To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
To correct a decrease in breast size or shape after pregnancy or weight change.
To balance a difference in breast size.
As a reconstructive technique following breast surgery.
By inserting an implant behind each breast, or even just one breast, surgeons are able to increase a woman’s bustline by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure–when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances.
The best candidates for breast augmentation
The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.
Breast augmentation is usually done to balance a difference in breast size, to improve body contour, or as a reconstructive technique following surgery.
Types of implants
A breast implant is a rubber shell filled with either silicone gel, hydrogel or a salt-water solution known as saline.
Saline-filled, hydrogel or silicon-filled implants continue to be available to breast augmentation patients on an unrestricted basis.
Implants are categorized according to their shape and texture. There are implants which have a smooth shell and those that have a textured shell. The texture of the implant may influence the likelihood of capsular contractures. Textured implants have a much lower likelihood of forming capsular contractures or hardness. Implants are also classified by their shape. There are two different shapes for saline filled implants – round and tear drop shaped. The round implants are measured by their fill volumes. The tear drop shaped implants are measured by their dimensions, such as their height, width and projection (ie, how far they push the breast outward). Since every patient’s body type is different, as are their goals for surgery, the wide range of sizes and shapes of the tear drop shaped implants enable the surgeon to match an implant which is precisely sized and shaped for you. By measuring the dimensions of your rib cage over the area where your breasts lie (or should lie), an implant is selected that corresponds to those measurements. This enables your surgeon to create beautifully shaped, natural looking breasts. There is fullness and a gentle slope to the upper breast, and pleasing roundness in the lower breast.
All surgery carries some uncertainty and risk
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant. The texture of the implant selected for you and its placement under the muscle can reduce the likelihood of capsular contracture.
Bleeding and infection after surgery is extremely rare. .
Temporary changes in nipple sensation can occur. Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.
There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.
Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. Replacement of a deflated implant is very straightforward and should be performed within a few days. No recovery is necessary for this procedure.
While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.
Planning your surgery
In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. Detailed measurements of your body and breast proportions are performed to help you select an implant. If your breasts are sagging, your doctor may also recommend a breast lift.
Be sure to discuss your expectations frankly with your surgeon. He should be equally frank with you, describing your alternatives and the risks and limitations of each. And, be sure to tell your surgeon if you smoke, and if you’re taking any medications, vitamins, or other drugs.
Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.
Preparing for your surgery
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.
While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Where your surgery will be performed
Your surgery will be performed in a hospital outpatient facility. You will go home after release from the recovery room.
Types of anesthesia
Breast augmentation is performed with a general anesthesia, so you’ll sleep through the entire operation.
The method of inserting and positioning your implant will depend on your anatomy and your surgeon’s recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. It also prevents any interference with the milk ducts and blood supply to the breast.
Incisions are made to keep scars as inconspicuous as possible, in the breast crease, around the nipple, or in the armpit. Breast tissue and skin is lifted to create a pocket for each implant.
Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.
Placing the implants behind your chest muscle reduces the potential for capsular contracture. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue.
The surgery usually takes one to two hours to complete. Many layers of internal stitches are used to close the incisions, which will be taped for greater support. There are no outside stitches. After surgery, breasts appear fuller and more natural in tone and contour. Scars will fade with time.
After your surgery
You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.
You will wear a supportive bra around the clock for the first 6 weeks after surgery. You may also be given a bandeau to help hold the breasts in position. It takes several weeks for the swelling to disappear. It takes even longer for the breasts to assume their final shape and softness. Getting back to normal
You should be able to return to work within 3-7 days, depending on the level of activity required for your job.
Follow your surgeon’s advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. Most patients can resume exercise, such as walking, treadmill, stairclimbers, at one week after surgery. Running and weight lifting can be resumed approximately 6 weeks after surgery.
Your scars will be firm and pink initially and then gradually fade and flatten for up to a year after surgery. You will be provided with a cream to help your scars heal and fade quickly
Your new look
For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.
Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.
Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.
Breast reduction (reduction mammaplasty) and breast lift (mastopexy)
Breast Reduction is a procedure designed to reduce the size of a woman’s breasts. This is done for both medical and cosmetic reasons. What is Breast Lift?
Breast lift surgery removes the excess skin of sagging breasts without greatly reducing the size of the breast. It is usually done as a cosmetic procedure.
You should expect that your breasts will be reduced to the size and shape that you discussed with your surgeon prior to surgery. They will be smaller, lighter and firmer. You should expect to be more comfortable and have fewer problems related to large breasts after the surgery.
The scars of breast lift or reduction are noticeable and the fold of fat that is often present under the arm will not be removed during the surgery. Scars are easily hidden under a bra or bathing suit.
Breast reduction is suitable for women who feel that their breasts are too large and/or pendulous or they are suffering physical symptoms related to the weight of large breasts. For example back, neck and shoulder pain, indented bra straps, breathing or skeletal problems or skin disease under the fold of large breasts.
This can be performed in healthy women of any age. This procedure may lead to an improvement in posture, greater range of physical activity, reduce hormonally related breast pain, reduce skin irritation under breast folds and increase self-confidence in women who are sensitive about their large breast size.
Breast lift is suitable for women who are happy with the size of their breasts but are dissatisfied with the sagging and loss of firmness that occurs with age.
This also can be performed in healthy women of any age however, it is more common in older women. It can be performed on women with any sized breasts but results are longer lasting in smaller breasted women.
