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Breast Augmentation:Cost from $ 2,650Cost with Financing $ 70 per monthWomen with small or underdeveloped breasts who wish to enhance their appearance may choose to have a procedure called breast augmentation or mammoplasty. A fuller body contour can be safely achieved through the placement of implants directly under the breast tissue or beneath the chest wall muscle. Implants that are filled with saline or salt-water, silicone or gel can be used for breast augmentation procedures.
Small incisions are made so that the implant can be inserted. These small incisions may be made in the crease under the breast or under the nipple. The implant is then filled to achieve the desired size and shape of the breast. The surgery can be performed as an outpatient under general anesthesia or ambulatory (local anesthesia) and takes approximately 2-3 hours to complete.
Most patients can resume to normal activities within 5-6 days following surgery. Sutures are removed in 7 to ten days and your surgeon may recommend a surgical support bra. Exercise and other strenuous activities may be resumed in about one month.
Anesthesia: General or local with Sedation Location: Hospital Minimum Stay: 10 days
At the initial visit, your doctor will likely ask you to describe in detail what you would like improved. Be specific about what you would like done. If your surgeon fully understands your expectations, he'll be able to determine whether your goals are realistic. Your surgeon will examine your breasts. He will talk to you about the size you want your breasts to be and other considerations involved with breast augmentation.
Discuss with your surgeon:
See Breast Augmentation Procedures/Techniques for detailed comparisons of these options.
You are at increased risk for complications if you have diabetes, poor circulation, heart, lung or liver disease, smoke, have a family history of blood clots, take certain medications, etc. You'll want to discuss your medical history thoroughly with your physician.
Breast Surgery Pre-op Preparation
Before Breast Surgery:
Breast Augmentation Procedures/Techniques
Anesthesia: General or Sedation
Location: Hospital
Surgery time: 2-4 hours
Breast augmentation will enlarge your breasts. It will not improve nipple asymmetry, move breasts closer together, or lift droopy breasts. If you have droopy breasts, consider a breast lift (mastopexy). 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. Saline Implants The majority of implants being used today are saline-filled implants. These have a silicone rubber shell and are filled with sterile salt water. During pre-operative exams you and your surgeon will determine:
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Breast Implant shape Round breast implants are not affected by rotation and cost less than teardrop implants. They do not require a textured surface. There 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 cost more than round breast implants and require a textured surface to prevent rotation. In the event that the implants rotate, it creates a distorted breast shape. A recent study determined that a round breast implant takes on the same shape as the teardrop implant when standing. The study also concluded that when lying down, the round breast implant is more natural in appearance than the teardrop implant because it retains the teardrop shape and the round breast implant does not.
Breast Implant surface Textured breast implants have an increased risk of rippling but a decreased risk of displacement. They also cost more (about $400). A recent study showed that textured breast implants have a higher deflation rate and are firmer than smooth implants. 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 350 ml have a lower risk of displacement, but may not provide the desired size. Breast Implants that are more than 400 ml have a higher risk of displacement, but may provide the desired size. Choosing your desired size can be a difficult decision. You'll want to decide your cup size and that will determine how large your implant will be. A 400 ml implant placed on a woman with an A cup will produce a C cup. The same implant placed on a woman with a B cup will produce a D cup.
Breast Implant placement
Breast Implant position refers to whether the breast implant is placed above or below the pectoralis muscle. See Illustration below.
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 women with small breasts. It has a better cosmetic result in athletic women. It is associated with a shorter recovery and less pain and swelling than placement below the muscle. This approach can be performed with intravenous sedation and local anesthetic.
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. This incision allows your surgeon the best visibility during surgery. Most commonly done. Periareolar incision: The second most common incision is made in the areola. The incision is usually a small semi-circle. The scar is camouflaged by the nipple. However, if there are any imperfections in the scar, it will be highly visible. This type of incision has an increased risk for diminished nipple sensation. Axillary incision: The incision is made in the armpit, and may require the use of an endoscope. The scar is well-hidden, but provides poor visibility for the surgeon. Umbilical incision: The incision is made in the belly button. It usually requires the use of an endoscope, and it is very difficult to place the implants below the muscle utilizing this method. Pain Level:
Swelling:
Bruising: Up to 2 weeks. Some patients experience no bruising.
Numbness: 1-2 weeks.
Work:
If job is strenuous or requires lifting, wait a month.
Exercise: Wait 2-4 weeks.
Final result: Breast Implants above the muscle: 1 month. Breast Implants below the muscle: 4 months.
On the day of surgery you will feel sleepy and may feel pain or be nauseated. Your chest may feel tight and uncomfortable. Your arms and back may also be sore. Pain medication will be prescribed to minimize your discomfort. After breast augmentation surgery your breasts will be very firm, high, and swollen. After about 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:
Your doctor knows your particular case best, these are only general guidelines.
