Breast Augmentation

Your overall shape, build, and skin available for breast augmentation will be important in determining the size of your breasts. Your expectations are also important in this decision. If you have little or no breast tissue, very tight skin or are young, you typically can expect to increase your size from an A cup to approximately a C cup; however, stretching the muscle and skin too tightly can be detrimental. Patients that want to be very large can do so if there is available skin for coverage; otherwise, this may require more than one procedure. Breast augmentation patients who have lost breast volume as a result of childbearing, breast feeding or weight loss typically have sufficient skin to restore their breasts to their original size or larger; and patients with moderate breast size usually can increase the size of their breasts easily.

Scars from a breast augmentation are short and generally well-hidden in the crease underneath your breast and can be covered up by a bra or bathing suit top. Longer incisions going up to the nipple will be made if you have a combination of breast procedures, including a breast lift.

While breast implants have the potential to last a lifetime, the manufacturers do not consider them ‘lifetime devices’, meaning that breast implants have the possibility of leaking over time. If a saline implant leaks, the saltwater is harmlessly absorbed by the body. If the implant does not show deflation, it can potentially be left in for a lifetime. A deflated implant is not a serious event or an emergency. Replacement can be performed at a convenient time for the patient. Silicone implants are now made so that even if their outer shell ruptures, the silicone inside remains intact and will likely not leak outside of the shell.

The implants used today are round or teardrop shaped. The teardrop shaped implants were designed to achieve a more natural, mature appearance; however, if they become displaced and turn within the breast pocket, this could cause distortion in breast shape. Round implants in a submuscular position can achieve the same result without the possibility of breast distortion. During your consultation your surgeon will review the different breast implant shapes available and your aesthetic goals to help you determine which implant style is best for you.

A saline implant has a silicone rubber shell filled with sterile saltwater. A silicone implant has the same shell filled with a silicone gel. Many consider silicone implants to feel softer and more like a natural breast while silicone implants will give you a rounder shape. Saline breast implants are somewhat heavier and will pull more on the breast tissue over time and may result in earlier drooping or a mature breast sooner than would be hoped for. A saline breast implant with a flaw will deflate slowly over several days or weeks and be easily noticeable; however, a silicone implant with a rupture may not be detectable by the patient, physician or even a mammogram.

Breast feeding after breast augmentation isn’t any more challenging than it would be otherwise. There is no danger of breast implant material, saline or silicone, being passed into the breast milk and affecting your child in any way.

Breast implant surgery, like all surgery, carries risks. Your plastic surgeon will provide you with comprehensive patient education materials. The immediate concerns after surgery relate to healing and bleeding. Bleeding occurs with any surgical incision and rarely is a problem; however, on occasion a hematoma (collection of blood) will cause one breast to be significantly larger. If this should occur, your surgeon will address the situation immediately by removing the blood. Capsular contracture (tightening of natural scar tissue around the implant causing breast firmness) is unpredictable but may require corrective surgery if severe. A capsulectomy or capsulotomy would be performed to alleviate the problem. As mentioned above, deflation can occur and is generally harmless but will require another surgical procedure to replace the implant. Infection associated with breast implantation is rare due to the use of a closed filling system to fill the implant with saline at the time of surgery. If infection does occur and healing problems result, you will be treated with antibiotics in an effort to avoid further surgery. Ultimately, it may be necessary to remove the implant until the infection is resolved. The breast implant can then be reinserted.

Within a day or two after surgery, you will be up and about and any discomfort can be controlled with prescribed pain medication. You will be able to shower almost immediately and you will return to the office for follow up and for stitch removal (unless dissolvable suture was used) within a week. You can resume sexual relations although breasts must be treated gently. Patients usually return to work within a week. Work activities requiring significant lifting, pushing or arm stretching may be uncomfortable at this time and the work may need to be modified accordingly. Implants in the submuscular position (which are the majority) take longer to be pain free. Returning to exercise is a personal decision. After the first two weeks few exercises would injure the incision or breast implant placement; however, strenuous activity that stresses the pectoralis muscle – bench presses or push – ups should be avoided. Most patients wait a month or so before a full return to their vigorous workout schedules.

Usually, steri-strips are applied over the small incision and a bra with minimal dressings is worn. Your chest will feel very tight. Some bras used following surgery will put pressure on the upper edge of the breast or implant to hold it in a lower position as the implants initially tend to sit somewhat high. This high position is due to the fact that the fold under the breast must stretch into the new relaxed shape to accommodate the larger implant. This process may take several weeks or even several months. Usually this surgical bra is worn for a week or more. Some surgeons may advise you not to wear a bra depending on the placement of your breast implants.

Once the breast implants are in good position, a bra of your choosing is advisable. A bra is recommended when exercising or even for normal activity if you have a very large breast augmentation. You may also wear an underwire bra after the implant has settled into the desired position. Your surgeon will advise you when that has happened.