Introduction

What is Breast Augmentation?

Breast Augmentation is the easiest way to increase the size of breasts by placing breast implants under breast tissue or chest muscles. This procedure is for those who have small breasts and are looking to gain self confidence by increasing the size of their breasts or improving symmetry to their body shape and proportion. It can also restore lost breast volume due to massive weight loss or pregnancy.

What can breast augmentation surgery do?

  • Increase fullness and projection of your breasts
  • Improve balance of breasts and hip contours
  • Enhance your self-confidence
  • Better fit in more variety of clothes

What can’t breast augmentation surgery do?

  • Correct sagging breasts, breast lift may be required along with breast augmentation
  • Wide gap sometimes cannot be corrected
  • Cannot 100% correct asymmetry breast

Preparation

How to prepare yourself before surgery?

  • You must have a consultation with a Plastic Surgeon in detail and understand the solution, result and outcomes. You have to discuss with the surgeon about the size, incision, type of implants, placement, estimate of time for surgery, result, risks and complications. You need to understand how to prepare yourself before and after surgery. If you are older than 40 years old or younger but have a history of cancer in the family, you must have a mammogram before surgery.
  • You must have a pre-operative check-up including Blood Test, EKG, and Chest X-ray with a medical doctor
  • Consult with your doctor and adjust medication if you have any underlying medical conditions, drug allergy and previous medical treatments.
  • Stop smoking at least 2-4 weeks before surgery.
  • Stop all vitamins and supplements including herbs at least 2 weeks before surgery. 6. Stop taking Aspirin or Anti-Inflammatory drugs.

Process

The process of Breast Augmentation

1.Anesthesia : General anesthesia

2.The incision

2.1) Transaxillary Incision
Pros : Hiding scar under armpit
Cons : Not a good option unless using endoscopic method

2.2) Inframammary Incision
Pros : The easiest way to have surgery and easy to stop bleeding
Cons : Scar will be under breast fold

2.3) Periareolar Incision
Pros : Hiding scar between areolar and skin tissue
Cons : Infection or Capsular Contracture can happen more than other incisions. Cannot choose too big implants, especially if the diameter of areolars is smaller than 40mm.

3.What types of Breast Implants are available?

Types of Breast Implants

1) Saline Breast Implants are filled with sterile salt water. Most of Plastic surgeons no longer choose this type of implant due to the risk of leakage.

2) Silicone Breast Implants are filled with silicone gel. The gel feels more natural. If the implant leaks, the gel will remain within the implant shell. Ultrasound or MRI can assess whether the implant is still in a good condition. There are many types of silicone implants.

  • 2.1) Round Breast Implant : is the most popular type of implant currently. It can create cleavage, projection and volume on top to make breasts appear fuller. Round implants are the same shape all over so there is less concern about the implant rotation. Round Implants are either smooth or textured surfaces.
    Smooth surface : gives more natural movement and can move with the breast implant pocket. It can be placed both Over the muscle or Under the muscle. The result will be the same. However, Capsular Contracture can occur.
    Textured Surface : was developed to prevent Capsular Contracture and makes them less likely to move around. However, it has been reported that “BIA-ALCL” ( Breast Implant Related-Anaplastic Large Cell Lymphoma ) occurs most in patients with this type of implant.Additionally, rippling can occur as well.
  • 2.2) Teardrop or Gummy Bear Breast Implant : the shape looks like a natural breast. This type of implant is suitable for people who have short lower poles or limited skin tissue and want a natural look. However, Teardrop Implant only has a textured surface to prevent the rotation. If the teardrop implant rotates, it may lead to an unusual appearance. A recent innovation has been developed with a round implant that can change shape with your movement which makes it feel like your own breast. The textured surface has been developed to reduce the risk of ALCL but it still needs further study and research.

4.Breast Implant Placement options There are 4 options of breast implant placement.

breast implant placeent

4.1. Subglandular Plane or Over the muscle
Pros : Provide a natural look, no animation deformity, correct some of the sagging issues.
Cons : Not suitable for a person who is skinny or has very skin tissue, risk of Capsular Contracture is slightly higher than other options, especially smooth implant.

4.2. Subfascial Plane
Pros : Provide a natural look, no animation deformity, can correct some of the sagging issues and less risk of Capsular Contracture. Cons : can feel implants in a person who is very skinny or skin tissue is very thin.

4.3. Submuscular Plane or Under the muscle
Pros : Reduce the risk of Capsular Contracture, especially with smooth surface implant. Cannot feel silicone implant from outside. Cons : More painful after surgery than the other options. Animation Deformity can happen.

4.4. Dual Plane – Dual Plane places the silicone implant at the same position as Under the muscle but the muscle is cut at the bottom from the rib to make the silicone implant sit half under the muscle (pectoralis major) and half over the muscle.
Pros : Reduce the risk of Capsular Contracture, especially with smooth surface implant. Cannot feel silicone implant from outside but can correct sagging breasts.
Cons : More painful after surgery than other options. Animation Deformity can happen.