Possible risks and complications associated with breast augmentation surgery:
Silicone Breast Implants
In the early 1990's it was reported that silicone breast implants were responsible for connective tissue diseases in some women. After a comprehensive evaluation of the evidence for the Association of Silicone Breast Implants with human health conditions, the Institute of Medicine concluded in June that there is "no definitive evidence linking breast implants to cancer, neurological diseases, neurological problems or other systemic diseases." However, silicone implants are still not available to the general public in the United States . They are still widely used in Europe and South America and may be available again in the US . Silicone gel-filled breast implants are available for select cases: women seeking breast reconstruction or revision of an existing breast implant, women who have had breast cancer surgery, a severe injury to the breast, a birth defect that affects the breast, or a medical condition causing a severe breast abnormality.
Capsular Contracture
Capsular contracture is one of the most common complications associated with breast augmentation. 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.
Breastfeeding
It is possible to nurse with breast implants as long as the milk ducts haven't been severed or blocked. You should discuss future breastfeeding with your surgeon so that they are careful not to damage the milk ducts. The recent report of the Institute of Medicine concluded that breast feeding with implants is safe.
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. Postoperatively, they may contribute to infection and/or capsular contracture. 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. A small scar can result from surgical draining.
Implant displacement
Implants can move out of position at anytime after surgery. If they move only a little, it may not be noticeable. If they move a lot, you may need surgery to put them into position. This is very uncommon except in women who have very large implants. The larger the implant, the greater the chance that it will displace.
Infection
Infection is very uncommon. The risk is about 1% but if it occurs the implants will have to be removed. If infection does occur, it is usually within six weeks of surgery.
Necrosis Necrosis is the dead tissue around the implant. This may prevent wound healing and require surgical correction and/or implant removal. Permanent scar and/or deformity may occur following necrosis. Factors associated with increased necrosis include infection, use of steroids in the surgical pocket, smoking, chemotherapy/radiation, and excessive heat or cold therapy. Galactorrhea Sometimes after breast implant surgery, you may begin producing breast milk. This is more likely if you have previously lactated. The milk production often stops spontaneously or medication may be given to suppress milk production. In other cases, removal of the implant(s) may be needed. 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. Regardless of where placed, breast implants do not interfere with self-exams. They do not interfere with MRI scans or ultrasounds, which are alternatives to a mammogram. No studies have shown a connection between implants and breast cancer. However, ineffective mammography could result in a higher risk of undetected breast cancer from other causes. If you have a history of breast cancer in your family, breast augmentation may not be an option. Rippling
Rippling looks like indentations or waviness on the surface of the breast. It is the saline moving inside the implants. In most cases it occurs during movement. According to a 1994 survey (commissioned by implant manufacturers) 12% of women who were dissatisfied with their implants were dissatisfied because of rippling. Rippling is less likely to occur with implants that have a smooth surface. It is more common in implants that are placed above the muscle, especially in women with little or no breast tissue. Rippling can be a result of under filling the implant.
Sagging
Sagging is less likely in implants placed above the muscle. Because the implant is likely to be higher on the chest than the breast tissue, you may have separate tissue hanging from the firmer implant. Your surgeon may recommend a mastopexy (breast lift) in addition to the augmentation.
Sensation Loss/Change
After surgery, you may have temporary or permanent numbness. There is also possibility of diminished sensation or increased sensitivity. The risk of having permanently numb nipples is roughly 15%. Implants placed above the muscle may have a greater risk for this as the surgery may interfere with breast tissue near the skin. You can also expect sensation change if your incision is in the areola. If the surgeon injures the nerves which lead to the nipple area it can lead to temporary or permanent numbness. All incisions have a risk of diminished sensation.
Rupture or Leak
Rupture of Saline Implants
If a saline implant breaks, it will deflate and the salt water will be absorbed by the body. Alert your physician right away as the implants will have to be replaced. Some implants deflate or rupture in the first few months after being implanted and some deflate after several years. You should also be aware that the breast implant may wear out over time and deflate. Additional surgery is needed to remove deflated implants. In a study conducted by Mentor , 3% of 1264 patients had deflation after 3 years. In a similar study by McGhan, the deflation rate was 5%of 901 women after 3 years. Another study indicates that 10.1% of women followed for an average of 6 years had at least one implant deflated.(2)
Rupture of Silicone-Gel Implants
When silicone gel implants rupture, women may notice decreased breast size, hard knots, uneven appearance of the breasts, pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation. According to the FDA, 69% of 344 women had at least one ruptured breast implant. Factors that were associated with rupture included increasing age of the implant, the implant manufacturer, and submuscular rather than subglandular location of the breast implant. For silicone gel and saline-filled breast implants, some causes of rupture or deflation include:
Additional Surgeries
Additional surgery may be needed to replace or remove the implants due to problems such as deflation, capsular contracture, infection, shifting, and calcium deposits. Women who do not have their breast implants replaced may have cosmetically undesirable dimpling, puckering of the breast following removal of the implant, or other unsatisfactory cosmetic outcomes.
Scars
Surgical scars are permanent. However, the incisions are placed so that they are not normally noticeable except on very close observation. Scar location will depend on the incision site (either in crease below breast, armpit, belly button or areola).
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