Breast augmentation is a simple surgical
procedure that takes one to
two hours. This is usually performed in a surgicenter or in the
surgeon's private operative suite; rarely these days the procedure is
done in a hospital. The surgical team for breast augmentation
includes the surgeon, anesthesiologist, scrub nurse, and
circulating nurse. Many times the surgeon will have a PA
(physician assistant) or another physician assist with the
operation. The type of operation can vary depending on the
location of the incision, the implant material and the pocket for the
implant. The anesthesia can range from light sedation to general
anesthesia depending on patient preference, the comfort of the surgeon
and his ability to adequately administer local anesthesia, and the
skill level of the anesthesiologist.
There are various surgical approaches for this procedure.
There are various surgical approaches for this procedure.
- Inframammary - an incision is placed below the breast where it meets the chest. This is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required.
- Periareolar - an incision is placed along the areolar border. The incision is generally placed around the inferior half, or the medial half of the areola's circumference. Silicone gel implants can be difficult to place via this incision. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment.
- Transaxillary - an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast, but is more difficult to consistently achieve symmetry of the inferior implant position.
- Transumbilical - a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult.
- Transabdominoplasty - the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.
There are two type of implants:
saline and silicone.
Saline-filled implants are the most common implant used in the United States. Good to excellent results may be obtained, but as compared to silicone gel implants, saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and be noticeable to the eye or the touch. Although most surgeons find silicone implants superior, saline implants can look very similar to silicone gel in patients with more breast tissue.
Silicone offer a more life-like feel
than saline implants.
Thinner shelled silicone implants in the 1970's, however, had a greater
tendency to rupture. Class action lawsuits against Dow-Corning
involved many of these implants. Third and fourth generation implants
had modifcations to the shell and a more cohesive gell filler in order
to reduce rupture and the bleeding of silicone. In addition, the
shell is textured to reduce rotation.
Implant Insertion
- Subglandular- implant between the breast tissue and the
pectoralis muscle. This position closely resembles the plane of normal
breast tissue and is felt by many to achieve the most aesthetic
results. Rippling and contractures are higher with this technique.
- Subfascial - the implant is placed in the subglandular position, but underneath the fascia of the pectoralis muscle.
- Subpectoral - the implant is placed underneath the
pectoralis major muscle after releasing the inferior muscular
attachments. This is the most common technique in North America and
achieves maximal upper implant coverage while allowing expansion of the
lower pole.
- Submuscular - the implant is placed below the pectoralis without release of the inferior origin of the muscle. This technique is most commonly used for maximal coverage of implants used in breast reconstruction.
Anesthesia
The patient can not eat or drink anything after midnight before surgery. If you are on any blood-thinners or smoke you should discuss this with your surgeon as this can affect the surgical outcome. The anesthesiologist will start a small intravenous line through for fluids and medications. If one wants mild sedation the surgeon needs to give local anesthesia. Depending on the type of approach and the patient's tolerance, mild sedation may not be an option and general anesthesia will be required. One might start out with mild sedation, but due to various reasons the patient might need to get converted to a general anesthetic technique. The benefit of sedation compared to general anesthesia usually includes faster recovery and reduced chance for post-operative nausea and vomiting; general anesthesia usually affords good muscular relaxation and ease of performing the operation.
Recovery
Complications
Please see disclaimer.
The patient can not eat or drink anything after midnight before surgery. If you are on any blood-thinners or smoke you should discuss this with your surgeon as this can affect the surgical outcome. The anesthesiologist will start a small intravenous line through for fluids and medications. If one wants mild sedation the surgeon needs to give local anesthesia. Depending on the type of approach and the patient's tolerance, mild sedation may not be an option and general anesthesia will be required. One might start out with mild sedation, but due to various reasons the patient might need to get converted to a general anesthetic technique. The benefit of sedation compared to general anesthesia usually includes faster recovery and reduced chance for post-operative nausea and vomiting; general anesthesia usually affords good muscular relaxation and ease of performing the operation.
Recovery
Complications
Please see disclaimer.