Breast Augmentation and Lift

Breast Augmentation and Lift - Also known as augmentation mammaplasty, breast augmentation surgery involves using implants to fulfill your desire for fuller breasts or to restore breast volume lost after weight reduction or pregnancy. This procedure is done in combination with a breast lift which requires removal of excess skin if your breasts have ptosis (droop).

Expectations

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Breast Augmentation with Mastopexy/Breast Lift with Silicone Implant for Breast Enlargement
Courtesy of Dr. Derek Ford
Breast Augmentation with Mastopexy/Breast Lift with Silicone Implant for Breast Enlargement
Courtesy of Dr. Derek Ford
Breast Augmentation with Mastopexy/Breast Lift with Silicone Implant for Breast Enlargement
Courtesy of Dr. Derek Ford

What should I expect?

Breast Augmentation/Lift is an outpatient procedure that can be done under sedation or general anesthesia. The breasts incisions are marked before the operation by your doctor. If you are undergoing a breast augmentation and lift, the incision options are 1) an incision just above the areola to give a small lift or 2) an incision around the entire areola to give additional lift or 3) if you need even more of a lift, you may also have a vertical incision below the areola and finally, 4) if you need the most lift possible, your incision could include the incisions mentioned above and a horizontal incision below the breast. The amount of lift you need can be discussed further with your doctor.

Once in the operating room, your doctor will place the implants under or on top of the muscle. The advantage to implant placement under the muscle is that it camouflages the implant better if you had very little breast tissue to begin with. If you have greater than a 2cm "pinch" of breast tissue before the operation, you may be a candidate for an implant on top of the muscle which avoids cutting of the muscle and less pain after your procedure. Your doctor can discuss this further with you.

What it won't do
Severely drooping breasts will not be corrected by a breast augmentation alone. If your breasts require lifting due to sagging and you desire a fuller look, a breast lift paired with a breast augmentation may be something to consider. Breast lifting can often be done at the same time as your augmentation or may require a separate operation Discuss these options with your plastic surgeon to make this decision.

How should I prepare?

It's important that you have very realistic expectations of what breast augmentation/lift can do for you. If you need a lift, you must accept that you may need additional incisions to give the breast the best shape possible. It's not just about size - shape is extremely important too. Implants can improve size and shape to some extent but necessary changes in shape may only be accomplished with a breast lift, which means more incisions. If you have a history of breast cancer in your family, consider getting a mammogram before you operation so that you have a baseline image. If you are younger than 40 and have no history of breast cancer, self breast exams are adequate for screening before a breast augmentation.

Refrain from taking aspirin, ibuprofen or certain herbal supplements, as these can increase the chance of bleeding. Be sure to disclose everything you are currently taking, regardless of how menial. Stop smoking and all other nicotine products several weeks prior to your procedure. Your surgeon will discuss the recovery with you as well.

You'll need help
Should your breast augmentation be performed on an outpatient basis, arrange for someone to drive you to and from the procedure and stay with you for at least 24 hours following the surgery.

Options for Breast Implants (saline vs silicone, smooth vs textured, round vs shaped)

Saline breast implants are filled with sterile salt water. The amount of saline determines the shape, firmness and feel of the breast. In the event the implant shell leaks, a saline breast implant will collapse and the saline will be absorbed and naturally expelled by the body. Ripples from the shell of saline implants can sometimes be felt on the skin after augmentation. These ripples are not typically felt with silicone implants. Saline implants are less expensive than silicone implants.

Silicone breast implants are filled with a silicone that has a consistency more like gel than liquid. The gel feels and behaves much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket. However, with this generation of gel implants, they are more likely to retain their shape rather than "spill" everywhere. If you choose a silicone implant, routine visits to your plastic surgeon are required to ensure the implants are functioning properly. The condition of implants can be monitored through an ultrasound or MRI screening. However, most insurance companies do not cover routine ultrasound or MRI screening for silicone gel implants.
Occasionally, new styles or types of implants are released, so there may be another option available. Recently, the "gummy bear" implant, a term coined by Dr. Grant Stevens, was approved for use in the United States. These implants contain a cohesive gel that is even more unlikely to leak.
Currently, women 18 years and over are FDA-approved for saline implants while women 22 years and over are FDA-approved for silicone implants. If used for reconstructive purposes, either may be recommended at a younger age.
In the past, there was concern about silicone gel implants causing connective tissue diseases like lupus. At this time, many studies have been performed that dispel the myth that there is a connection between gel implants and connective tissue diseases.
A recent study that the FDA has begun is to see if saline or silicone implants cause a very rare type of lymphoma. In patients that have lymphoma that is thought to be from implants, the treatment is removal of the scar tissue around the implant for a cure. While the incidence of this type of lymphoma is very rare, in the cases that have been seen, it appears to only be associated with textured, rather than smooth implants.
As for mammograms, there are techniques that radiologists use that allow them to fully evaluate the breast tissue in mammograms even if implants are present. Therefore, implants should not interfere with mammographic screening.

Textured Implants are implants, either saline or silicone, that have a rough, textured surface. The potential benefit is less movement in the breast pocket and potential lower rate of capsular contracture (deformation of the breast due to surrounding scar tissue).

Smooth Implants are implants, either saline or silicone, that have a smooth surface. There is a potential for a higher rate of capsular contracture (deformation of the breast due to surrounding scar tissue).

Round Implants are implants, either saline or silicone, that have a flat base but rounded like a dome. The potential benefit is that if the implant moves within the breast pocket, it is still in good position.

Shaped Implants are implants, either saline or silicone, that are in a tear-drop shape. The potential benefit is that the implants will give the breast a more natural teardrop appearance but if the shaped implant moves within the breast pocket, it could change the shape of the breast.

What does all of this mean?! With the options of saline vs silicone, smooth vs textured or round vs shaped, you and your doctor can evaluate the benefits and risks and decide on saline, smooth, round implants or silcone, textured, shaped implants or any variation above.

What are the risks?

As with any implant, there is always a risk of infection. And as with any surgery, there is always a risk of bleeding. With any type of breast implant, saline or silicone, there is a risk of capsular contracture which is when the scar tissue that forms around the implant can distort the breast. If this happens, it can be treated by removing the scar tissue inside the breast that is around the implant. There could be temporary or permanent changes in nipple sensation with breast augmentation around the nipple but this is rare. There is no documented increased risk with implants and cancer and no evidence that breast augmentation interferes with breast feeding.

How do I ensure my safety?

Breast implants have been deemed safe by the Food and Drug Administration. Currently there is no evidence that they cause autoimmune diseases or cancer.

What will recovery be like?

Although each individual's recovery time may vary, generally your post-surgical recovery time will last 24-48 hours. In the days following, limit yourself to low-key activities. You will experience soreness and swelling however that will subside after a few weeks. Your plastic surgeon will inform you when you are able to resume normal activities and exercise. Your incision lines will be visible at first, but over time these will fade. You will be given specific instructions that may include: post-operative care for your breasts, activity and breast massage to minimize the chance of capsular contracture.

How much does it cost?

In the United States, the average cost of a breast augmentation and lift is $8,550, according to BuildMyHealth's Pricing Database.This includes costs of anesthesia, operating room facilities, and other related fees.

See more detailed pricing for this procedure