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Your Online Guide to Skin Aging and Cosmetic Surgery Procedures.
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Breast Augmentation
Breast augmentation is a commonly performed cosmetic surgical procedure. Surveys conducted in 1998 revealed that up to 34% of North American women were dissatisfied with their breasts. In 2003, breast augmentation was the third most common cosmetic surgical procedure performed by members of the American Society of Plastic Surgery (with only Botox injections and microdermabrasion being more common).
Breast augmentation is designed to add volume and improve the shape of the breasts by the insertion of a breast implant. Alternatively, your plastic surgeon may recommend a breast lift to restore shape and nipple position to the breast. Breast augmentations or lifts are best for healthy women with small breasts, or women who have lost breast volume through childbirth, weight loss or age.
Insertion of a breast implant will hide a small amount of breast tissue from mammogram assessments. Each patient needs to consider this, and discuss with their surgeon. This can be especially important if the patient has a family history of breast cancer.
IDEAL CANDIDATE
The ideal candidate is a younger woman with a normal breast examination, no personal or family history of breast cancer, small breast size, and without inherent breast abnormalities.
LOCATION
Breast augmentation, formally known as augmentation mammoplasty, is performed as an outpatient procedure under general anesthesia in a hospital or surgical clinic, although a combination of local and regional anesthesia is sometimes used instead. For safety reasons, the patient should be accompanied home by a friend or a relative on the night of the surgery.
CONTRAINDICATIONS (some may be relative)
- Multiple surgical procedures on the breasts
- Undiagnosed breast lump(s) or known breast cancer
- Obesity
- Likely or planned future pregnancy
- Medical conditions prohibiting elective surgery
- Unrealistic expectations
PREPARATION
There are some preparatory steps that should be taken prior to surgery to ensure safety and maximum benefit. Alcoholic beverages should be avoided for a week prior to surgery, and anti-inflammatory drugs such as Aspirin®, Motrin®, Ibuprophen, and Advil® should be avoided for two weeks prior to surgery. This is to avoid excessive bleeding, blood clotting, and post-operative bruising. Tylenol ES®, is a painkiller that can be used for those who suffer from chronic pain. Any use of herbal supplements or other alternative medicine should be discussed with your surgeon. Finally, alcohol should be avoided for at least a week prior to the surgery date.
Additionally, any medical condition or medications that are used must be disclosed to your surgeon prior to the procedure. Conditions such as high blood pressure are important considerations in all plastic surgeries where bleeding and hematomas are a real risk.
Smoking is a very important factor in plastic surgery. Chemicals from smoking can cause vasoconstriction of blood vessels, which restricts the blood supply to the newly re-draped and transferred tissues. Smoking must be stopped at least 2 to 3 months prior to surgery in order to eliminate the risk of further tissue loss. It is important to understand that all smokers, regardless of quantity, are at an increased risk of tissue death following surgery, and for this reason, some surgeons will refuse to perform elective cosmetic surgeries on smokers.
Several decisions must be made by the patient and surgeon prior to surgery. Size of augmentation or implant, the type of implant (saline or silicone, round or anatomic, textured or non-textured), the location of the implant, and the surgical approach to reaching the location. Many of these choices are individual, and it is important that you discuss in depth with your physician, the various pros and cons of each of these choices.
THE IMPLANTS
Breast implants were first introduced to the market in the early 1960's, and since then, have undergone many revisions. Concerns over the safety of silicone in the body, and some failures of second generation silicones lead to the end of silicone implants in 1992.
Today's fourth generation breast implants are made of a silicone shell filled with sterile salt water called a saline implant, or a weakly cross-linked silicone gel (standard silicone implant). Most recently, cohesive gel implants have been introduced to the market, which carries less risk of gel bleed. These new implants carry a much smaller risk than the earlier implants.
Implants can vary in size and profile. Your surgeon will help you choose the appropriate size and profile for your body frame based on your preference, and also your body frame and specific anatomy.
Both cohesive and non-cohesive silicone gel implants are available for breast augmentation in Canada. Saline implants are currently the most popular choice for implants, but this may change with the reintroduction of silicone implants to the cosmetic marketplace.
IMPLANT PLACEMENT
Breast implants are placed into tissue pockets created below the glandular breast (subglandular), below the chest wall muscles (submuscular).
