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Breast Augmentation

ARE YOU CONSIDERING BREAST AUGMENTATION?

If so, you are one of 40,000 women in North America annually who do. And perhaps 80 percent more consider it but don’t proceed for unknown personal reasons. Breast augmentation, technically known as “augmentation mammoplasty,” is a well-researched surgical procedure to enhance the size and shape of a woman’s breasts for a number of reasons:

  • To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.

  • To restore a reduction in breast volume after pregnancy.

  • To balance a difference in breast size.

  • As a reconstructive technique following breast surgery.

By inserting an implant behind each breast, surgeons are able to increase a woman’s breast size by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure – when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please ask Dr. Dolynchuk if there is anything you don’t understand about the procedure.

THE BEST CANDIDATES FOR BREAST AUGMENTATION

Breast augmentation can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

TYPES OF IMPLANTS

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. Health Canada has made use of silicone implants available as a result of experience over the past ten years in Canada with round and tear-drop anatomical implants, which have been shown to be safe. Saline-filled implants continue to be available to breast augmentation patients on an unrestricted basis, but you should ask your doctor more about the specifics of the two styles of implants and which is best for you.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

As with any operation, there are risks associated with breast augmentation surgery, although the procedure is straightforward technically. Specific complications associated with this procedure are capsular contracture, migration, infection, and rippling. Capsular contracture occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant. Migration and rippling is less common with textured implants as compared to smooth walled implants. However, fold formation may still occur. Excessive bleeding and infection following the operation may cause some swelling and pain, as with any surgical procedure. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples change in sensation, being either increased or decreased. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within six weeks, but may be permanent in some patients.

There is no evidence that breast implants will alter fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within a year of surgery, you may produce milk for a few days after augmentation surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may rupture. This can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If you have a saline-filled implant, the implant will deflate in a few hours and the salt water will be harmlessly excreted.

If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue unless it is a cohesive gel implant. The gel may remain in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the appearance and feel of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In the case of older style silicone implants it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms.

While there is no evidence that breast implants cause breast cancer, they may require that the way mammography is done to detect cancer be altered from the routine positioning. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable X-ray of a breast with an implant. Eckland views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant. A form of lymphoma or abnormal immune cell proliferation which occurs rarely has been reported. Although it may not require chemotherapy, occasionally it does. While the majority of women do not experience these complications, you should discuss each of them with us to make sure you understand the risks and consequences of breast augmentation.

PLANNING YOUR SURGERY

In your initial consultation, Dr Dolynchuk will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, we may also recommend a breast lift as well.

Be sure to discuss your expectations frankly with us. You may want to ask for a copy of the manufacturer’s insert that comes with the implant we will use — just so you are fully informed about it. And, be sure to tell us if you smoke, and if you’re taking any medications, vitamins, or other drugs.

Dr Dolynchuk will also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because Medicare and third party insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

PREPARING FOR YOUR SURGERY

Dr Dolynchuk will give you instructions to prepare you for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

WHERE YOUR SURGERY WILL BE PERFORMED

We may prefer to perform the operation in a freestanding surgery center, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.

TYPES OF ANESTHESIA

Breast augmentation can be performed with a general anesthesia, combined with a local field block to make you feel less discomfort when you awake.

THE SURGERY

The method of inserting and positioning your implant will depend on biodimensional assessment preoperatively. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit.

Every effort will be made to ensure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision, we will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.

It is believed that putting the implants behind your chest muscle may reduce the potential for capsular contracture if untextured implants are used. Saline filled implants appear and feel more natural behind the muscle as well. Drainage tubes may be used for 24 hours following the surgery. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue.

You’ll want to discuss the pros and cons of these alternatives with Dr Dolynchuk before surgery to make sure you fully understand the implications of the procedure he recommends for you.

The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which may also be taped for greater support. A light gauze bandage is applied over your breasts to help with healing.

AFTER YOUR SURGERY

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by prescribed medication.

Within 24 hours, the gauze dressings will be removed, and you will be put into a surgical bra. You should wear it as directed. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

Your stitches are dissolving and disappear in six weeks, but the swelling in your breasts may take three to five weeks to disappear.

GETTING BACK TO NORMAL

You should be able to return to work within a few days, depending on the level of activity required for your job.

Follow our advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars will be firm and pink for at least six weeks, during which time Micropore tape is applied daily after the shower. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to ensure that you get a reliable reading, as discussed earlier. (see All surgery carries some uncertainty and risk.)

FINAL OUTCOME

For many women, the result of breast augmentation can be satisfying – even exhilarating – as they learn to appreciate their fuller appearance. Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help ensure that any complications, if they occur, can be detected early and treated.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If we’ve met your goals, then your surgery was a success.

ASPS, founded in 1931, is the largest plastic surgery organization in the world and the foremost authority on cosmetic and reconstructive plastic surgery. Dr Dolynchuk is a physician member of the ASPS and is certified by the American Board of Plastic Surgery (ABPS) and the Royal College of Physicians and Surgeons of Canada.

If you are interested in breast augmentation surgery in the Winnipeg area, please schedule a consultation with Dr. Dolynchuk by calling 1 (204) 231-1542. For your convenience, you may also fill out our online contact form.