Augmentation mammaplasty (breast enlargement) is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty is not a substitute for mastopexy, which is a procedure to “lift” breasts that sag significantly.
Augmentation Mammaplasty with Implants
Silicone and saline are the two implant types most commonly used in augmentation mammaplasty. Silicone implants feel more like natural breasts than saline ones. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant has an extracapsular rupture (a rupture to the outer capsule), silicone filler leaks into the body, possibly resulting in inflammatory nodules or enlarged lymph glands.
Implants are placed behind each breast, underneath either breast tissue or the chest-wall muscle. The procedure lasts 1 to 2 hours, and is typically performed with general anesthesia, although local anesthesia combined with a sedative may be used. Incisions are made in inconspicuous places (in the armpit, in the crease on the underside of the breast, or around the areola) to minimize scar visibility. The breast is then lifted, creating a pocket into which the implant is inserted.
Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around implant), and less interference during mammograms. Disadvantages include the possible need for drainage tubes, and a longer recovery period. Advantages of implant placement beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles, and that slight breast sagging is corrected.
Other types of implants include “gummy bear,” round, smooth and textured.
Augmentation Mammaplasty with Fat Transplantation
Augmentation mammaplasty with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Augmentation mammaplasty is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible.
For a number of weeks prior to augmentation mammaplasty, tissue expanders may be placed below the muscles of the chest wall to expand the breasts, and increase the amount of fat they can hold. When the tissue has expanded enough, augmentation using fat transfer can begin. First, fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified. In the second procedure, which takes place on the same day, the fat is injected into the breast through small incisions. The procedure takes approximately 4 to 5 hours.
Recovery from Augmentation Mammaplasty
After augmentation mammaplasty with implants, drainage tubes may be inserted; incisions are stitched, taped and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days postsurgery, most patients feel tired and sore, but many return to work within a week. Stitches are removed in 1 week to 10 days; postoperative pain, swelling and sensitivity diminish during the first few weeks. Scars begin to fade in a few months.
After augmentation mammaplasty with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction.
Risks of Augmentation Mammaplasty
In addition to the risks associated with surgery and anesthesia, those related to augmentation mammaplasty using implants include the following:
- Capsular contracture
- Implant leaks and ruptures
- Implant deflation or shifting
- Temporary or permanent change in nipple/breast sensation
- Irregularities in breast contour/shape
- Asymmetry
- Partial or total loss of nipple/areola
The risks related to augmentation mammaplasty using fat transplantation include those related to liposuction, as well as the following:
- Calcification
- Fat embolism
- Fat necrosis
- Oil cysts
- Loss of volume
Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary. Injections can be performed using local anesthesia.
Frequently Asked Questions
Breast implants can replace lost volume, which is something that occurs predominantly after giving birth. In addition, women who have undergone treatment for breast cancer and possibly a mastectomy may also be suitable candidates. You can also choose to have breast implants if you are looking to regain your self-confidence.
There are two primary types of breast implants you can choose from: saline and silicone. Silicone implants are filled with silicone gel. Saline, on the other hand, is filled with sterile salt water. Both types of implants come in various shapes, sizes, and textures. You and your surgeon will work together to decide which has been planned best for you.
The lifespan of breast implants depends on a number of factors, such as the type of implant used, the surgical technique, and a patient’s biology. Breast implants, while able to last years, are not a permanent solution. Some patients may have their implants last as long as 15 years, while others need to replace them within 10 years.
The cost of a breast augmentation procedure depends on the location, experience of the surgeon, the implants being used, the cost of anesthesia, and if there are any fees. For a more accurate price, you will need to receive a quote from Dr. Ferguson during your consultation.
Yes, having a breast augmentation will leave a scar. However, the appearance of scars will fade over time, and your surgeon will use a variety of different techniques to minimize their visibility. These techniques include placing the incision in the natural creases of your breasts and using other minimally invasive approaches to ensure the best cosmetic effect.
The best candidates for breast augmentation are women who are in overall good health, have realistic expectations about what a breast augmentation can and cannot do, and desire enhancement or restoration of lost breast volume and shape.
When choosing a surgeon for breast augmentation, it's important to research their credentials, their experience, and past patient reviews. Be sure to schedule multiple consultations with different surgeons so you can discuss your goals, concerns, and all the surgical options before making an educated decision. The most important thing is to feel comfortable with the surgeon you choose and have verifiable proof from past patients' reviews and before and after photos that they are able to help you obtain your esthetic goals.
Yes, it is possible to have revision surgery for breast implants as long as it is done by a qualified plastic surgeon who understands the complexity of the case. It is also important to note that there may be cases where revision surgery may not be possible. A variety of factors, such as scarred tissue and severe capsular contracture, can cause this.
