What is breast augmentation (enlargement with breast implants)?

A breast augmentation is a surgery to enlarge the size of the breast. It can be also be combined with other procedures such as a breast lift (mastopexy) to improve the shape of the breast.  Patients undergo breast augmentation for a variety of reasons including but not limited to volume loss after aging, weight loss or childbirth, uneven breast size, or because of a desire to increase the size of their natural breast.

What happens prior to breast augmentation surgery?

Prior to breast augmentation surgery you will have a consultation with the plastic surgery resident and their supervising staff physician. In this consultation you will discuss your medical history as well as your expectations and desired outcomes.  Your surgeon will discuss the surgical plan and decisions will be made about the type and size of implant that will be used. An examination of your breasts will be conducted which will include measurements and an assessment of skin quality and nipple position Preoperative photographs are taken for surgical planning.

Where is the breast augmentation surgery performed?

All surgeries are performed at Women’s College Hospital as day surgery by the plastic surgery senior resident under the supervision of a faculty plastic surgeon. The procedure itself can take from 1 to 2 hours.

How is breast augmentation surgery performed?

Incisions and Scars

There are three different incisions that may be used to place your breast implant.

With a periareolar approach, a small incision is made at the lower border of the areola where the darker areolar skin meets the lighter breast skin. It may be preferred in patients with a less defined inframammary fold beneath their breast. However, the size of the implant that can be inserted this way may be limited. Because the tissue below the areola contains many nerves and the milk producing glands of the breast, there may more problems with nipple sensation or breast feeding after this approach.

The inframammary fold incision is the most popular incision for breast augmentation. A small incision is made in the inframammary fold where the breast lies over the chest. This allows for easy access for implant placement either above or under the pectoralis muscle.

A transaxillary incision can be made in the armpit (axilla) and a tunnel is created between the armpit and the breast through which the implant is inserted into the desired position. This can only be used for below muscle implants and there is a limitation on the size of the implant that can be inserted in this fashion.

All incisions are made as discretely as possible to minimize the size and visibility of the scar. However, each person heals differently and there will be variation between patients as to the final outcome of their scar. Usually the scar will be red and raised initially and will flatten and fade with time.

Placement of the Implant

There are two locations for implant placement relating the position of the implant to the pectoralis muscle.  Each method has advantages and disadvantages and may produce different aesthetic results.  In the subglandular location, the pocket for the breast implant is made above the chest muscles and below the fatty and glandular tissues of the breast.  This method often produces a rounder breast with more fullness at the top of the breast. It can be a better choice if you have a larger amount breast tissue prior to your surgery. Benefits of this method include a less painful recovery, and a more prominent, rounded appearance. However, there is no muscle coverage of the implant, and in patients with little breast tissue, it may be more visible under the skin and can lead to problems such as a rippled appearance.  In the submuscular location, the pocket for the breast implant is made below the main pectoralis muscle. This method may produce a more natural upper contour of the breasts. Other benefits include less likelihood that the implant will be visible under the skin. Disadvantages to this method include that there will be some animation of the implants with pectoralis muscle contraction.

The benefits and risks to each method will be discussed in detail prior to your operation and the surgeon will help you to choose the method that is best for you based on your individual body type and desired outcome.

Which breast implant is right for me?

There are two main types of implants – saline and silicone implants.

Saline implants are filled with sterile salt water. Varying amounts of saline are injected into the implant to change the size.  These implants are less expensive but can give a less natural feel to the breast after surgery and may have visible rippling in patients with little breast tissue.

Silicone implants are filled with a silicone gel. The newest type of silicone implant is called a cohesive gel implant. These implants are more expensive but are more similar to a natural breast in both feel and appearance.

Other aspects of a breast implant that can be altered to impact the aesthetic outcome include size or volume, vertical height, horizontal width, projection (length front to back), and shape of the implant, which can be round or anatomic (tear drop) shaped.

In your consultation, the advantages and disadvantages of each implant type will be discussed and the appropriate size, shape and type of implant will be chosen to help you achieve your desired aesthetic goals.

Choosing the size of the implant

Implant size is a very personal decision. During your consultation your plastic surgeon will provide you with a variety of implant sizes from which you can choose based on both your preoperative measurements as well as your desired outcome. It is important to think about what your goals of surgery are prior to meeting your plastic surgeon. There are many resources that patients use to help them decide including looking at photos, discussing with friends or family members or looking at websites for before and after comparisons. Once in your consultation, there can be an opportunity to try sample implants in a bra.  A decision about the size of your implants should not be rushed and many patients will take some time to think about their choice after their consultation prior to making their final selection. There is a limit on how large of a breast implant can be used and this is based on your body and the existing shape of your breasts.

What to expect in the recovery? How long will I be off work? When can I resume exercise?

Breast augmentation is performed under general anesthetic. An anesthetist will put you to sleep and monitor you throughout your operation. Once your operation is complete you will be monitored in the recovery room. Once the effects of the anesthesia have worn off you will be able to go home. You will need a friend or a family member to accompany you home from your operation and help you until you are able to manage independently. You will have some soreness and swelling after your surgery and will be given pain medication to help manage these symptoms. You will be required to wear a supportive bra throughout your recovery period. You will not be able to perform strenuous physical activity after your surgery until cleared by your physician. Plan on relaxing and taking it easy for 1 to 2 weeks postoperatively at which time you will likely be able to begin increasing your activity level.  Activity restrictions moving forward will be discussed with you at your follow up visits.

Immediately postoperatively, your breast implants may not appear exactly as you had planned which is normal. Your implants will begin to settle into your desired shape and position as the postoperative swelling subsides. This process usually takes between 3 to 6 months.

What are some common complications of surgery?

Breast surgery is generally very safe however it is not without risk. Your fitness to undergo elective surgery will be determined pre-operatively by your surgeon and risks related to the surgery and anesthesia will be discussed.  If you have preexisting medical problems you may see an anesthesiologist prior to your operation. Some patients may not be suitable for elective surgery due to an unacceptable level of surgical risk although this is very rare.

Risks of breast augmentation include infection (which may or may not require removal of the implant), bleeding and blood clots, pain, fluid accumulation in the implant pocket and complications related to the anesthesia. Sometimes patients complain of difficulty with breast feeding postoperatively or a change in breast or nipple sensation. A scar forms internally surrounding the implant that is called a capsule. This may harden or tighten, a process known as capsular contracture. This can lead to discomfort, breast firmness and an abnormal appearance. Sometimes surgery is required to remove the capsule or implant. As well, skin scars can vary and occasionally can be permanently raised or discolored. Finally, breast implants may have to be changed or replaced if they are damaged (a saline implant deflates or a silicone implant ruptures).

These risks will be reviewed with you preoperatively. It is important to consider these possible early and late complications when deciding if breast augmentation is right for you.

When will I see the final results of the surgery?

Healing after breast augmentation is a gradual process. Some mild swelling may persist for several months. This process usually takes between 3 to 6 months.