Breast Augmentation

So you're seeking a way to enhance your breasts, perhaps you are planning to improve their overall appearance?

The good news is that you're one of many women who want to have this procedure. According to the American Society of Plastic Surgeons, breast augmentation increased 533% between 1992 and 2001, from over 32,000 cases to more than 206,000 surgeries a year, respectively.

Women get their breasts augmented for a variety of reasons: they may seek to increase the size of their breasts, or improve breasts that have taken a beating due to multiple pregnancies. In some cases, women seek breast augmentation as a form of reconstructive surgery or to provide balance to uneven breasts.

But before you jump in, it's important to educate yourself. We've compiled this information as a basic overview; however, this does not replace the advice of a surgeon.

Your Consultation

Before you undergo breast augmentation, you'll meet with your surgeon. You should prepare for this consultation by thinking about what you like and don't like about your breasts. Remember, you're not seeking perfection, but improvement. Also, be sure that you're in good mental and physical health, overall, and that you have realistic expectations. This surgery is not going to solve problems for you.

Your surgeon will need to take a detailed medical history, including any previous problems you've had with your breasts, including lumps. You also should be able to tell your surgeon of any medication you are taking.

How It's Done

The procedure will take about one to two hours. It will be performed either under general anesthesia (you'll go to sleep) or local anesthesia with an oral sedative. You and your surgeon will make this determination together.

Breast augmentation can be performed with one of several approaches. Your surgeon can perform the procedure via the crease under your breast (known as the inframammary fold); via the areola (known as the "nipple" incision); via your armpit (known as transaxillary); or a newer, lesser-used method, via your belly button. Your surgeon will discuss all the possible methods with you and together, you will determine which best suits your needs.

There are different types of implants used as well, including saline or silicone gel. It's very important to keep up to date on FDA for any implants. Since 1992, silicone has only been approved for use in some clinical studies. Your surgeon will discuss all your implant options with you.

There are two different ways for your surgeon to insert the implant: either under the breast tissue or behind the breast muscle. You can discuss the benefits of each one with your surgeon and make that determination together.

After the implants are placed, the incision sites will be stitched close and your surgeon may also use drainage tubes. It's very important that you follow your surgeon's follow-up care for the incision site. Your breasts will be covered with a bandage of gauze or you may even be sent home with a surgical bra.

How to Prepare

During your consultation, your surgeon will tell you which foods, medications and vitamins you should avoid for a designated time before and after your surgery. These include, but are not limited, to:

• Aspirin
• Vitamins E and C
• Ibuprofen (Motrin or Aleve)
• Certain foods or medications that contain salicylate (such as aspirin)

If you are a smoker, your surgeon may have instructed you to quit smoking for a certain period before and after the surgery. It's crucial that you follow his or her instructions very closely as smoking can impede the healing process.

You should arrange for someone to drive you home from your surgery and also have someone who can stay with you the first night at least. You will need to take at least three days off from work, so plan accordingly.

Before surgery, you'll need to prepare your home for our recovery time. Make sure you have:

• Plenty of ice
• Container for ice, or freezer bags (frozen veggies like corn or peas work, too)
• Ointment or cream for incision sites as recommended by your surgeon
• Plenty of loose, comfortable blouses or shirts which button down
• Telephone within reaching distance of your main seating or lying area
• Magazines, books or movies

Recovery and Follow-Up Care

Your surgeon will give you a prescription to control pain, if necessary. If you have drainage tubes, your surgeon will tell you when to return to have those removed, as well as when to remove the gauze bandage. Your surgeon will probably remove your stitches in about one week. You should do no heavy lifting for at least four weeks. If you are physically active in sports, it may take up to six weeks for you to return to those activities.

Complications and Side Effects

As with any surgery, there are side effects complications that may occur.

Side effects can include soreness and increased sensitivity in the nipple region, bruising or swelling. You may experience swelling for a few weeks.

Complications can include:

• The formation of scar tissues, also known as capsule contracture
• Sagging of the implants in the breast, causing your breasts to droop
• Symmastia, or the implants trend toward the middle of the chest and can give the appearance of one continuous breast
• Rupture or deflation
• Hematoma(blood collection in the surgical area), or fluid around the implant, also known as seratoma

Know that breast implants can also interfere with mammography screening tests. It's very important that you discuss all your concerns with your surgeon. If you are planning to breast feed, you should make your surgeon aware of this.

QUESTION

An average adult has about ________ square feet of skin. See Answer

After Your Surgery, Contact Your Doctor Immediately Should Any of the Following Occur:

• Fever
• Abnormal discharge, such as pus, from incision site
• Rupture of stitches

Does Insurance Cover This?

In most cases, breast augmentation is elective cosmetic surgery and therefore is not covered by insurance carriers. However, if you are having implants put in as part of reconstructive surgery , your insurance carrier may provide coverage.

It's very important that you find out well in advance what type of coverage your carrier may provide. If you are undergoing this procedure purely for cosmetic purposes, it's important that you realize this may affect future insurance coverage and your premiums may increase. Be sure to ask your insurance carrier about this specifically.

Reviewed by the doctors at The Cleveland Clinic, Department of Dermatology.
Edited by Charlotte E. Grayson , MD, Sept. 2003.

WebMD Medical Reference