Information about Surgery and Recovery for Breast Augmentation
Breast Augmentation Surgical Procedure
Site of Incision
Four different incision sites are used for "primary" breast implant surgery, meaning the first breast implant surgery for that patient. Each has its advantages and disadvantages. All can produce a very acceptable cosmetic result. The choice largely depends upon the surgeon's training and preference, the patient's specific wishes, and the planned position of the implant.
- Inframammary (lower breast crease): Placed beneath the breast, in the crease where the lower breast meets the chest, this is one of the two most common incisions. Its advantages are that it provides a direct view of the breast, direct implant placement, and may be the simplest of the implant techniques. Its disadvantages are that it can produce the most visible scarring (except in pendulous breasts) and involves visible incisions of 1.5 - 2.5 inches in the lower breast tissue.
- Areola (in the nipple complex): The areola is the pigmented, soft tissue surrounding the nipple, which varies widely in color, size, and consistency, depending upon the individual. A 1.5 inch incision is made in the lower areola, near the edge of the pigmented area. This is the other of the two most common implant incisions. Its advantages are that it provides a direct view of the breast, direct implant placement, and a scar which is usually less visible than the inframammary incision. Its disadvantages are that it can leave visible scarring in the inferior areola, breast-feeding may be somewhat more difficult (this is debated), it is the only type of incision which directly invades breast tissue, and the chances of decreased nipple sensation are slightly higher.
- Axillary (in underarm hollow): A 1.5-2 inch incision is made in the upper "dome" of the armpit. This is the least common of the incisions. Fewer than 10% of implant surgeons perform this technique. Its advantages are that it is the least visible of the incisions and scars (unless the patient is a ballet dancer), it provides direct access and implant placement, it does not invade breast tissue, and it is the best incision for sub-fascial placement of the implant. Its disadvantages are that it is not widely known, it provides less direct visibility for the surgeon, and it is somewhat more technically difficult than the inframammary or areola incisions.
- Trans-Umbilical (TUBA, through "belly button"): A small incision is made in the "belly button", and a one-inch hollow tube is then advanced under the stomach skin (over the stomach muscles) to the breast area. The entire dissection and implant placement is done through this tube path. It is the most recent of the incision styles, and is usually used for placement of the implant above the muscle (sub mammary placement). Its advantages are that the incision is almost invisible, and no scarring of the breast tissue is involved. Its disadvantages are that the surgeon is working a large distance from the site, correct and consistent implant placement and positioning are very difficult (some say almost impossible for sub pectoral or subfascial placement), and postoperative discomfort can be significant.
Type of Implant
Before 1992 and the FDA scare, seven implant manufacturers existed. Today, only Inamed and Mentor survive. Saline implants produce a reduced incidence of capsular contracture and require smaller incisions.
Different shapes and "projections" are available, and the saline "bag" surface can be textured or smooth. The literature regarding implants is massive and confusing, and different surgeons constantly debate which implant type and shape is the best. Most surgeons whom I respect and have worked with prefer the following implant characteristics for primary implantation:
- A smooth shell, without texturing, filled with saline
- Spherical (not "anatomic" or "teardrop") shape
- High profile
Hospital, Surgical Center, or Office Surgery
Breast implant surgery can be safely and effectively performed in any of these settings. Surgical center and office settings are usually more convenient for all involved, are more confidential, have lower rates of infection, are usually less expensive, are usually very safe, and provide a pleasant surgical experience.
Anesthesia Type: General, IV Sedation, or Local
This will depend upon your preferences, the surgeon's preferences, and the facilities available. True local anesthetic is the safest, but is rarely adequate for breast implant surgery, except in very unusual cases. IV sedation is also very safe, and is routinely performed in almost all ambulatory surgical centers and many offices. An example of this type of sedation is the IV anesthesia routinely given by oral surgeons (dentists with advance anesthetic and surgical training) for the extraction of wisdom teeth. General anesthesia involves intubation (a tube in your throat) and a breathing machine. In many situations, for breast implantation in most healthy females, this is also a generally safe procedure. We use conscious sedation, without any general anesthesia or tubes.
Placement & Position of Implant
The surgeon's preferences and experience will almost always be the determining factor. This decision should be discussed with you in detail, because the position of the implant is critical to the final appearance, the possible complications, the incision placement, and your satisfaction with your ability to function with the implant. Three types of placement are possible: Sub-glandular (under the breast, but over the muscle); Sub-pectoral (under the muscle); and Sub-fascial (under the breast, over the muscle, but under the very tough covering of the muscle, the fascia).
As you can see, each of the implant positions has its advantages and disadvantages. This is why discussion with your surgeon is critical.
