Breast Implant Surgery (Augmentation)
Breast implant surgery (breast augmentation) is a cosmetic procedure that increases the size of your breasts. Breast implants are put in above or below the chest muscle, to make the breasts larger.
Different kinds of implants
Breast implants are made of a silicone shell. The shell may be filled with saline (saltwater) or silicone (gel). Different implant sizes, shapes, and textures are available. There are also different thicknesses of silicone available. There are benefits and drawbacks to each type of implant. You and your doctor will discuss which type is best for you.
Preparing for surgery
Meet with your surgeon before the day of surgery to ask questions about the doctor's experience with breast augmentation, your specific surgery, and the results you can expect. The Food and Drug Administration (FDA) provides a list of questions that may help you with this conversation. Ask your doctor what makes you a good candidate for breast implants, and what your options are for size, shape, and surface texture. Your doctor will also review the risks and benefits of the surgery. Ask for before and after pictures of other patients so you can understand whether your expectations are realistic.
During this meeting, ask the doctor for a copy of the patient labeling for the breast implant that will be used. As a patient, it is your right to have this information and the doctor will expect to provide it. Talk with your doctor about the risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL), a rare type of non-Hodgkin's lymphoma that can develop after breast implants. While the exact number of cases is not known, the most current data suggest that BIA-ALCL is seen more often after breast implants with textured surfaces rather than those with smooth surfaces.
Read and understand the informed consent form. Ask any questions before you sign it.
Prepare for the surgery as you have been told. In addition:
Tell your doctor if you think you could be pregnant.
Some surgeons ask that you have a mammogram or breast X-rays before the surgery. This helps show any breast abnormality and gives the doctor a preoperative image of your breast tissue.
Tell your doctor about all medicines you take. This includes herbs and other supplements. It also includes any blood thinners, such as warfarin, clopidogrel, or daily aspirin. You may need to stop taking some or all of them before surgery.
Follow any directions you are given for not eating or drinking before surgery.
The day of surgery
The surgery takes about 1 to 2 hours. You will usually go home the same day, but you may stay overnight.
Before the surgery
An IV line is put into a vein in your arm or hand. This line delivers fluids and medicines.
You will be given medicine to keep you pain free during surgery. This may be general anesthesia, which puts you into a state like deep sleep. A tube may be inserted into your throat to help you breathe. Or you may have sedation, which makes you relaxed and sleepy. If you have sedation, local anesthesia will be injected to numb the area being worked on. The anesthesiologist will discuss your options with you.
During the surgery
The doctor makes an incision. This may be made under the breast, under or within the areola (dark skin around the nipple), or under the arm. You and your doctor will have decided on the incision site or sites before the surgery.
Next, the doctor forms a “pocket” to hold the implant. This may be above or below the chest muscle.
The implant is inserted through the incision and placed into the pocket. If the implant needs to be filled with saline, that is done next. The implant is then positioned.
If both breasts are being treated, the process is repeated on the other breast.
The incisions are closed with stitches, surgical glue, or both. A tube (drain) may be placed into the incisions before they are closed. This will drain excess fluid as the wound starts to heal.
A bra or surgical gauze may be applied at the end of your surgery.
After the surgery
You will be taken to a room to recover from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You’ll be given medicine to control pain. When you’re ready, you will be able to go home with an adult family member or friend. Or, you may be taken to a room to stay overnight.
Recovering at home
Once home, follow any instructions you are given. Your doctor will tell you when you can return to your normal routine. During your recovery:
Take any prescribed medicines exactly as directed.
Wear the special bra or bandage you were given before discharge as directed by your doctor.
Care for your incisions and the dressing (bandage) over them as instructed by your doctor.
Follow your doctor’s guidelines for showering. Don't swim, bathe, use a hot tub, and do other activities that cause the incisions to be covered with water until your doctor says it’s OK.
When you shower, gently wash your incision sites. Then pat the incisions dry. Don’t apply lotions, oils, or creams to the incisions until after they are fully healed.
Don’t raise your arms above breast level for 10 days. And don’t lift, push, or pull anything heavier than 10 pounds for at least 7 days.
Don’t drive until you are no longer taking prescription pain medicine and your doctor says it’s OK. When riding in a car, carefully position the seatbelt so that it doesn’t compress your breasts.
Be aware that breast swelling may last for 3 to 5 weeks. If advised by your doctor, use a cold pack wrapped in a thin towel to relieve discomfort and control swelling. Don't leave the cold pack on for too long, or it may damage your skin. Put the pack over your bandages for no more than 20 minutes at a time. Then, leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don’t fall asleep with the cold pack on. If you’re not sure how to safely use the cold pack, ask your doctor.
When to call your healthcare provider
Call your healthcare provider right away if you have any of the following:
Extreme chest pain or trouble breathing (call 911)
Severe swelling in one or both breasts
A fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Bleeding or drainage through the special bra or bandage
Symptoms of infection at an incision site such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Pain that is not relieved by medicine or gets worse
Much more soreness, swelling, or bruising on one breast than the other
Breast that is very warm to the touch
You will have follow-up visits so your doctor can see how well you’re healing. If needed, stitches or drains will be removed at one of these visits. If you have any questions or concerns about your recovery, let your doctor know. Also tell your doctor if you notice any changes in your breasts during or after recovery. This may include injury to the breast or dimpling of the skin of your breast or nipple. If the implants leak or break, they will need to be removed or replaced.
Risks and complications
Risks and possible complications include:
Bleeding or infection
Capsular contracture (scar tissue squeezing the implant)
Breasts that are too firm
Excessive internal or external scarring
Changes in breast or nipple sensation (temporary or permanent)
Rupture or leakage of an implant
Breasts that are not the same shape or size
Not being happy with cosmetic result
Risks of anesthesia
December 03, 2017
Breast Implant-Associated Anaplastic Large Cell Pymphoma (BIA_ALCL), Food and Drug Administration, Implant-based reconstruction and augmentation, Up To Date, Overview of breast reconstruction, Up To Date
Fraser, Marianne, MSN, RN,Lickstein, David, MD