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Breast Augmentation
Breast augmentation (or enlargement) aims at making the breasts larger and fuller for women with small breasts or those who have experienced a decrease in breast size or shape due to pregnancy or weight loss. Implanted breasts, however, tend to be a bit more round and less saggy than natural breasts of the same size, and do not usually look or feel completely "natural".
What does it cost?
The average cost for breast augmentation in the US is around $3,000; the cost of the augmentation varies from surgeon to surgeon and according to where they practice. In Canada, the cost varies from $5000 to $8,000 CDN. There may be additional costs such as anesthesia, operating room facility, prescription medicines, etc.
What happens during the procedure?
A breast augmentation procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 1-3 hours, but depending on the extent of the procedure, it can take longer. If you are having another cosmetic surgery at the same time as a breast augmentation, overnight hospitalization may be required.
Breast augmentation surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. The surgery consists of making an incision, lifting the breast tissue, creating a pocket in the chest/breast area, and placing an envelope containing a soft, implant material underneath. The incision can be made in the crease below the breast, around the areola or under the armpit. The breast implants can be placed either under the chest muscle or directly under the breasts based on considerations like the anatomy of your breasts, soreness after surgery, exercise activities and interference with mammograms.
Although several types of breast implants are available, the breast implant that is used nearly universally for breast augmentation purposes, is made of a silicone rubber sack, which is filled with a saline solution. Under certain conditions, silicone gel implants can be used, but these breast implants are only offered on a limited basis, under approved studies, due to questions about silicone implants correlated to autoimmune diseases. There are a variety of implant designs, all of which have advantages and disadvantages. Your surgeon will discuss the choice of the breast augmentation implant, reasons for the selection, safety issues and will review with you the size changes that are possible with the operation.
Are there risks or potential side effects?
As with all cosmetic surgery, there is always a possibility of complications following including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics.
Breast augmentation with implants have been the topic of tremendous debate over the past few years. If you are considering this surgery, you should talk to your doctor about the potential side effects and keep up to date with the FDA ongoing surveillance of the safety of implants.
The FDA states that “recently published reports show that breast augmentation patients with silicone gel-filled breast implants do not have a greatly increased risk of some well-defined autoimmune diseases, which were among the serious health concerns surrounding the devices. These include potentially fatal connective tissue diseases such as scleroderma and lupus erythematosus. The new studies do not, however, rule out the possibility that a subset of women with implants may have a small increased risk of these conditions, or that some women might develop other immune-related symptoms that don't conform to "classic" disease descriptions. There are other important safety questions that surround breast implants as well, “including implant rupture rates and the incidence of capsular contracture (shrinking of scar tissue around the implant, which can cause painful hardening of the breast or distort its appearance).
The FDA has listed the following as potential side effects of saline breast implants:
Surgical Risks
All surgery carries risks. These are some of the potential risks in breast augmentation surgery:
- possible complications of general anesthesia, as well as nausea, vomiting and fever
- infection
- hematoma (collection of blood that may cause swelling, pain and bruising, perhaps requiring surgical draining)
- hemorrhage (abnormal bleeding)
- thrombosis (abnormal clotting)
- skin necrosis--skin tissue death resulting from insufficient blood flow to the skin. Radiation treatments, cortisone-like drugs, an implant too large for the available space, or smoking may increase the chance of skin necrosis.
Implant Risks
- capsular contracture (hardening of the breast due to scar tissue)
- leak or rupture--silicone implants may leak or rupture slowly, releasing silicone gel into surrounding tissue; saline implants may rupture suddenly and deflate, usually requiring immediate removal or replacement
- temporary or permanent change or loss of sensation in the nipple or breast tissue
- formation of calcium deposits in surrounding tissue, possibly causing pain and hardening
- shifting from the original placement, giving the breast an unnatural look
- interference with mammography readings, possibly delaying breast cancer detection by "hiding" a suspicious lesion. Also, it may be difficult to distinguish calcium deposits formed in the scar tissue from a tumor when interpreting the mammogram. When making an appointment for a mammogram, the woman should tell the scheduler she has implants to make sure qualified personnel are on-site. At the time of the mammogram she should also remind the technician she has implants before the procedure is done, so the technician can use special techniques to obtain the best mammogram and to avoid rupturing the implant.
