Introduction

Breast augmentation is a cosmetic procedure that uses implants to enlarge and shape the breasts.

The female breast has become a symbol of nurturing, femininity, and sexuality.  Some women feel dissatisfied because their breasts never developed to a size that meets their expectations.  Others want to restore their natural breast volume which may have decreased after pregnancy / breast feeding, weight loss, or aging.

Improving the size or shape of one’s breasts often leads to improved self-image and confidence, looking better in clothing, and better body proportions.

What type of anesthesia is used during the operation?

This procedure is usually performed under General Anesthesia.  An Anesthetist is always present.  If you have any particular problems with anesthesia, please let us know.

How long is the operation?

The actual surgical time varies depending on the amount of surgery necessary for each patient, but usually is about 2 hours.

Where are the incisions made?

The incision for breast augmentation can be made in one of three places.  The first type of incision is placed at or slightly above the crease under the breast (infra-mammary incision).  This is one of the most common incisions because it allows for accurate placement of the implant.  The second incision type is placed along the lower border of the pigmented skin around the nipple (peri-areolar incision). This incision usually heals quite well, but this approach is not suitable for women with very small nipples.  The third incision is placed high in the armpit (trans-axillary incision) eliminating scars on the breast, but making accurate implant placement slightly more difficult.

What else is done during the procedure?

A pocket is made for the implant.  The pocket can either be made under the breast itself (sub-mammary) or under the chest muscle (sub-pectoral).  Sub-mammary placement is usually used in women who already have some breast tissue and are slightly droopy, since it helps to improve the shape.  Sub-pectoral positioning is usually used when a woman has little or no breast tissue so the implant will be less “feelable”.  

The implant is a solid silicone shell filled with liquid saline (salt water, a natural body fluid also used for intravenous solutions). Implants filled with silicone gel have recently come back on the market. The newest type of implant is the 'cohesive gel implant'. These implants are filled with a thicker type of silicone. When you cut into a cohesive gel implant, nothing oozes out. It is similar to cutting into a gummy-bear or jello.

If droopiness or sagging of the breast is advanced, it may be necessary to tighten up or ‘lift’ the breast in addition to the augmentation.

How long is the hospital stay?

Breast augmentation is an outpatient procedure, meaning you can go home the same day once you have recovered from the anesthetic.

When are the stitches removed?

Stitches are removed between 10-14 days.  Sometimes dissolving stitches are used that don’t have to be removed.

What happens after the surgery?

Most people feel tender and bruised after surgery, but are not in a great deal of pain.  Pain medication will make you comfortable.  Immediately after surgery, you will have a bandage and a bra on.   A supportive brassiere should be worn day and night for the first two weeks, and then during the day for another two weeks.

You should plan to be off work for 5-7 days.  Mild exercise may be resumed after two to three weeks, but strenuous exercise (for example, upper body weight training) should not be started before six weeks. Special breast massage exercises will be done to keep the breasts soft and help prevent excessive hardness (scar capsule) from developing.

Drains are occasionally placed to remove excess fluid when the implant is inserted through the armpit, and will be removed within two or three days.  Showering is permitted on the 2’nd day after surgery. Scars will initially be red and a little raised, but over 3-6 months they usually get lighter in colour and flatten out.

What are the results?

Enlargement of the breasts with improvement in shape.  The scars are usually well hidden.  Most patients are very happy with their results.

Some additional points:

Make sure you let me know your complete medical history as well as any medications, drugs, vitamins, or natural herbs you are taking.  For example, diabetes is known to affect wound healing.

Smoking also affects your ability to heal, and I recommend that you stop smoking at least 2 weeks before surgery.  Aspirin, anti-inflammatory pills (like anaprox or motrin), and vitamin E also should be stopped 2 weeks before surgery because they can cause extra bleeding.

I strive to make sure all my patients are well informed.  Your questions are more than welcome.