Augmentation, also known as augmentation mammaplasty, is a procedure that uses implants to increase the fullness and shape of the breasts. It is currently the most popular type of cosmetic surgery performed.
Women choose to get breast implants for a wide variety of reasons:
• Fulfill a desire for bigger breasts
• Improve the balance of the figure
• Correct size and shape difference between uneven breasts
• Restore breast volume after weight loss or pregnancy
• Reconstruct a breast after a mastectomy or injury
• Enhance self-image and self confidence

Breast surgery pre-op preparation:

Before Breast surgery:
• Do not take aspirin or anti-inflammatory medications
• If you smoke, quit smoking for at least 2 weeks pre-op
• Make arrangements to have someone drive you to and from the operation
• Arrange for someone to care for you the first 24-72 hours after surgery
• Fill prescriptions before surgery
• Prepare icepacks to reduce post-op swelling
• On the day of surgery, wear loose clothing which will be easy to get off and on after operation
• Follow your physician’s directions carefully regarding medications, eating and drinking

Breast augmentation procedures :

Breast augmentation will enlarge your breasts. Breast augmentation is performed to balance a difference in breast size, improve body contour or as a post-surgery reconstructive technique. Silicone shells filled with saline solution are implanted either directly under the breast tissue or beneath the chest wall muscle, giving breasts a fuller and more natural contour.

During pre-operative exams you and your surgeon will determine:

1. Breast Implant shape: round or teardrop

2. Breast Implant surface: smooth or textured

3. Breast Implant size and volume

4. Breast Implant placement: above or below the muscle

5. Breast Surgery Incision site: areola, breast or belly button

Breast Implant shape:

• Round breast implants are not affected by rotation. They do not require a texture surface. They are no disadvantages to round breast implants. This is the most common implant employed.
• Teardrop breast implants were developed to provide a more natural look. They require a textured surface t prevent rotation.

Breast Implant surface:

• Textured breast implants have an increased risk of rippling but a decreased risk of displacement.
• Smooth breast implants have a lower risk of rippling, are less firm than textured breast implants. Any rotation of the implant will not affect the appearance. Smooth breast implants are used in 90% of operations.

Breast Implant size and volume:

Breast Implants that are less than 300 ml have a lower risk of displacement, but may not provide the desired size. Breast Implants that are more than 450 ml have a higher risk of displacement, but may provide the desired size.

Breast Implant placement:

Breast Implant position refers to whether the breast implant is placed above or below the pectoralis muscle.
• Subpectoral or submuscular breast implants: Placement under the pectoralis muscle is the approach most commonly used. It has a lower risk of capsular contracture, interferes less with mammogram, and a better cosmetic result in women with small breasts. It is associated with a lengthier recovery and more pain and swelling than placement above the muscle.
• Subglandular breast implants: Breast Implants that are placed above the pectoralis muscle and below the breast tissue. This has a greater risk of capsular contraction, interferes more with a mammogram, and a worse cosmetic result in athletic women. It is associated with a shorter recovery and less pain and swelling than placement below the muscle.

Incision site:

• Inframammary incision: the incision is made on the lower portion of the breast, in the crease where the breast meets the chest, so that any scar will still be hidden. Most commonly done.
• Periareolar incision: The incision is usually a small semi-circle. The scar is camouflaged by the nipple.
• Axillary incision: The incision is made in the armpit, and may require the use of an endoscope.
• Umbilical incision: The incision is made in the belly button. It requires the use of an endoscope, and it is very difficult to place the implants below the muscle utilizing this method.

Recovery:

After breast augmentation surgery your breasts will be very firm, high, and swollen.
After a month, the swelling will be gone and they will be lower, smaller and softer. It may take up to a year for the breast implants to settle into a permanent position.

For faster recovery:

• Keep ice packs applied to your chest on the day of your surgery.
• Sleep in an upright position. Do not sleep on your stomach for the first two weeks after surgery.
• Do not exercise or do any other activities that could increase pressure in your chest during the first week.

Complications:

Capsular Contracture: it occurs when the scar tissue hardens around the implant. It may be more common following infection, hematoma, and seroma. Capsular Contracture is much less common and less severe with saline implants than with silicone implants.