Mastopexy can be performed in conjunction with breast enlargement using implants to lift and enlarge a woman’s breasts. It may also raise the position of downward facing nipples and reduce the size of large areolae.
In certain circumstances, breast lift and/or reduction can be used to balance asymmetry of breasts or to match a healthy breast to one that has been operated on for breast cancer.
Breast reduction is usually done in hospital and most people are admitted for 1-2 days.
At your initial consultation with your surgeon, he or she will assess your health and examine your breasts, to determine which type of procedure will give you the best possible outcome. Be sure to discuss your expectations with your surgeon.
You will need to inform your surgeon of any medicines or vitamins that you may be taking. You may be asked to stop medications such as Aspirin, anti-inflammatories or Warfarin as they increase the risk of bleeding at the time of surgery. Smoking increases risks of complications and if possible, you should stop prior to your surgery.
You should discuss any other medical conditions that you have as they may influence the surgery or anaesthesia. You should especially discuss any previous treatment for breast cancer. Allergies to any medications should also be reported to your surgeon.
You may require some screening blood tests or X-rays prior to your surgery. Your surgeon will discuss this with you. You will need to arrange for someone to pick you up after your surgery.
If you fall into an older age bracket, you may be advised to have a pre-operative mammogram. This is to detect any abnormalities of the breast tissue or evidence of breast cancer.
Immediately prior to your surgery, your surgeon will need to measure and mark your breasts with a marking pen. Photographs may also be taken for your medical record with your consent.
After surgery, it is normal to have some dressings over your breasts. It is also normal to have some discomfort and pain but this is usually well controlled with analgesic tablets. You will need to return to your surgeon’s rooms for removal of sutures. This is usually around 7-10 days.
You should not drive yourself home from the hospital. You should avoid Aspirin for 2 weeks after your surgery.
Some minor ooze from the surgical wounds is normal for a few days after the surgery. You will need to keep dressings in place until instructed by your surgeon. The wounds should have healed by about 10-14 days after surgery. You may also need a supportive bra for the first couple of weeks after the surgery.
It may be weeks to months before your breasts settle into their new size and shape and begin to really feel normal again. When can I return to Normal Activities?
You will be up and about within one day of your surgery but you will need plenty of rest initially. You can eat and drink, as you feel ready to do so.
Your surgeon will instruct you as to when you can shower and start returning to normal activity. Most people take 2-4 weeks off work.
You should avoid strenuous activity especially heavy lifting for at least 2-3 weeks after the surgery. You will find it uncomfortable to sleep on your front initially therefore you should sleep on your back or side in the first few weeks. Sexual activity may cause the breasts to swell with arousal and should be avoided for at least one week after surgery. When you do start returning to usual activity, start gradually.
Driving a car should be avoided for about 3 weeks after the surgery as it can cause strain on your incisions. Also the pressure of a seatbelt may exacerbate this.
It is not uncommon to experience some emotional instability after surgery but this should pass within a short time. Your initial swelling will have gone down sufficiently by about 2-4 weeks so you can purchase a new bra to wear.
As with any surgery, it is possible for complications to arise. In the hands of an experienced plastic surgeon, these risks are minimised.
If complications arise that require further treatment or surgery, a Medicare and/or private health insurance rebate may apply.
Complications may be related to the surgery or the anaesthetic. These include:
- Wound Infection – usually can be treated with antibiotic tablets. It is more common in smokers and people with diabetes. Occasionally it is severe and intravenous antibiotics may be required.
- Wound breakdown – may require regular dressings to aid healing
- Bruising and Swelling – is to be expected in the early stages after surgery and usually subsides in 1-2 weeks.
- Bleeding – occasionally a collection of blood called a haematoma may occur. This may settle by itself or require a small drainage procedure by your surgeon.
- Chest infection – may develop after a general anaesthetic.
- Keloid Scarring – lumpy, pink scars may occur but is more likely in people who are already known to have this tendency.
- Other – sore throat, blood clots, heart and circulation problems.
Specific Complications related to Breast lift or reduction surgery:
- Asymmetry – complete symmetry cannot be guaranteed, especially if there is a degree of asymmetry pre-operatively.
- Altered sensation of nipple/areola – reduced or heightened sensitivity may be experienced after breast reduction or breast lift. This is usually temporary but may take several months to return to normal. In cases where the nipple and areola had to be replaced as a graft, loss of sensation is usually permanent. In women having a larger breast reduction, this sensation loss can be permanent.
- Loss of nipple or areola tissue – in some cases, the blood supply to the nipple and areola may be insufficient after the surgery and this tissue will die. Reconstruction may be needed. This complication occurs infrequently.
Breast-FeedingBreast lift surgery does not usually interfere with a woman’s ability to breast-feed. Breast reduction however, is more extensive surgery and may interfere with milk production and the ducts that emerge at the nipple. It is not recommended for women who may wish to breast-feed in the future. If the nipples require grafting as part of the surgery, breast-feeding will not be possible.
You should be in the best possible health prior to your surgery. If you are a smoker, it is advisable to stop at least 1-2 weeks before your surgery.
Discuss your medications, allergies and medical problems with your surgeon prior to your operation.
Plan for adequate time off work and other activities to recover as best as possible.
Breast size and shape will continue to change with pregnancy, age, weight loss or gain and other factors. Revisional surgery may be required at some time in the future for any of these reasons.