What is a breast augmentation?
Breast augmentation is a common surgical procedure to enhance breasts' size and shape. Before consulting with a surgeon, however, it's important to educate yourself. The following information is a basic overview. Keep in mind that this information does not replace the advice of a professional surgeon.
What happens at your consultation for breast augmentation?
Before you undergo breast augmentation, you'll meet with your surgeon. You should prepare for this consultation by thinking about what you like and don't like about your breasts. Remember, you're not seeking perfection, but improvement. Also, be sure that you're in good mental and physical health, overall, and that you have realistic expectations. This surgery is not going to solve problems for you.
Your surgeon will also need to take a detailed medical history, including asking you what medications you are taking, what allergies you may have, your smoking history and any prior surgeries. This history taking will also include discussion of any previous problems you've had with your breasts, including lumps, previous mammograms and any family history of breast problems.
How is a breast augmentation done?
The procedure will take about one to two hours. It will be performed either under general anesthesia (you'll go to sleep) or local anesthesia with an oral sedative. You and your surgeon will determine this together.
Breast augmentation can be performed in one of several ways. Your surgeon can perform the procedure via the crease under your breast (known as the inframammary fold); via the areola (known as the "nipple" incision); or via your armpit (known as a transaxillary approach). Your surgeon will discuss all the possible methods with you and together you will determine which approach best suits your needs.
Different types of implants are used as well, including saline or silicone gel. Your surgeon will discuss all your implant options with you. Ask your surgeon for FDA information on the different types of implants.
There are two different ways for your surgeon to insert the implant: either under the breast tissue or behind the breast muscle. You can discuss the benefits of each method with your surgeon and make that decision together.
After the implants are placed, the incision sites will be stitched closed, and your surgeon may also use drainage tubes. It's very important that you follow your surgeon's follow-up care instructions for the incision site. Your breasts will be covered with a gauze bandage or you may even be sent home with a surgical bra.
How do I prepare for a breast augmentation?
During your consultation, your surgeon will tell you which foods, medications, and vitamins you should avoid for a designated time period before and after your surgery. These include, but are not limited to: aspirin, Vitamin E, ibuprofen (Motrin® or Advil®), and certain foods or medications that contain salicylate. If you are a smoker, your surgeon may instruct you to quit the use of nicotine in any form (smoking, patch, or gum) for a certain period of time before and after the surgery. It's crucial that you follow his or her instructions very closely as smoking can impede the healing process.
You should arrange for someone to drive you home after your surgery and also have someone stay with you the first night at least. You will need to take at least three days off from work, so plan accordingly.
Establishing a home recovery area
Before you undergo surgery, you should set up an area in your home for recovery. Make sure you have:
- Pain medication prescribed by your surgeon and/or acetaminophen (Tylenol®)
- Ointment or cream for incision sites (if recommended by your surgeon)
- Clean gauze to cover the incision sites
- Plenty of loose, comfortable, button-down blouses or shirts
Recovery and follow up care
Your surgeon will give you a prescription to control pain, if necessary. If you have drainage tubes, your surgeon will tell you when to return to have those removed, as well as instructions as to when to remove the gauze bandages. Your surgeon will probably remove your stitches in about one week. You should not do any heavy lifting for at least four weeks. If you are physically active in sports, it may take up to six weeks before you are able to return to those activities.
Risks / Benefits
What are the complications and side effects of a breast augmentation?
As with any surgery, there are side effects and you do risk certain complications. Side effects can include soreness and increased sensitivity in the nipple region, bruising, or swelling. You will experience some swelling for a minimum of a few weeks.
Immediate complications, though rare, can include:
- Wound healing issues
- Hematoma (blood collection in the surgical area)
Complications that might happen over the long-term include:
- The formation of scar tissues, also known as capsule contracture
- Sagging of the implants in the breast, causing your breasts to droop
- Symmastia, which means the implants trend toward the middle of the chest and can give the appearance of one continuous breast
- Fluid around the implant (also known as seroma)
- Rupture or deflation. Implants are not designed to be life-long. You might need another procedure later on.
- Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This immune system cancer is very rare, but has happened in patients who have received breast implants that have rough or textured surfaces. Symptoms, such as changes in the size or shape of breasts, swelling, or lumps, may show up 2-8 years after the implant.
You should let your surgeon know if you are planning to breastfeed. It is very important that you discuss all your concerns with your surgeon.
Will breast implants affect cancer screenings?
Although all breast tissue is in front of the implant, breast implants can, nonetheless, affect self-examinations. Women need to become familiar with examining their breast with the implant in place.
Implants can also make it more difficult for a mammogram to detect the presence of cancer. However, as screening technology becomes more advanced, the issue of implants preventing the detection of cancer becomes less of an issue.
Currently, if you have breast implants, the American College of Radiology, the American Cancer Society, the American Society of Breast Imaging, and the American Society of Plastic and Reconstructive Surgeons recommend that you receive your breast examinations at a facility accredited by the American College of Radiology. Because they are capable of multiple, special views of the breasts, these facilities will be more equipped to make a proper evaluation than screening clinics, which often only screen using two basic views of the breast.
When to Call the Doctor
When should I call the doctor after a breast augmentation?
Contact your doctor immediately should any of the following occur:
- Abnormal discharge, such as pus, from incision site
- Rupture of stitches
- Increasing enlargement, or firmness, of one or both breasts associated with pain and pressure
Does insurance cover breast augmentation?
In most cases, breast augmentation is elective cosmetic surgery and therefore insurance carriers will not cover the procedure or any necessary follow-up visits. It is possible that your premiums for future insurance coverage may increase. Additionally, insurance might not cover the procedure should you want your implants removed in the future. Therefore it is important to receive your doctor's charges in writing.
However, if you are having implants put in as part of reconstructive surgery, your insurance carrier may provide coverage. It's very important that you find out well in advance what type of coverage your carrier may provide.