Introduction

Over the past couple of decades, American women have increased their bust size from a 34 B to a 36 C cup. This increase is more than likely due to the increase in the average dress size as opposed to an increase in plastic surgery patients. However, the view of what constitutes a beautiful bust-line has definitely expanded since the 1900s, and with the advances in surgical techniques, breasts can now be designed to be the ultimate fashion accessory. But is bigger really better? With surgery comes many risks from trivial things like stretch marks to life threatening side effects from the anesthesia. This article will go over what your options are for breast augmentation surgeries, their pros and cons, what you need to do to prepare for surgery, and what to expect after your surgery.

Risks Involved

There are many risks related to breast augmentation surgeries.

1. The first is the possibility that an implant will rupture or leak. In addition to negatively impacting the appearance of the breast, the rupture of an implant allows the material contained within the implant to be leached into the body. If the implant is filled with saline solution there won’t be a problem, as the body will simply absorb the saline solution. However, if the implant was silicone-filled then certain health problems like crystallization and autoimmune diseases may develop.
2. Implants impair a doctor’s ability to detect breast tissue abnormalities or cancers.
3. Hardening of the breast tissue due to capsular contracture can occur.
4. Infection (including Staph) can develop.
5. Calcium deposits may occur that require surgical removal or treatment.
6. The need for more surgeries to correct mistakes, sagging, rupture, or to refine results may be needed.
7. Hematomas, collections of blood, may need to be drained.
8. Nerve damage can occur at the site of incision, along the path of insertion, or at the implant site.
9. Neuroma, or excessive sensitivity in localized areas can develop that can be extremely painful and debilitating.
10. Excessive scarring, especially for women of color can develop.
11. Allergic reaction to medication, anesthesia, or medical dressings can occur.
12. Mondor’s Disease, blockage or hardening of vein leading away from the surface of the breast can develop that causes the patient pain and physical distortions.

Breast Augmentation Options

When you are considering breast augmentation you will be faced with a number of surgery options that give you a choice of what type of incision to have, what type of implant placement that you want, the size of the implant, and even the shape of the implant. To make the choice you will need to know a little bit about each option.

Incision Types

The kind of incision you get will be determined by your doctor’s preferences, the result you want, your body, and the type of implant that you have chosen.

If you have had breast surgery before, either because of a previous breast augmentation or because of a mastectomy, then you may have scar tissue that inhibits the ability to insert an implant with a small endoscopic incision, and may require a larger incision to be made for the implant to be inserted.

Under the right conditions scarring can be greatly reduced by using the Transumbilical Method also referred to as the TUBA method. In this procedure a small incision is made inside the belly button, and a slender surgical instrument is passed through the incision under the skin to the location where the implant is to go. A sizer is then passed through the tunnel and expanded to make space for the actual implant. Once the size and position is right the sizer is removed and the actual, empty, implant is passed through the tunnel, filled, and the incision is closed by several absorbable stitches. This particular procedure has many advantages. It has a hidden scar inside the belly button, it has a faster recovery time associated with it, it has a decreased risk for nerve damage in the nipple and breast, it reduces the amount of tissue trauma experienced, and it takes a shorter amount of time than most other incision methods to perform.

Another incision option is the Infra-mammary or "crease" incision. Here, as the name suggests, the incision is made on the natural crease of the breast. This particular incision procedure has, in the past, been very popular with doctors because it is easier to place implants, however, if the implant is large and/or textured then the scar left by this incision type can be relatively large. To reduce the size of the scar doctors can use an endoscopic technique and Steri-Strips to help reduce the appearance and texture of the scar.

The Peri-Areolar Incision is another breast-site incisions. However, this one is made on the outer edge of the areola. This particular incision method is best used in conjunction with a breast or areola reduction surgery. It has an increased risk of developing nipple nerve damage or loss of sensitivity, and an increased chance of developing a Staph infection. To reduce the chances of Staph infections doctors may use a sleeve to cover milk ducts during surgery to prevent naturally occurring bacteria from invading the incision. Scars from this type of surgery are often faint and fade with time, however, stretching of scars may occur if the implant is large or if excessive weight gain is experienced post-op.

The Trans-Auxiliary or "armpit" incision is made in the armpit with an endoscopic technique. The scar associated with this incision is on average, about one to one and half inches long.

Implant Placement

The placement of the implant will greatly depend on the result that you want, especially in regards to texture and shape.

Sub-glandular implant placement position the implant over the pectoral muscles, but under the glands in the breast. This particular implant positioning is used to improve sag and has less pain and recovery time associated with it. However, it has a number of drawbacks. First, this positioning makes it easier to detect the implant either by touch or by sight. This is especially true when the patient has little breast tissue or is very thin. It also makes breast exams more difficult, and requires more views of the breast to ensure the breast is healthy.

Sub-pectoral only placement is a half in, half out placement. Here the implant is positioned under the pectoralis major muscle. This positioning gives a result that has better cleavage. One of the drawbacks to this procedure is that there is more work involved for the doctor. They have to manually separate the pectoralis major muscle from the pectoralis minor muscle in order to insert the implant. This positioning under only the pectoralis major muscle will not completely cover the implant and will result in an unnatural contraction of the muscle during exercising. Many patients have stated that it took them quite a while to get use to the sensation of the pectoralis major contraction over the implant, especially when lifting weights and swimming.

