The decision to undergo breast augmentation and the surgeon you choose are very important, but the decisions don’t stop there. There are many other factors to consider and choices to make regarding this surgery. During your consultation, your surgeon hopefully discuss these options with you and fully educate you on every option so that you can make the decisions that are right for you.
Step 1 – Anesthesia
Breast Augmentation is typically done under general anesthesia with an anesthesiologist who will put you completely asleep, with a temporary breathing tube. Very rarely are breast augmentations done under local or tumescent anesthesia with sedation. Not every surgeon has privileges at a facility accredited for general anesthesia so be sure to ask. Medicines are administered for your comfort before, during, and after your surgery. In healthy patients with no significant medical history, the risks of general anesthesia are very low and complications from anesthesia are rare.
Step 2 – The location of incision
Incisions are made in an inconspicuous locations to lessen noticeable scarring. You and your surgeon will go over which incision location options are available for your individual anatomy and desired result. Incision alternatives consist of:
- Inframammary incision. This incision is ideal for most patients with a well-defined inframammary fold and those who do not want a scar around the areola or nipple. It generally heals very well and is hidden in fold underneath the breast. It can be used easily for silicone implants and can be used repeatedly for future replacements or revisions.
- Transaxillary incision. This is ideal for patients who don’t want any scars on or around the breast. The incision may be visible when in a swimsuit or sleeveless dress but only when you raise your arm. It is more difficult place silicone implants through this incision and also difficult to perform revsions since it offers less direct vision of the pocket. Some surgeons use a camera or endoscope to perform this approach.
- Periareolar incision. This is also known as the nipple incision and is placed from 3 o’clock to 9 o’clock around the areola. It generally heals very well and can be used to place silicone or saline implants, and can be used for revisions easily as well. Because of the placement on the border of the areola, these incisions are barely visible once healed. There is slightly higher risk of nipple numbness and slight increase incidence of infection with the nipple incision since the milk ducts do contain a small amount of bacteria.
Not depicted here is the trans-umbilical or belly button incision, which is only done by a few surgeons and can only be done using saline implants.
Incisions differ based on the kind of implant, degree of enlargement desired, your pre-existing anatomy, and patient-surgeon preference. Each incision has advantages and disadvantages, so be sure to discuss all of these options with your surgeon.
Step 3 – Implant selection: Silicone breast implants or saline breast implants?
Saline implants are essentially made of a silicone “shell” that has a valve much like a balloon through which sterile saline or salt solution is injected after the implant is in place. They can be filled with different quantities of saline which can impact the shape, suppleness and feel of the breast. If the implant happens to leak, which is rare, the saline will be harmlessly absorbed by the body since it is essentially the same composition as the water in your body. If this happens, the implant can be replaced immediately.
Silicone or “gel” implants made of the same silicone “shell” but are pre-filled with a silicone gel solution which is an elastic semi-solid material. Silicone gel implants do not have a valve and cannot be adjusted. Silicone gel implants are more pliable and feel more like natural breast tissue compared to saline implants. A leaking silicone implant may not collapse. Because the gel is a solid, it will generally stay confined inside the shell and does not “flow” out like a liquid. You should see your cosmetic surgeon regularly to ensure the implants are working as they should. An ultrasound or MRI screening can examine the condition of implants breast augmentation and the time frame may vary.
Implant suppliers or inventors occasionally come out with brand-new designs and kinds of implants, so there might be extra options available.
The FDA currently approves Saline implants for augmentation in women 18 years of age and older.
The FDA currently approves Silicone implants for augmentation in women 22 years of age and older.
Be sure to discuss the pros and cons of each implant type with your surgeon to determine the right type for you.
Step 4 – Placement of the implant and pocket type
After the incison is made, a breast implant is inserted into a pocket either:
Beneath the pectoralis muscle (a submuscular placement), or.
Right behind the breast tissue, over the pectoralis muscle (a submammary / subglandular placement).
In general, submuscular placement is the preferred placement due to increased tissue coverage of the implant. In this method, approximately 10% of the pectoralis muscle is cut or “released” at it’s inferior and medial attachment to the sternum in order to make room for the implant. There may be mild movement of the implant when flexing the chest muscles, but this is generally not bothersome to most patients. Most patients do not notice a significant change in strength of the muscle either.
In some cases the subglandular placement is preferred like when there is mild ptosis and no lift is being done, or in body-builders and males who have thick pectoralis muscles or need full function of these muscles.
Make sure you discuss this very important aspect of the implant placement with your surgeon as each surgeon may have a different preference or insight.
Step 5 – Size of the implant
Once the type of implant, incision, and placement of the implant is decided, the size of the implant needs to be determined. This should be done using measurements on the chest and breast as well as sizers or simulators to approximate the final result. Keep in mind that your surgeon should help you realize your aesthetic goal, but there are limitations on the size of implants that can be placed, especially if your breasts are very small and your skin is very tight. Your surgeon will help guide you in making a good aesthetic decision to achieve your look, while not exceeding the safe range in terms of your pre-existing anatomy.
Step 6 – Set your date prepare for recovery
Remember that although it is a cosmetic and elective procedure, it is still a surgical procedure so you must plan accordingly. When choosing your date, make sure to allow plenty of time for recovery as well as time for the breast to settle into their final result. A good rule is to plan your schedule around your surgery and not the other way around. Because it is a surgical procedure, there is always the possibility of unpredictable healing process or complications that are unforeseen, so be prepared for additional healing time if necessary. If you have significant medical history or have certain risk factors, you may need to do some pre-operative tests like lab work or EKG or a mammogram prior to your surgery.
Overall, breast augmentation is a very safe procedure for most with a very high satisfaction rate. You will increase your chances of being satisfied with your result if you take the time to educate yourself on what to expect and the options you have. A good surgeon will make guide your through the decision-making process and make sure you are fully educated in your decisions.
Best of luck on your journey!
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