How is a breast augmentation done?

The underlying concept of a breast augmentation is the same no matter how the operation is done. A pocket is made under the breast and an implant is placed in this pocket. Only one kind of implant is available for general use in the United States. This is a saline filled implant. This has a silicone plastic outer bag and is filled with salt water. Elsewhere in the world silicone gel implants are available. Other implants, including those filled with a soy products, are under investigation at this time but a return to gel implants seems likely, including in the United States.

 

Saline filled implants are available with two types of surface, rough and smooth. The traditional implant has a smooth surface and was found to have a higher rate of hardening of capsule. The smooth implant is now used mainly under the muscle. A rough or textured implant is commonly used above the muscle because it seems to reduce the risk of capsular hardening. It is important to know what type of implant you have placed because after surgery most surgeons do not recommend massaging textured implants but do recommend massaging smooth implants

 

Implants also come in two main shapes, round or pear shaped (anatomical). Some surgeons believe that the anatomical implants produces a more natural shape to the breast. Other surgeons disagree. Some believe that anatomical implants may have an increased risk of folding of the silicone envelope which may lead to tearing.

 

The implant can be placed under the gland of the breast or more deeply under the muscle of the chest wall. One position is not better than another. The position must be decided on an individual basis. There is no perfect operation so wherever the implant is placed there will be good and bad effects. In general placing the implant under the muscle places it further from the surface so that the implant is less likely to be felt. Capsule formation is also less likely to contract. Placing the implant over the muscle usually produces a more natural look and does not have the disadvantage that when the muscle contracts the breast changes shape. Patients who already have a significant amount of breast tissue are often advised to have the implant above the muscle because as time passes the implant will remain high because of the muscle but the normal breast will tend to droop which may cause a bilobed or double breast.

 

Several incisions can be used to position the implant. Again no incision is without problem and no approach is perfect. Each case must be decided on the needs of the patient. Incisions in the arm pit are sometimes used to put the implant under the muscle. This is a direct route to the pocket but has the disadvantage that the incision is always visible when the arms are raised. An incision around the nipple may not be appropriate in women who may want to breast feed in the future. An incision on the undersurface of the breast is always concealed by clothing and provides a direct access to the pocket. If placed too high it may become thick and if placed too low it will show if the arms are raised and a bikini or bra rides up. Some surgeons use an incision in the navel and burrow up under the skin into the breast area. This is called an endoscopic approach. It is suitable for some patients but is not widely used.

 

The pocket is made a little larger than the implant. The pocket for smooth implants is usually made significantly larger than for a textured implant. After the pocket is made the surgeon checks for bleeding and often washes out the pocket with an antibiotic to reduce the risk of infection.

 

The incision is then closed. There are many different methods used to close the skin. Most doctors use stitches and sometimes dissolvable stitches are used.

 

Surgeons use many different kinds of bandage. They all have in common a need to apply some compression and keep the area rested. A commonly used and simple dressing is a wide ace bandage.