What to expect for breast augmentation

Consultation

During your breast augmentation consultation, be prepared to discuss:

• Why you want breast augmentation surgery, your expectations and the desired outcome
• Medical conditions, drug allergies and previous medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Family history of breast cancer and results of any mammograms or previous biopsies

Your plastic surgeon will also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine and measure your breasts, including detailed measurements of their size and shape, skin quality and placement of your nipples and areolas
• Take photographs
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of breast augmentation and any risks or potential complications

The consultation is the time to ask your plastic surgeon questions. To help, we have prepared a checklist of questions to ask your breast augmentation surgeon that you can take with you to your consultation.

It's important to understand all aspects of your breast augmentation surgery. It's natural to be nervous about it, whether it's excitement for your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with your plastic surgeon.

Question to ask

Use this checklist as a guide during your breast augmentation consultation:

• Are you certified by the American Board of Plastic Surgery?
• Were you trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
• Am I a good candidate for breast enhancement or breast enlargement?
• What will be expected of me to get the best results?
• Where and how will you perform my breast augmentation surgery?
• What shape, size, surface texture, incision site and placement site are recommended for me?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What risks and complications are associated with my procedure?
• How are complications handled?
• How many additional implant-related operations can I expect over my lifetime?
• How will my ability to breastfeed be affected?
• How can I expect my implanted breasts to look over time? After pregnancy? After breastfeeding?
• What are my options if I am dissatisfied with the cosmetic outcome of my implanted breasts?
• How will my breasts look if I choose to have the implants removed in the future without replacement?
• Do you have breast augmentation before and after photos I can look at for this procedure, and what results are reasonable for me?

Preparation

In preparing for breast augmentation, you may be asked to:

• Get a blood test
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin and certain anti-inflammatory drugs as they can increase bleeding
• Stop taking recreational drugs, such as cocaine

Breast augmentation surgery should be performed in an accredited outpatient or ambulatory surgical center or a hospital. This is for your safety. If your surgeon has an informal setting, he or she may not be a board-certified plastic surgeon.

If your breast augmentation is performed on an outpatient basis, arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

Procedure Steps

A breast augmentation procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). A belly-button approach is associated with a higher complication rate.

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting and placing the breast implant

After the incision is made, a breast implant is inserted into a pocket either under the pectoral muscle (a submuscular placement) or directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement).

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon's recommendations.

Step 4 – Closing the incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin.

Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

Step 5 – See the results

The results of breast augmentation are immediately visible. Get more information about breast augmentation results.

Recovery

During your breast augmentation recovery, your breasts will be wrapped in gauze dressings and an elastic bandage or support bra will minimize swelling and support the breasts as they heal.

Immediately after surgery, you will be taken into a recovery area for close monitoring. You may be permitted to go home when you are stable for discharge, typically after an hour or so.

Before leaving, you will be given specific postoperative instructions for your breast implant recovery and a follow-up appointment with your plastic surgeon. You may also receive medications or a prescription, but many plastic surgeons prescribe postoperative medications in advance. Your prescribed medications may include pain pills and an antibiotic to prevent infection.

Wear your support garment (a bra or elastic band, called a bandeau) around the clock as instructed by your plastic surgeon. Some surgeons may ask patients cleanse the incision sites and apply ointment, while others will ask their patients to keep tape or a bandage on. Instructions vary, so it's important to follow all your plastic surgeon's directions carefully.

Because it is possible to bleed into the pockets around the breast implants for the first several days, take it easy until you have permission to increase your activity level. Acute pain typically subsides after one to five days, but you may experience soreness and swelling for a few weeks. Resume exercise and normal activity according to your plastic surgeon's directions.

Results

While a breast augmentation yields larger breasts right away, the final results may take a few weeks as the swelling subsides and the skin stretches. Some patients may need to wear a bandeau to help shape their breasts, especially if they have underlying asymmetry or very small breasts to start with. Incision lines may take several months, even a couple of years, to fade.

To achieve optimal breast augmentation results, follow your surgeon's postoperative instructions and return for follow-up visits.

Breast implant replacement

Breast implants are not considered to be lifetime devices, and they may need to be replaced. You can see your plastic surgeon for an annual examination to evaluate your breast health and implant integrity.

Over time, your breasts will change due to aging, weight fluctuations, hormonal factors and gravity. As the appearance of their breasts changes with time, some patients have a breast lift or an implant exchange to restore a more youthful contour.