Breast augmentation or breast implant surgery was the most popular plastic surgical procedure in 2006.  Breast augmentation will enhance the size of your breasts giving them a firmer and slightly rounder look.  The procedure is done on an outpatient basis in a hospital or surgicenter operating room under general anesthesia. It typically takes about an hour and a half.

Where is the incision located?

The two most frequently used incisions for breast augmentation are in the crease under the breast—called the infra-mammary fold—and around the areola, the dark skin around the nipple. During your consultation, Dr. Bonness will discuss which incision is best for you. An incision around the areola carries an increased risk of losing nipple sensation and a possible increase in the risk of scar tissue around the  implant. Both types of incisions are small and heal with minimal visibility. 

Where are the implants placed?

Breast implants are always placed under the breast tissue either above or below the muscle. The best long-term position for the implants is below the muscle. Placements below the muscle provides a more natural look and feel, less implant edge superiorly, less wrinkling, less scar tissue formation around the implant, and less interference with mammograms. The only disadvantage to placement below the muscle is a slight increase in immediate post-operative pain.

Who is a good candidate for breast implants?

Breast augmentation is performed to increase the size of your breasts one to two cup sizes. Women of any age—but usually older than 18—who have small breasts without significant sagging or who have breasts that have lost volume after pregnancy and breastfeeding are good candidates for breast augmentation surgery. When the breast tissue is sagging too much, implants alone are not enough to elevate the breasts. In these cases a breast lift is also necessary, which will involve more scarring. 

What can I expect after surgery?

The results of breast augmentation surgery are immediate, and there are changes that occur over time as the implants settle in and take on a better, softer shape. Initially the implants will be very high on the chest, firm, and swollen with little shape. It takes time for the muscle to stretch and relax and the swelling to go down and more completely fill out the bottom of the breast. Most of these changes occur within the first two weeks after surgery, but it will take months for the implants to become very soft.

Any significant bruising or drainage could be a sign of bleeding. Post-surgical pain will be more severe for the first three days and will decrease significantly after that. Most patients are taking Tylenol or Ibuprofen by day four.

Do breast implants cause cancer?

Breast implants do not cause cancer nor do they make you sick. Mammograms remain an important diagnostic test after surgery, however mammograms performed after surgery will be different. Eight views of each breast will be required rather than the typical four views. And even with these additional views, all the breast tissue cannot be visualized. Dr. Bonness feels it is important to obtain your post-breast augmentation mammograms from a facility that specializes in breast imaging. She recommends Dr. John Milbrath of both the Breast Diagnostic Clinic (mammogram) and the Center for Diagnostic Imaging (MRI).

Are breast implants safe?

Breast augmentation is a safe surgery. Complications can occur but the incidence is extremely low. Potential risks of breast augmentation surgery with either silicone gel implants or saline implants are: bleeding, infection, deflation, asymmetry, loss of nipple sensation, difficulty breastfeeding, and capsular contracture.

What is a capsular contracture?

The scar tissue that forms around the implant is called the capsule. Scar tissue formation is a normal response to a foreign body; the same scar tissue forms around pacemakers and hip replacements. Normally the scar tissue remains thin and soft, but when the scar tissue around the implant tightens down, thickens and squeezes on the implant it is called capsular contracture. This tightening can be severe, causing significant firmness to the breast, pain, and distortion with implant displacement. Fortunately, capsular contraction occurs very rarely because today most implants are placed under the muscle. 

What causes capsular contracture?

Capsular contracture can happen anytime after surgery, but it most commonly occurs within the first three years. It can happen in one breast and not the other. In some cases we know the cause—for example, infection, bleeding, radiation—but in most cases there is no obvious reason. The best ways to prevent capsular contracture are to place the implant under the muscle, massage the area after surgery, and to stop smoking. Textured implants can also help prevent capsular contracture, but they are not necessary when the implants are placed under the muscle. 

How long will breast implants last?

All medical devices have a limited life expectancy. Breast implants should last up to twenty years. If you are a very young patient you will likely need another breast surgery at some point in your life. In addition, the implant manufacturers provide a warranty for deflation where they will replace the implants if leaking occurs.

What are breast implants made of?

There are two types of implants available today for breast augmentation: saline implants filled with sterile salt water and silicone gel implants filled with gel. Both have a shell made of silicone. Prior to December 2006, silicone gel implants were only available in studies to women needing breast reconstruction. As of December 2006, they are available to all women seeking breast augmentation. The new gel implant is much different than the older gel implant. The shell is thicker thereby limiting leaking and the gel itself is firmer or more cohesive so it does not spill as much.

Silicone gel implants are widely considered “better” implants in terms of providing a more natural look and feel with less implant palpability and wrinkling. The risks associated with gel implants are the same as those for saline, with the exception of leaking. When a saline implant leaks the saline comes out into your body and is absorbed with no harm to you. You will know immediately if a saline implant has leaked because it will deflate. The surgery to exchange a saline implant is straightforward: the old one is removed and a new one is put in its place. 

A leaking gel implant is quite different. When a gel implant leaks there is no significant change in the shape or feel of the breast, at least not for a long time. The gel is not absorbed into the body, but rather stays within the capsule of scar tissue that has formed around the implant. It is difficult to determine if it is leaking since there are not usually any symptoms or visible changes. Advanced radiology techniques like MRI are required to determine if a gel implant has leaked. It is recommended that an MRI be performed every 2 - 3 years for women with gel breast implants.

Surgical exchange of a leaking gel implant is more involved than for a saline implant as some of the leaked gel must be cleaned out. The bottom line is: gel implants are very safe and attractive but they do require more maintenance.