Talksurgery urges its users to read the material surrounding breast implants at the following sites:
Breast Implant Information from the Center for Devices and Radiological Health (CDRH) at the Food and Drug Administration (FDA)
National Center for Policy Research for Women and Families (CPR)
What to expect after a breast augmentation procedure?
Your breasts will be wrapped with gauze bandage as well as a tighter bandage for protection and support. You also may have drainage tubes coming out of the incision for several days, to help drain some of the excess fluid.
The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keeping the head and torso elevated and applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a watertight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving the often-considerable swelling.
After several days, the gauze dressing will be removed. You may be required to wear a support bra to help your breasts form and maintain a balanced shape. You may or may not be able to shower, depending on where your stitches are.
For at least 3-5 days, you should try to keep arm extension to a minimal. Elbows should not be raised higher than armpit level. The tissues will heal more quickly if you avoid stretching and separating muscle/tissue surrounding the breast implants. You may be able to resume work within a few weeks of your surgery. You should still avoid physical exertion for several weeks, depending on the advice of your doctor. Finally, you can expect your scars to be pink for several weeks.
As with any cosmetic surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following breast augmentation surgery. If there is heavy bleeding or increased pain, be sure to inform your surgeon.
How soon does normal life resume?
You will probably be able to resume exercise and normal physical activities within a month or two, when the soreness has subsided. Recovery varies from patient to patient and depends upon the technique, type of breast implant, and site of placement that the doctor uses, as well as the level of activities in your daily routine. Ask your doctor for more specific information.
The stitches will come out within a week to ten days, but swelling may continue, gradually subsiding over several weeks. With the swelling, your breasts may seem hard and unnatural, but eventually they should soften to a more natural feel.
Who performs breast augmentation?
Board-certified reconstructive or plastic surgeons perform breast augmentation surgery. A "cosmetic surgeon" does not necessarily have the same training and patients should verify the surgeons certification with the American Board of Medical Specialties or the Royal College of Physicians and Surgeons in Canada and the UK.
Are you a good candidate for breast augmentation?
While breast augmentation surgery can improve a woman’s body image and self-esteem, it does not remedy pre-existing psychological and personal problems. As with all elective surgery, good health and realistic expectations are prerequisites, but if you are thinking of breast implants you should:
- Make sure that you are free of known allergies to the breast implant material.
- Make sure you are not prone to scarring problems such as keloids.
- Make sure you are not currently pregnant or nursing.
- Tell your surgeon about any and all medical conditions and any allergies you may have and whether you are a smoker as well as any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:
- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed.
- Avoid drinking alcohol a few days before your surgery.
- Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anesthesia.
- Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.
Is there anything else I need to know about breast augmentation?
In July of 2000, the Plastic Surgery Educational Foundation (PSEF) created a Saline Breast Implant Registry (SaBIR). The registry provides physicians and consumers with valid and accurate real-time information about clinical practices and outcomes of patients who receive saline breast implants.
In the US, there is currently no pending or actual law requiring participation in an implant registry; however, voluntary reporting to the registry is viewed by regulatory agencies and consumers as an aspect of good professional practice.
WHAT: The registry collects information from physicians throughout the United States. Some of this information includes implant type and size, incision site, implant position and reasons for re-operations.
The registry is designed so that patient and physician confidentiality is secure.
WHY: PSEF will use this information to provide reports to PSEF members, researchers and consumers about overall patterns of use, fill volume data and procedural characteristics, including various re-operation rates and outcomes. Information will also be used to identify patient cohorts for implant related matters should questions about safety or efficacy arise in the future. In the near future, the registry will be expanded to include all types of breast implants.
Since SaBIR's launch, 25 physician practices have begun to actively submit data. These practices cover the entire United States and Canada. Of these practices, PSEF is pleased to have three general surgeons participating in the registry. PSEF is also currently discussing joining with European communities/countries to establish a global breast implant registry.
HOW: Physicians complete a one-page form, either over a secure internet connection, or on paper, faxing the completed form to a contracted independent consultant who will enter the data into the database.
An annual report of breast implant information will be published in Plastic Surgery News. SaBIR activities will also appear periodically in Plastic Surgery News, and on PSIS.
Please ask your physician to participate in SaBIR. For more information, he/she may contact Mary Lewis, RN at ml@plasticsurgery.org.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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