Advantages of Placing the Implant under the Muscular Fascia
- Discomfort and operative injury are less
- Rippling of the implant under the skin is decreased
- Flattening and distortion of the inflated implant are less
- The implant "rides" in a lower, more natural looking position
- Surgery control is better, bleeding is reduced
- Less tethering of the implant to surrounding tissues
- The breasts feel softer, and more natural
- Better results for mild to moderately sagging breast
|Placement of Implant||Under Gland||Under Muscle||Under Fascia|
|Ease of surgery||Equal||Most difficult||Equal|
|Potential Surgical Bleeding||Slightly higher||Slightly less||Slightly less|
|Discussed in literature||Frequently||Frequently||Uncommonly|
|Popularity with patients||Somewhat less||Somewhat higher||Somewhat higher|
|Hardness with capsular contracture||More||Less||Least|
|Muscle movement keeps implants softer||No||Moderate||Mild|
|Done with TUBA incision||Frequently||Sometimes||Rarely|
|Done with underarm incision||Sometimes||Rarely||Frequently|
|Done with sub mammary or areola incision||Frequently||Frequently||Rarely|
|Chances of a "stuck on" or "softball" look||More||Less||Less|
|Implants separated from breast tissue by muscle or fascial barrier||No||Yes||Yes|
|Chance of nipple numbness||Slightly greater||Slightly less||Slightly less|
|Mammography Interpretation||More difficult||Less difficult||Less difficult|
|Comfortable for serious amateur athletes or very active women||More comfortable||Less Comfortable||More comfortable|
What Are My Choices At Trillium?
At Trillium, we offer only the following:
- You may choose the volume of the implant. With some exceptions (and some special circumstances), Dr. Sampson strongly suggests volumes less than 375 cc. If we can safely abide by your chosen size, we will.
- High profile, saline Mentor implants
- Sub-fascial placement position
- Axillary (underarm) incision (without incisions or scarring of the breast)
- Conscious (IV) sedation in our office surgical suite
*These choices are made for maximum safety, minimal complications, shortest downtime, and the best looking, longest lasting cosmetic result possible. This is what we would suggest for our families and friends.
About Mastopexy or Breast Lift Surgery
Surgery to lift the breast and/or nipple is sometimes performed during breast implant surgery. With one exception (internal mastopexy), this surgery involves scars on the breast, sometimes around the areola, sometimes under the breast fold, often in a line from the nipple complex to the inferior breast fold.
Some surgeons will attempt to lift the breast while enlarging it with an implant. Attempting to lift the entire breast any discernable amount with only skin incisions and tension (after making the breast even heavier than it was with an implant) is illogical, temporary (3-5 yrs) at best, and often leads to significant complications.
Surgery to lift the nipple, while often initially successful, involves a scar along the top half of the nipple/areola complex, at the very least. In the best cases (assuming that the breast is not enlarged at the same time) the results may last 4-8 years or less.
Office, conscious (intravenous) sedation for breast augmentation is very safe, very common, and assists in the rapid recovery from surgery. Implantation with only local anesthesia (for a patient who is awake) is impractical, and would be extremely unpleasant. Although general anesthesia is also often used, the anesthesia recovery time is then prolonged.
At Trillium, the CRNA (Certified Registered Nurse Anesthetist) will give you an intravenous relaxant prior to beginning surgery, and during the operation. During surgery, you are breathing for yourself (without a tube in our throat), but not aware of the surgery or being in the operating room. The surgery should take less than 1.5-2 hours. Following surgery, you awaken very quickly, and should be able to leave after a recovery period of less than 45 minutes.
You may return to work or most normal activities after 2-3 days.
These are examples only. Return visits are the day after surgery, one week after surgery, one month and two months after surgery, and one year after surgery. We strongly suggest yearly follow-up exams, for which there is no charge. You are given a comprehensive list of do's and don'ts after surgery.
Your Trillium Consultation for Breast Augmentation Surgery
- You will not be charged for your consultation.
- Allow an hour for your consultation.
- If you have questions, write them down before you arrive at the office.
- Please bring a list of all the medications that you take, and all previous surgeries.
- It never hurts to bring a friend or loved one with you; sometimes they will hear something that you don't.
- If you have breast pictures that you would like to use as examples, bring them.
- If you would like to estimate the size of the implants which you might like (using the methods discussed earlier) by all means, bring that information, and a non-padded, non-elastic bra with the cup size you would like to fill (after the surgery). We have "sizers" in the office. If you have a bra size that you would like to be, or any other ideas, bring those as well.
- If you have had previous implant surgery, we will be glad to examine you and consult with you. If you need further surgery, and it is not within the scope of Dr. Sampson's practice, he will be glad to suggest other surgeons whom he respects.
- Do not schedule your consultation until six months after your delivery (if you are not breast-feeding), or at least four months after you stop lactating and/or breast-feeding.
What Pre-Operative Evaluation Does Trillium Require?
|Evaluation||What Ages?||How Soon Before Surgery?||Comments|
|Blood Tests including HIV & Hepatitis||All||Within 1 month||Included in surgical fee|
|Mammogram||All over 29 years of age||Within 1 year||Often covered by insurance|
|Pregnancy Test||All||Within 24-48 hours||Done in our office, no charge|
|Written proof of breast exam by internist, ob-gyn, family doctor, or other doctor familiar with your breasts||All under 30||Within 1 year||All under 30 years of age|
|Chest x-ray||All over 50||Within 1 year||Often covered by insurance|
|EKG-electrocardiogram||All over 45||Within 1 year||Often covered by insurance|
Learn More About Breast Enlargement:
- General Information about Breast Augmentation
- Risks and Possible Complications of Breast Augmentation
- Costs of Breast Augmentation
- Frequently Asked Questions about Breast Augmentation
- Links to Additional Information about Breast Augmentation
- Things to Consider Before Cosmetic Surgery