5. Check the final result before close the incision
6. Close the incision and put the elastic bandage around the chest.

Indication

Who is a good candidate?

  • 18 years old above
  • Physically healthy
  • Not pregnant or breastfeeding
  • Have good skin elasticity and ability to stretch for implants
  • Unhappy with having small breasts
  • Dissatisfied with breasts losing shape and volume after pregnancy, massive weight loss, or aging.
  • Have asymmetrical breasts
  • Have realistic expectations and be able to admit that after surgery, there may be some changes of feeling such as hypersensitivity or loss of sensation of nipples.

Result

  • You can see the results right after surgery. However, the final results may take a few weeks as the swelling subsides and the skin stretches. Usually you can see the final results within 6 months to 1 year.
  • The swelling will gradually improve within 4-6 weeks.
  • Scar will gradually fade away within 1-2 years depending on your skin type. Some people may have a bad scar or Keloid.
  • Strictly following the doctor’s advice and recommendation will yield the best results.

Recovery

  • After a surgery, blood and fluid may collect inside your body in the surgical area. Surgeons will insert a surgical drain tube which can be removed in 1-2 days.
  • The surgeon will wrap your chest with Elastic bandage which will be replaced with a support bra after the surgeon removes the surgical drain tube.
  • An appointment will be made to remove the eternal stitches 5-7 days after surgery. Usually the patient can return to work within 7-10 days after surgery.

Post-op care

How to take care of yourself after surgery

Bruising and Swelling

  • Bruising and Swelling will occur within 48-72 hours after surgery. The third day is usually the worst and then it will gradually get better after day 4.
  • Bruising will be better after 4 days and will be gone in 21days.
  • Swelling will subside quite quickly in the first 2-3 weeks and then disappear in 3-6 months.
  • Cold compress with a cold pack or a bag of ice is needed in the first 3 days. It will help reduce swelling and bruising.

Pain and Medication

  • The most painful moment is right after surgery and on the first day. In some patients, it will take more time before all the pain disappears.
  • Surgeons recommend taking pain relievers only when you are in pain. Do not take it more than 6 times per day.
  • There may be some side effect such as nausea or dizziness
  • If rash or itch occurs after taking medication, the patient must inform the surgeon immediately.
  • The antibiotic medication must be taken until it is finished.
  • Any underlying condition and medication needs to be informed and adjusted by both a surgeon or medical doctor before and after surgery.
  • Do not take Aspirin or any medication in Aspirin group, Vitamin E, Herbs, or any supplements at least 2 weeks before and after surgery. It can cause bleeding and bruising.

Smoking and Drinking

  • You must stop smoking 4 weeks prior to and 4 weeks post surgery.
  • You must stop drinking 2-4 weeks prior to and 2-4 weeks post surgery.

Sleeping positions after surgery

  • Get enough sleep and rest after surgery.
  • Use 2 pillows to lift your head up, it will help reduce swelling.
  • Sleep on your back at least 2-3 weeks with a pillow supporting your side.

Wound dressing

  • Patients can take a sponge bath before the surgical drain tubes are removed . After the surgical drain tubes are removed, the surgeon will put waterproof dressing so you can take a quick shower.
  • Check waterproof dressing, and make sure that it is clean and dry at all times.
  • Remove waterproof dressing within 48 hours after discharge from hospital.
  • Do not touch the wound directly after removing waterproof dressing.
  • Use wooden cotton buds with normal saline to clean the wound and apply antibiotic cream twice a day.
  • The stitches will be removed in 7-10 days
  • If there is any sign of infection or complications, please inform surgeons immediately.
  • Scar cream, scar gel, or silicone sheet can be used 5-7 days after all stitches are removed.

Support bra

  • You must wear a support bra or sport bra 24 hours for at least 1-2 months after the surgery.
  • After 2 months, the surgeon recommends wearing it to reduce a chance of sagging.
  •  Underwire bras can be worn after 6 months.

Massaging

  • Massaging is recommended for Round Implant only.
  • Start massaging 4 weeks after surgery.
  • Massaging 5-10 minutes twice a day after shower.

Exercise

  • Avoid exercise for at least 2 months after surgery. No weight lifting or lifting anything heavier than 5 kg.
  • Avoid hot tubs or saunas at least 6 months after surgery.

Risks

Risks and Complications

  • Complications of general anesthesia
  • Infection
  • Bleeding
  • Blood Collection
  • Deep Vein Thrombosis
  • Keloid scar
  • Seroma
  • Loss of nipple sensation
  • Numbness ( usually will improve in 3-6 months )
  • Capsular Contracture
  • Double Bubble Fold
  • Rippling
  • After surgery, Breast shape can change after massive weight loss or gain due to pregnancy.

Review

FAQs

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