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Submuscular Implants |
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Advantages |
Disadvantages |
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Subglandular Implants |
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Advantages |
Disadvantages |
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Discuss implant location with your plastic surgeon and have a clear understanding of all benefits and disadvantages before making the choice that is right for you.
THE PROCEDURE
An incision is made at the edge of the areola under the breast or in the armpit. Difficulties in breast-feeding have been reported with some approaches.
Dissection is performed to create a pocket for implant under the glandular breast itself or under the muscles of the chest wall. A pocket combining both planes may also be employed. The implant is inserted, and filling is performed if a saline implant is used. Incisions are closed and dressings are placed. Many surgeons employ elastic dressings or special tapes to assist in maintaining implant location in the early post-operative period.
The TUBA (Trans-Umbilical Breast Augmentation) technique was designed as a means to insert breast implants through the belly button, in an effort to avoid scarring on the breast itself. This is a controversial procedure due to the complexity of the procedure and the distance between the incision and operation site. However, it is generally thought that, in the hands of excellent surgeons, this procedure is effective, and provides patients with yet, another choice to avoid breast scarring.
THE RECOVERY
The typical recovery time following breast augmentation is 3 to 4 weeks. During this period, a contouring garment or bra is often used. Pain is controlled with prescription medication for the first days, up to a week. Generally, over the counter pain medications should suffice. In some cases, stool softeners may be helpful if a prescription narcotic is required. Bruising and swelling can become noticeable 3 or 4 days after the procedure. This is a normal part of the recovery process, and will subside within 2 to 3 weeks following the procedure.
We recommend a recovery time of a week or more. Booking time off of work, and completing physical chores such as cleaning the house, should be taken care of prior to surgery as you will be unlikely to be able to perform these chores for at least a week. Preparations such as having prepared meals on lower shelves, or arranging childcare for the first few days after the procedure are some of the many preparations that may help you recover.
Work activities should be avoided for 2 to 4 weeks post surgery, and longer in the case of manual labour. It is important to allow 3 to 4 days before engaging in any activities that require any use of the arms. Activities which cause a rise in blood pressure, including sex, should be avoided for 2 weeks. Sports may be resumed after 1 or 2 months. It is important to note that these are only guidelines, as recovery is an individual process, so listen to your body.
POTENTIAL COMPLICATIONS
It is important to understand that any form of surgery carries a certain amount of risk. Although these risks are uncommon, it is imperative that these be discussed with your surgeon. Below are some of the potential risks with a breast augmentation procedure:
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Intra-operative |
Early Post-operative |
Late Post-operative |
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*Formation of a fibrous capsule around ANY foreign body is a normal part of your body's healing. Excessive formation resulting in deformity of the implant is termed a capsular contracture.
† Complication rates increase with the size of implants
For a more detailed discussion on expected results, recovery, and specific complications, please see your individual surgeon.
WHAT TO EXPECT
Pain perception varies widely from individual to individual, but in most cases, the post-operative pain is underestimated. New techniques have been developed to help with this problem. Also, early in the post-operative period, the implants may sit high on the chest wall, usually for 4 to 8 weeks, but this will settle over time. Many women comment that initially, the breasts feel very firm, but will begin to soften over time, although they will never be the same consistency as natural breast tissue. Finally, bruising in the arm pit or abdominal region can occur, and in some cases, can be significant with the trans-axillary or TUBA procedures.
Scarring on the breasts will take approximately 12 to 18 months before they can be assessed. Prior to assessment, it is essential that the scarred area is protected from the sun (using 45 o 60 SPF sunscreens) to prevent permanent darkening of the scars. With proper precaution, most scars should be good to excellent at 18 months. Although rare, some people may experience residual breast numbness.
Despite the above inconveniences, the general patient satisfaction rate is extremely high. Implantation and lifting often have many tertiary benefits. Breast sagging is often reversed by the added volume, and also reduces the appearance of stretch marks. It should be noted, however, that some people can develop new stretch marks if the implanted breast size is very large in proportion to the body size.
COST
Breast augmentation surgery is not covered under the Canadian Medical Plan and the final cost for such procedures will be at the discretion of the plastic surgeon performing the procedure. The average cost of this procedure, published by the Canadian Society of Aesthetic (Cosmetic) Plastic Surgery (CASPS) is $6000 (with a range of $6000-$12,000). Costs will vary based on the implant type used.
DISCLAIMER
This website does not cover all of the medical knowledge related to breast augmentation nor does it deal with all possible risks and complications of surgery on the breasts. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical procedure.