Breast Augmentation

Breast augmentation (breast implantation / augmentation mammaplasty) surgery is one of the more common aesthetic procedures performed worldwide. This operation enlargens & beautifies undershaped and/or underdeveloped mammary glands. Through the use of small camouflaged incisions (either within the areola, the inframammary fold or the armpit) breast implants are placed either in front of the chest muscle (pectoralis major muscle) or behind it – of course, depending on individual conditions. General anesthesia is typically required and is administered at a first-rate accredited surgical center under the care of a board-certified anesthesiologist.

Breast augmentation (breast implantation / augmentation mammaplasty) surgery can be performed in a variety of different ways.

• Traditional breast augmentation can be performed through an incision along the bottom areolar rim (periareolar), the bottom breast fold (infrmammary fold), or dome of the armpit (transaxillary).
• Of course, in addition to external insision being made, a custom-designed surgical pocket is created for the placement of the respective breast implant. The pocket may be in front of the muscle (behing the breast gland still, so subglandular) or behind the muscle (behind the pectoralis major muscle, so retropectoral or subpectoral). Sometimes a behind the muscle implant is actually partially behind and partially in front of the pectoralis major muscle.
• Many types of implants exist – the main categories being saline implants and silicone implants. Within those different categories, further subtypes exist – those main sub-type categories being smooth surface implants and textured surface implants. An additional consideration involves the actual shape of the implant, and different categories exist there too – the main shapes being round implants or anatomical-shaped (tear-drop shaped) implants. A further consideration involves the actual projection of the implant, and different categories exist there too – the main projections being low-profile implants, medium-profile implants, medium-plus-profile implants, and high-profile implants.

As you can see there are many complexities and subtleties of arriving at a customized surgical plan. Dr. Minoli will discuss with you the recommended methods for treating specific areas of your body. These considerations are based in part upon realistic goals that you and he set.

You may be a candidate for breast augmentation (breast implantation / augmentation mammaplasty) surgery if one or more of the following conditions exist:

• You are bothered by the feeling that your breasts are too small.
• Clothes that fit well around your hips are often too large at the bust line.
• You feel self-conscious wearing a swimsuit of form-fitting top.
• Your breasts have become smaller and lost their firmness after having children.
• Weight loss has changed the shape of your breasts.
• One of your breasts is noticeably smaller than the other.

Your consultation likely will include a discussion about your overall goals – particularly your desired shape & size. What do you wish to achieve through breast augmentation (breast implantation / augmentation mammaplasty) surgery?

You should come to the consultation prepared to discuss your medical history – including any conditions you may have such as diabetes, high blood pressure or heart disease. Dr. Minoli will want to know about your current medications and your previous surgeries & medical treatments. If you plan to become pregnant or change weight in the future, you should discuss this with Dr. Minoli. Complete information is important for proper decision-making.

You will be asked if you have had prior breast surgery (including breast biopsies), prior mammograms, or a known family history of breast cancer. If you think you may want to become pregnant in the future, you should mention this to Dr. Minoli; pregnancy can alter breast size in unpredictable ways. In addition, your current weight, diet & exercise regimen will be amongst the considered factors.

Dr. Minoli will examine, measure & photograph your breasts. Your skin tone and its associated elasticity will be assessed along with the underlying glandular & fatty elements of your breasts. Chest (pectoralis) muscles and pre-existing scars will also be evaluated. Overall, a multitude of factors are considered – such as size, shape, skin quality, and nipple position.

If your breasts are sagging, a breast lift may be recommended in conjunction with augmentation; and this topic is detailed further in the Breast Lift, Breast Reduction & Combined Breast Lift/Augmentation section.
Not everyone will achieve the same results. Dr. Minoli will take into consideration your unique features. During the consultation, you will be asked to point out the exact areas you would like improved. This will help Dr. Minoli understand the reality of your expectations.

Breast augmentation (breast implantation / augmentation mammaplasty) surgery is typically a cosmetic procedure and, as such, is not covered by most insurance companies. In rare instances a congenital or acquired breast deformity may be causing a functional problem, and as such, reimbursement may be available … but for breast augmentation (breast implantation / augmentation mammaplasty) surgery, this would be rare. Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. Dr. Minoli & his staff will discuss these matters with you.

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and Dr. Minoli & his staff. Fortunately, significant complications from breast augmentation (breast implantation / augmentation mammaplasty) surgery are uncommon – this takes into consideration thousands of procedures worldwide. As benefits are considered, so too are specific risks: These include the possiblity of bleeding, infection, bruising, prolonged discoloration, swelling, numbness, reactions to anesthesia, painful or unattractive scarring, contour irregularities, fluid collections, tissue loss, need for further surgery, and unsatisfactory overall results.

