A breast implant is a prosthesis used to change the size, shape, and contour of a woman's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast mound for post–mastectomy breast reconstruction patients or to correct congenital defects and deformities of the chest wall. They are also used cosmetically to enhance or enlarge the appearance of the breast through breast augmentation surgery.
Breast augmentation is one of the most common cosmetic surgery procedures in the country. According to the American Society of Plastic Surgeons, 307,000 women had breast implants placed in 2011. Of course, all of these surgical cases were different and the women chose the procedure for a variety of reasons.
Breast implant surgery can be performed in a hospital, surgery center. Breast implant surgery patients may have to stay overnight in the hospital (inpatient surgery) or may be able to go home afterward (outpatient surgery). Most women receive general anesthesia for this surgery. Breast implant surgery can last from one to several hours depending on the procedure and personal circumstances.
If the surgery is done in a hospital, the length of the hospital stay will vary based on the type of surgery, the development of any complications after surgery and your general health. The length of the hospital stay may also depend on the type of coverage your insurance provides.
If you are undergoing breast implant surgery for reconstruction, you will also need to speak with your surgeon about your personal circumstances, including being treated with chemotherapy and/or radiation therapy, as these can affect your risks of complication and the appearance of the reconstructed breast. The surgeon should also speak to you about the amount of breast tissue that will remain after surgery and future screening for breast implant ruptures and breast cancer.
During the consultation be sure to ask the surgeon for a copy of the patient labeling for the breast implant s/he plans to use. You have the right to request this information, and your physician is expected to provide it. Be sure to read the patient labeling entirely prior to surgery. It will provide you with information specific to your breast implants, including how to take care of them. Make sure you read and understand the informed consent form before you sign it.
Breast implant manufacturers are currently conducting clinical studies to evaluate new types of breast implants and to understand the long term experiences of women who receive breast implants. If you are interested in participating in a clinical study, be sure to ask your surgeon what specific steps you will need to take.
Once you have been given anesthesia and it has taken effect, the surgeon will make an incision (cut) in one of the following areas:
along the underside of your breast (inframammary)
under your arm (transaxillary)
around the nipple (periareolar)
through the mastectomy scar (for reconstruction)
The FDA-approved labeling warns surgeons NOT to place breast implants through the belly-button (peri-umbilical approach). The location of the incision can affect how visible the scars are, as well as any complications you may experience after surgery.
Cutting the underside of the breast is the most common location used since it is where the skin naturally folds. Your scarring with this type of incision may be a bit more visible, especially if you are younger, thin and have not yet had children.
Placing the implant through an incision under the arm will likely require your surgeon to use an endoscope, a tool with a camera and other surgical instruments inserted into the incision site to help the surgeon guide the implant into place. While there will likely be no visible scar around your breast, you may have a scar on the underside of your arm.
Cutting around the edge of the nipple (areola) may cause problems with loss or change of sensation in the nipple.
The surgeon will place the implant above (subglandular) or below (submuscular) the chest wall muscles. Be sure to discuss the pros and cons of the implant placement selected for you with your surgeon prior to surgery.
If you are getting silicone-gel filled implants they will already be filled with silicone gel when inserted. If you are getting saline-filled implants and the implant is not pre-filled, the surgeon will insert the silicone shell and then fill the implant to the desired level with saline.
After surgery you will be taken to a recovery area to be monitored. Your surgeon should describe the usual after surgery (postoperative) recovery process, the possible complications that may occur, and the recovery period. Following the operation, as with any surgery, you can expect some pain, swelling, bruising and tenderness. These effects may last for a month or longer, but should disappear with time. Scarring is a natural result of surgery. For most women, scars will fade over time. The darker your skin, the more prominent the scars are likely to be.
Your surgeon may prescribe medications for pain and/or nausea. If you experience bleeding, fever, warmth, redness of the breast, or other symptoms of infection, you should immediately report these symptoms to your surgeon. Post-operative dressing to be in our clinic at free of cost.
You may need a postoperative bra, compression bandage or jogging bra for extra support as you heal.
If you received silicone gel-filled breast implants, the FDA recommends that you receive MRI screening for silent rupture 3 years after receiving your implant and every 2 years after that.
Continue to get screen for breast cancer.
Mastopexy, or breast lift, is a procedure designed to improve the appearance of sagging or ptotic breasts. The goal of surgery is to improve the shape of the breast while minimizing visible scars. To achieve this end result, multiple procedures and countless modifications of the mastopexy have been suggested.
If your breasts are small size or when it sags after pregnancy or due to age, the breast implants are inserted in same sitting with mastopexy. The procedure can increase both the firmness and size of your breasts. Best results are achieved in female with small, drooping & sagging breasts.
Procedures to recreate breast fullness using autologous tissue either primarily or after breast prosthesis using the dual pedicle dermo-parenchymal mastopexy and the de-epithelialized transverse rectus abdominis muscle pedicle, as well as by Flowers. Graf and Biggs modification of the vertical approach that places an autologous tissue flap deep to a strip of pectoralis muscle to improve shape and maximize longevity of the lift. Modification of the vertical scar approach as superior pedicle and popularized with the use of breast liposuction. A further modification of the vertical approach with using a Y-scar vertical mammaplasty as an alternative to reduce further scar burden. a vertical scar bipedicle technique, a combination for minimal scarring and robust blood supply to the NAC, as a further option for mastopexies. Owl-technique combined with the inferior pedicle in mastopexies. This technique carries the advantage of the conization effect from the vertical reduction combined with a short L–shaped vertical-horizontal scar, and also uses the inferior pedicle flap described by Ribeiro. Singh et al advocate a Z-mammaplasty technique.
Mastopexy usually takes 2 to 4 hours.
Breast lifts are usually performed under general anaesthesia, may use local anaesthesia, combined with a sedative.
Your breast lift is usually performed on day care basis in the clinic, It is sometimes performed on an inpatient basis.
Mastopexy presents one of the greatest challenges to the breast surgeon. Numerous techniques provide improvement in the shape of the breast. The aesthetic goals are to obtain a more youthful appearance, improved projection, and reduced ptosis. Unfortunately, aesthetic improvement comes at the cost of scars. In addition, although breast implants can provide the upper pole projection patients often desire, they present specific risks and complications.
The goals of surgical therapy are to restore normal contour and size and to do so with a minimal amount of visible scars. The strategies needed to achieve this goal are (1) remove the excess skin and/or (2) replace or augment the atrophied volume. The types of mastopexy are classified by the amount of scars produced, which often are related directly to the amount of lift achieved. The choice of technique is determined by the degree of ptosis and the desired size of the breast postoperatively.
Minimal breast ptosis can be corrected with breast implant augmentation. Minor ptosis can be corrected with periareolar skin resection with or without augmentation. Grade 2 ptosis can be corrected using a circumareolar donut mastopexy including the cerclage techniques as described by Benelli. Moderate grade 2 ptosis can be addressed using the vertical scar mastopexy procedures, including the Regnault B technique and Lejour/Lassus techniques. Severe grade 2 ptosis and grade 3 ptosis usually require inverted T incisions regardless of the pedicle used. Pseudoptosis can be addressed with augmentation and/or skin excision without nipple transposition (excision of lower pole skin) or with the circumareolar cerclage technique.
These guidelines can be modified for individual patients. In some patients, a circumareolarmastopexy can be modified by adding a small vertical component to achieve the desired result. Likewise, extra remaining skin following a vertical scar technique may require excision with addition of an inframammary fold scar.