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Breast Augmentation

Category(s): Cosmetic Surgery

Breast augmentation also known as augmentation mammaplasty, is a procedure which uses implants to enhance breast size. The request for augmentation is based on the desire for a fuller bust, to replace breast volume after pregnancy and/or weight loss, or in the process of breast reconstruction.

Breast implants are constructed with silicone rubber shells called the lumen and are filled with one of two types of liquid: silicone or saline. Saline implants are filled with sterile salt water (saline). They can be pre-filled or filled during the procedure which can result in a smaller incision required to place the implant. Silicone implants are filled with soft elastic gel (silicone). They are filled before the surgery and may require a longer incision but many women say they feel more natural after surgery. They also pose more health risks if they form a leak post surgery.

Typically, augmentation surgery is an outpatient procedure which lasts one to two hours. Using a general or local anesthesia, an incision is made behind each breast to form a pocket where the implant is inserted. Incisions can be made under the breast, under the arm, or around the nipple. The implant is placed either between the breast tissue and the chest muscle (sub-glandular) or partially or wholly under the pectoralis major chest muscle (sub-muscular).

Although sub-muscular placement can result in a longer recovery time than sub-glandular it may (1) reduce the risk of developing capsular contracture (a lining of tissue formed around the implant which can distort the shape/size of the implant), (2) can better camouflage the implant and rippling providing a more natural look and feel, and (3) can improve mammogram readings.

Since a sub-glandular placement surgery only involves cutting the skin and fat, recovery times are reduced, larger implants can be placed, and implants can be more easily seen and felt through the skin. This type of implant placement can increase the risk of rippling, capsular contracture, and can make mammogram readings more difficult to obtain.

After the incision is made and the implants have been placed, the surgeon will close the incisions with sutures or surgical tape and the breasts will be covered with gauze. Drainage tubes may be in place for a few days following surgery. Their purpose is to assist in the healing process by draining away fluid that collects in the area of surgery.

After surgery, the patient is advised to avoid strenuous activity for a period of time, usually between 3-4 weeks. Soreness may occur and depending on if the implant was placed above or below the muscle can last 4-10 days. Swelling may occur for up to 6 months after the surgery. Over the counter medication such as acetaminophen may be recommended to reduce pain and swelling. A surgical bra may be recommended for a few days to a few weeks after surgery to help with pain management and swelling.

Possible complications that can arise post surgery:

• Pain in the breast area

• Bleeding

• Infection

• Changes in nipple or breast sensation

• Scarring externally at the incision sites or scar tissue hardening the area around the implant

• Problems with the size and shape of the implant, such as asymmetrical breasts, or rippling effect of the implant

• Possible rupture and leak of the implant

Your doctor can advise you on what to do in case any of these complications occur.

Breast lifting, also known as mastopexy, is a procedure that removes excess skin, tightens the surrounding tissue, and may reposition the nipples higher on the breast wall. This surgery can be performed on its own if the patient is satisfied with the size and shape of their breasts or in conjunction with a breast augmentation if the size/shape is not satisfactory.

Several factors can affect the elasticity and shape of the breasts over time is pregnancy, breast feeding, weight fluctuations, genetics, and age. A breast lift can give a more youthful profile but will not add fullness to the breast. Good candidates for this type of surgery are women who are healthy and maintain a stable weight, do not smoke, have experienced a change in the shape of their breasts that could be described as flatter, pendulous, sagging, or lacking in firmness, or whose nipples and areolas point down or fall below the breast crease.

A common breast lift surgery is an outpatient procedure using general or local anesthesia. An incision is made around the areola, running vertically from the bottom edge of the areola to the crease underneath the breast, and a final incision horizontally beneath the breast following the natural curve of the breast crease. Excess breast skin may be removed and then the areola and nipple will be raised to a higher position. The areola can be reduced in size during this process. Finally breast skin that may have been located above the areola previously can be brought down and together underneath to create a firmer breast profile. The nipples and areolas remain attached to the underlying tissue and this usually allows for the preservation of sensation and ability to breast feed.

The patient should avoid heavy lifting for several weeks but can normally resume activities such as work in as little as one week after surgery. Complications with this type of procedure are rare but can include bleeding, infection, and scarring.

Breast reduction, commonly termed reduction mammaplasty, is a procedure which removes breast fat, tissue, and skin to reduce the size and shape of the patient's breasts. Breasts that are disproportionately large to a person's body can cause physical and emotional problems such as head, neck, shoulder, and back pain and/or self-consciousness.


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