The most frequently performed cosmetic surgery procedure in the U.S., breast augmentation can give women with small or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of implants in the breast. Women may elect to undergo breast augmentation for many different medical and aesthetic motivations, including enhancing naturally small breasts, balancing breast size and compensating for reduced breast mass after pregnancy or surgery. The procedure may be combined with others such as a breast lift for the correction of sagging breasts.
Implants are silicone shells filled with saline (salt water) and are placed behind each breast, underneath either breast tissue or the chest wall muscle. The procedure lasts one to two hours and is typically performed with general anesthesia, although local anesthesia combined with a sedative is also possible. After surgery the patient’s bustline may be increased by one or more cup sizes.
The Procedure
Incisions are made in inconspicuous places on the breast to minimize scar visibility (in the armpit, in the crease on the underside of the breast, or around the areola, the dark skin around the nipple). The breast is then lifted, creating a pocket into which the implant is inserted.
Placement behind the chest wall muscle offers a few advantages over placement beneath the breast tissue only. These include reduced risk of capsular contracture (post-operative tightening around the implant) and less interference with mammogram examinations. Possible disadvantages include need for drainage tubes and elevated pain in the first few days following surgery.
After the implants are placed and centered beneath the nipples, incisions are stitched, taped and bandaged. In a few days the bandages may be replaced with a surgical bra.
Recovery
Most patients feel tired and sore after surgery, but this usually passes in a day or two and many patients return to work within the week. Stitches are removed in a week to 10 days and any post-operative pain, swelling and sensitivity will diminish over the first few weeks. Scars will begin to fade in a few months and will continue to fade for months or years.
Risks
Complications following surgery are uncommon and usually minimal. They may include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, milk production if you nursed a baby within a year before the procedure, and breakage or leakage of the implant as a result of injury or the normal compression and movement of your breast (if this happens the implant will simply deflate in a few hours and your body will absorb the salt water).
» Learn more about Breast Augmentation from the American Society of Plastic Surgeons
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A breast lift, or mastopexy, is performed to return youthful shape and lift to breasts that have sagged as a result of weight loss, pregnancy, loss of the skin’s natural elasticity or simply the effects of gravity. The procedure can also reduce areolar size (the dark skin surrounding the nipple), and it can be combined with breast augmentation for added breast volume and firmness. Breasts of any size can be lifted, but results last longest when they are originally small and sagging.
Breast lifts are ideal for women whose breasts:
- Sag or hang but are in proportion to the rest of the body
- Have lost firmness or elasticity
- Are flat and elongated
- Have nipples/areolas that point downward or fall below the breast crease when the breasts are unsupported
- Have stretched skin and/or enlarged areola
Women planning to have children are advised to postpone surgery, since pregnancy and nursing can counteract its effects by stretching the skin. However, mastopexy should not affect your ability to breast-feed.
The Procedure
Mastopexy may be performed in a hospital, an outpatient surgery center or a surgeon's office-based facility. It is usually done on an outpatient basis under general anesthesia, and lasts from 1-½ to 3-½ hours. A number of pre-operative steps are typically taken such as a mammogram, measurement of the bustline, and discussion with Dr. Funt about the desired size and shape of the breast and placement of the nipple. During the procedure an anchor-shaped incision is made from the location of the new nipple down to and around the crease beneath the breast. Dr. Funt removes excess skin, relocates the nipple and areola, and reshapes the breast using skin from around the areola before closing the incisions with stitches.
Patients with small breasts and minimal sagging may be recommended for smaller-incision mastopexy. One such modified procedure is concentric ("doughnut”) mastopexy, in which two concentric circular incisions are made around the areola and a doughnut-shaped swathe of skin is removed.
Recovery
After surgery the breasts are wrapped with gauze dressings, over which an elastic bandage or a surgical bra is placed. After a few days this is replaced with a soft support bra which is worn 24 hours a day for about a month. Breasts will probably be bruised, swollen, and uncomfortable for a few days, but this will pass. Numbness in the breasts and nipples should lessen as swelling subsides. Stitches are removed after one to two weeks, and many patients return to work then.
Risks
Complications are uncommon but may include bleeding, infection, numbness, uneven positioning of nipples and widenening of scars. Scars can be covered even beneath bathing suits and low-cut tops. » Learn more about Breast Lift from the American Society of Plastic Surgeons
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