Full sub-muscular placement involves the separation of the pectoralis major from the pectoralis minor muscle like the sub-pectoral only placement, but it also involves the separation of the pectoralis muscle from the chest wall, the separation of the fascia from the muscle, and the manipulation of the serratus muscle fascia. These added surgical procedures provide a more secure and stable location for the implant, and a more natural feel when the muscles are in action. This decreases visible rippling of the implant, and increases support of the implant. You should note here that a large implant may not be completely covered or supported by this procedure, but it will provide more coverage and support than a sub-pectoral only placement. You should also note that there is a risk of damaging or cutting the Cooper’s ligaments during this procedure, which can result in substantial drooping of the breast tissues.

Finding a Surgeon

After you have done a little research of what your options are, your next step is to find a doctor that will be able to produce the results you want. Get a referral from a friend who has had a breast augmentation, who was happy with their results, and who was happy with the medical care that they received. If this is not an option, check out websites for local doctors, or doctors in areas that you would be willing to travel to for surgery and recovery. Read through patient reviews, view available before and after photos, and check out credentials of the doctors that you are interested in. Look to see how many surgeries they have performed, what their specialties are, and what organizations they belong to or have been accredited by.

After you have narrowed your doctor list down to probable choices you will want to make an appointment for a consultation with each of your finalists. You should know that in some areas the waiting list for a consultation may be one or two months, so you will want to begin your search as soon as possible after deciding on breast augmentation surgery.

At your consultation: (1) ask to see before and after photos, (2) ask if there are any patients that you can call for a reference, (3) show the doctor what kind of result you are looking for by bringing in photos or cutouts from magazines, (4) have a list of medical concerns you may have, and (5) ask how the doctor determines if you will be a good candidate for the type of surgery that you want. Your doctor should be able to answer all of your questions and inform you of all of the pros and cons of different procedures, implant placements, incision placement, and even anesthesia options. They should also be able to give you an estimate on how close they will be able to come to what you want.

Before Surgery

If everything falls into place and you decide to go through with the surgery, you will need to make some preparations before you go under the knife. If your surgeon doesn’t do blood work, you will need to schedule an appointment with your regular doctor for a physical exam and blood work at least one week before your surgery. Again you will want to schedule this appointment as soon as possible, as some doctors are booked weeks in advance.

You will need to expect to spend at least the first two to three days basically incapacitated, so you will need to have someone available to take care of your children and you during this recovery period. To reduce the stress and disruption your recovery will cause your household make a few preparations before you go to surgery.

1. Clean your house so you don’t have to worry about it for a couple of weeks.
2. Wax areas like underarms and legs right before surgery so you don’t have to bend to shave. This is especially important if you plan on getting an underarm incision.
3. Water your plants.
4. Remove nail polish from your nails. This is necessary because doctors examine the coloration of your nails to monitor your blood oxygen levels during the times when you are under anesthesia.
5. Shop for convenience. Buy prepared meals that can be microwaved or heated up easily, place items on lower shelves so you don’t have to reach to retrieve them, and place pain meds and water containers on bed stand so they are easy to get to.
6. Get extra pillows, ice packs, and support garments ready for your post-op recovery period.
7. Get someone to stay with you to help you for the first week after your operation, and especially for the first three days after surgery.
8. Purchase stool softeners or gentle laxatives. Some people have a tendency to get constipated after being sedated.

After Surgery

The types of incisions, the placement of the implant, the type of implant, the size of the implant, and your own healing tendencies will all influence how well you will feel after your surgery. In any circumstance you should be prepared to feel pain. The intensity of the pain seems to be greater in breast augmentations that involve an under-the-muscle procedure. Post-operative pain management is definitely an issue that you should discuss with your doctor BEFORE you have surgery.

Physical symptoms, besides pain, may also cause you some concern, especially if you are not expecting them. First you will probably notice that the implant will look high and boxy at first. Your nipple placement may also seem "odd" at first. However, with time the implant will settle, swelling will go down, and the shape, texture, and overall appearance of your breasts will improve. You should expect your breasts to look "odd" for at least the first 2 to 6 weeks, and they will not look completely normal for at least 3 months.

Bruising is another possibility that you may experience. Ice packs seem to help reduce the severity of the bruising experienced as well as reducing the amount of pain and swelling that is experienced.

Scars are inevitable even with the TUBA method. To improve the appearance of scars use topical treatments like Neosporin to help reduce infections, and Mederma to help reduce the raised portion of the scar. Ask your doctor for other suggestions for minimizing scars after surgery.

Stretch marks will either be "filled out" or created because of your augmentation depending on your skin tone and the size of the implant.

The total time for post-op recovery varies from person to person. Generally speaking, most doctors say that you should dramatically restrict the amount of physical activity you participate in during the first two weeks, and that you should be able to resume all of your normal physical activity after about four weeks.