1. What is breast augmentation?

Breast augmentation is a surgical procedure where the breast is enhanced by inserting, saline or silicone implants which can be placed either underneath the chest muscle or on top of the muscle.


2. How should one prepare for breast augmentation surgery?

Probably the most important things to do is to make sure that one is seeing a truly Board Certified Plastic Surgeon and probably the best way to do that is to visit the website of the American Society of Plastic Surgeons as all members of the American Society of Plastic Surgeons are members or are certified by the American Board of Plastic Surgery. Their website is www.plasticsurgery.org.

It is important to select a surgeon that you are comfortable with and it may be necessary to get several consultations before one finds a surgeon you really do feel comfortable with. Anytime someone has a consultation and either they are not comfortable, they don’t feel comfortable or they feel like they are being rushed into surgery, it’s probably a good idea to get another opinion.

It’s also important before surgery to listen to the plastic surgeon because there are a lot of things to do to get ready for surgery. Certainly it is best to avoid things that could cause problems in surgery such as smoking, or taking medications that would increase the risk of bleeding like aspirin, Ibuprofen, Vitamin E and things of that nature. Most surgeons would give their patients a list of medications to avoid before surgery.


3. How is a breast augmentation surgery performed?

Breast Augmentation surgery is performed under some form of anesthesia as an outpatient. Anesthesia can be an epidural anesthetic or a general anesthetic. Most patients probably have a general anesthetic. A small incision is made either underneath, in the crease underneath the breast, around the edge of the areola, or in the armpit. A pocket is created to insert the implant. It can be placed on top of the muscle but most surgeons these days would have the implant placed underneath the muscle.

A saline or silicone implant can be used. The decision as to which one a person chooses depends on what their goals are and what their concerns are with the different types of implants. Saline has the advantage of a smaller incision and the cost is less, and it’s very easy to tell when the implant has ruptured. Silicone implants are more expensive, around a $1000 per pair. The incision has to be a little bit larger and it’s difficult to tell when silicone implants have ruptured.

Currently the FDA recommends that if a patient gets silicone implants they should have an MRI every couple of years looking for rupture because it can be difficult to tell by examination. As I said earlier the procedure is one as an outpatient. The incisions are typically closed with sutures and are generally removed about a week after surgery.


4. What are the possible immediate post-operative risks in breast augmentation surgery?

I will tell you the probable risks. That’s possibly what you are concerned about. The immediate risks of surgery, with any type of surgery would be anesthesia, and that’s something that could be discussed with the anesthesiologist prior to surgery. Bleeding is a risk. Therefore avoiding the medications which I mentioned earlier, prior to surgery is important. Infection is one of the biggest risks in breast implant surgery. If an implant were to get infected it is possible that it would have to be removed and then you will have to stay out for at least 3 or 4 months before another implant could be put in. Therefore, most surgeons will put patients on antibiotics at least for a short period of time around the time of surgery.


5. What are the possible longer-term risks in breast augmentation surgery?

The long term risks include things like numbness to the nipple. It is not uncommon to have temporary numbness initially after the surgery, or temporary hyper-sensitivity to the nipples. The concern really is more of a long term loss of sensation and that happens probably ten to fifteen percent of the time. It does have a relation somewhat to the size of the implant that is put in, because for the larger implant, a larger the pocket that has to be created and therefore it is slightly bigger surgery creating a slightly higher risk of numbness to the nipples. So then probably 10 - 15% is a pretty common average.

Other long term concerns include capsular contracture which is the scar tissue that forms around the implant, and if the scar tissue compresses the implant it makes the implant hard which makes the breast hard and that can also be painful. Capsular contracture has a lower risk when the implants are put underneath the muscle, which is one of the advantages of putting them underneath the chest muscle. And saline implants can have a lower risk of capsular contracture than silicone implants.

Deflation of the implant is also a concern and this can happen within months or it may take 30 years for it to happen. As a general rule at the current risk rate of deflation of the implants most patients are going to probably go at least 15 maybe 20 years before having a deflation. Both breast implant companies currently provide a lifetime warranty for the implants. If either implant ruptures the patient will receive a free implant. And if that happens within the first ten years currently both implant companies will provide patients with an additional 1,200 dollars towards the cost of replacing the saline implant and up to 3,500 dollars towards the cost of replacing a silicone implant.


6. Who is not a good candidate for breast augmentation?

Patients that have a very high risk for breast cancer, such as someone whose mother has had pre menopausal breast cancer, and additional say sisters that have had breast cancer, may not be good candidates simply because the implants will be a hindrance in doing a mammogram and they can make it more difficult to identify a breast cancer. That’s another advantage of putting the implants underneath the muscle as they do tend to be non interfering when doing a mammogram. Any patient that simply is not healthy enough to undergo surgery obviously will not be a good candidate for breast augmentation. And anyone who has an ongoing infection somewhere in their body would not be a good patient.

I think in addition patients need to psychologically prepare for surgery. Occasionally patients will possibly use breast augmentation as something to help with their marriage, or do it at a time when they are getting divorced which I think is a mistake. They need to be in a really good frame of mind and probably let those secondary things get resolved before considering having surgery at this time.