There are four grades of capsular contracture-Baker Grades I through IV

Grade I : the breast is normally soft and looks natural
Grade II: the breast is a little firm but looks normal
Grade III: the breast is firm and looks abnormal
Grade IV: the breast is hard, painfull, and looks abnormal

Grade I and II require no treatment. Grade III is treated by reopening the incision and releasing the capsule. Grade IV requires repositioning the implant and may require implant removal.

Hematoma/Seroma:

Hematoma is a collection of blood inside a body cavity, and seroma is a collection of watery blood around the implant or around the incision. If a hematoma occurs, it is usually soon after surgery; it can also occur after an injury to the breast. While the body absorbs small hematomas and seromas, large ones will require the placement of surgical drains for proper healing.

Implant displacement: This is very uncommon except in women who have very large implants.

Mammography: Saline and silicone implants affect a mammogram reading. Implants placed below the muscle permit a clearer reading. When implants are below the muscle, 90% of breast tissue is visible. When breast implants are above the muscle, 75% of breast tissue is visible.

Sensation loss: All incisions have a risk of diminished sensation.

Rupture or leak:

For silicone gel and saline-filled breast implants, some causes of rupture or deflation include:
• Underfilling of saline (only) breast implant
• Capsular contracture
• Trauma, injury, or intense physical manipulation
• Excessive compression during mammographic imaging
• Placement through the belly button
• Normal aging of the implant
Deflation is less likely to occur if the implants are over filled. If the breast implants are not over filled they will fold when you move and may eventually rupture and deflate.

The augmentation surgery can instill more self-confidence in one’s both types of clothing and swim wear. Breast implants can improve both happiness and satisfaction in one’s figure.

 

FAQ:

Will breast augmentation increase my risk of breast cancer?

This is one of the most frequently asked questions by women considering this surgery. Many studies have shown that women who get implants are not at an increased risk for getting breast cancer. In addition, implants do not delay the detection of breast cancer.

How do I choose my new size?

This is often one of the most difficult decisions, and for many reasons, has the most potential for disappointment. During your consultation, your plastic surgeon will work with you to identify what size of breast you desire from augmentation. “Breast size” as measured by bra-size is variable and is often not a good way to measure final size. As a general rule, every 125-150cc of implant volume equals an increase in a single cup size

Will augmentation work for me if I feel my breasts are sagging?

Women with sagging breasts, which is called “ptosis”, can also receive breast implants. Depending on how much the breast sags, an additional surgery may also be necessary. For breasts with nipples that droop below the lower crease of the breast, a  mastoplexy, is often required as well. This surgery will also add scars all the way around the nipple-areola unlike most breast augmentation surgeries. Without this additional surgery to remove excess skin, placement of the implant may not adequately correct the sagging.

How long until I can exercise?

It is recommended that patients begin walking immediately after surgery. However, women should not perform any intense physical exercise for six weeks following the operation. Physical exercise including weight lifting, biking, jogging, and other forms of intense activities may cause implants to shift position or cause wound healing problems that may alter the appearance of the breasts after surgery.

Am I too old for the surgery?

Many women in their 40s and 50s have undergone breast augmentation surgery with good results. The most common patient for this surgery is a woman in her 30s with two children who has been considering this operation for many years

Should I wait until I am done having children to have augmentation?

It is usually recommended that pregnancy be postponed until 6 months after the surgery. Breast-feeding with implants is still possible and has been shown to be safe for the baby and the mother.

When can I drive?

Women may start driving a car 10 days after surgery as long as they are not taking any pain medications.

Will my nipple sensation or feeling change?

Few women will have loss of some feeling or sensation following breast augmentation surgery. For most of them, this lasts 6 months before returning to normal. 15% of women, however, have permanent alterations in nipple sensation specially  if a breast lift is associated with the breast implant.

 When can I return to work?

This depends on your job and its physical demands. Some general guidelines are: Upper arm movements, like reaching, should be avoided for the first 1-2 weeks. Lifting anything heavier than 5 pounds should be avoided for 6 weeks after the operation. This lifting restriction may prevent some women from returning to work.

How much pain can I expect?

The pain from breast augmentation surgery is usually in the mild range and generally can be well controlled with medication in the first 1 week following the surgery. It is important to note that severe or untreatable pain following surgery can mean infection or another complication.

Will the new implants affect my physical functioning, can I lift heavy objects?

It is unlikely that you will experience long term changes in physical functioning. Depending on the size of the implant, most women find no trouble performing most physical activities following the surgery. Weight lifting or lifting heavy objects will not affect the implant once the area has properly healed.