Further considerations which pertain to breast augmentation (breast implantation / augmentation mammaplasty) surgery include the following:

• When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may sometimes tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in breast shape. In such cases, more surgery may be needed to modify or remove scar tissue, or perhaps remove or replace the implant itself.
• Breast implants are not “lifetime devices” and cannot be expected to last forever. If a saline-filled implant breaks, its contents are harmlessly absorbed by the body. Breast changes are usually noticeable. Implant rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause. Surgery is required in order to replace the ruptured implant; but this surgery is typically straightforward.
• If you are at an age when routine mammograms should be conducted, it will be important for you to select a radiologist who has experience & skill in taking x-rays of augmented breasts. Additional mammogram views of your breasts will be required. In some instances Dr. Minoli may recommend other imaging exams such as ultrasound or magnetic resonance imaging (MRI).
• Some women with breast implants have reported the co-existing presence of connective-tissue disorders or autoimmune-related diseases. Women without implants also have these disorders. Several large studies provide reassurance that women with breast implants do not have any unusual or increased risk of contracting connective-tissue disorders or autoimmune-related diseases.
• Permanent changes in sensation (or loss of sensation) within the nipples or breasts can occur.
• In the unlikely event of injury to the nipple-areolar complex, small skin grafts or skin flaps can be used for a satisfactory reconstruction.

Minor irregularities can sometimes arise (e.g., in certain instances – when incisions have not healed in an ideal way, when contour irregularities arise in the healing process, when the breasts are not perfectly symmetrical, or when nipple height varies somewhat from side to side), but office-based postoperative treatments are usually available to help minimize these problems if they occur. You can help to lessen certain risks by following the professional advice given by Dr. Minoli and his staff

You will be returning to Dr. Minoli’s office at regular intervals so that your postoperative progress can be properly evaluated. During the first few postoperative days your breasts may be tender, but this usually subsides later in the 1st week or so.

In the early stages of recovery (the first 2 or 3 days especially) you may need personal assistance. Washings must be done in a gentle manner during this early period; and in fact, specific instructions are given to each patient.
The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Straining, bending and lifting must be avoided, since these activities may cause increased swelling or even bleeding. You may be instructed to sleep on your back with a pillow under your knees.

In rare instances (e.g., some revision breast surgery patients), small temporary drainage tubes may be placed in the breasts under the bandages. These drains can help prevent the accumulation of postsurgical fluids in the breasts: They are usually removed the first day after surgery; but a full shower or bath is not permissible until the drains are gone.

As the 1st postoperative week progresses so does one’s sense of independence. External sutures are usually removed in about 7 to 10 days. (In rare instances, if drainage tubes and their associated sutures are used, they are typically removed on the 1st postoperative day.) Bruising and swelling, common during the first few postoperative days, subside during the 2nd week. By the 2nd week driving privileges will likely resume.

Special notes: Dr. Minoli recommends that breast-implant patients take antibiotics at the time of dental procedures to indirectly protect their breast implants from oral germs: So you may need our assistance in such an event. Following surgery, you will still be able to perform breast self-examination. The surgery itself will NOT increase your risk of developing breast cancer. Of course, we continue to recommend that you schedule routine mammograms appropriate for your age.

It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

Straining, bending and lifting should be avoided during the early postoperative period. Depending on the extent of your breast surgery – and your general physical condition – you may be able to return to non-strenuous work anywhere from 1 to 3 weeks after surgery. Any sexual activity should be avoided for a minimum of 3 weeks. And vigorous activities, especially extended arm movements, should be restricted for at least 3 weeks.

In many instances, you can resume most of your normal activities, including some form form of mild exercise, after a few weeks. You may continue to experience mild periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported. In general, the timing of your recovery depends largely on the extrent of your surgery and your individual healing capacity.

Bruising & swelling, common during the 1st week, begin to subside noticeably during the 2nd week. In a broader sense: It takes about 6 weeks after surgery to pass social scrutiny … & 6 months or more before residual lumps & bumps soften & dissipate. Incisions will initially be red or pink in color: They will remain this way for many months following surgery – and may even appear to worsen before they fade – but eventually incisional scars fade. There may also be numbness in some areas; it may take months before feeling returns. Of course, Dr. Minoli will help guide you through these milestones.

You should be up and gently about during the first few days following surgery; but without strain. Your dressings will be removed in the days following surgery so that Dr. Minoli can examine the treated areas. You will be advised to wear a supportive post-surgical bra. Stitches will be removed in 5 to 10 days, depending on their nature. If present, drains and their associated sutures are typically removed within the 1st week. A full shower or bath is usually permissible on the 2nd or 3rd postoperative day.

It is important to realize that recovery time varies greatly among individuals. Please remember that your relationship with our staff does not end when you leave the operating room. Since the healing process is gradual, you should expect to wait up to 1 year to see the final results of your breast surgery. You are likely, however, to begin enjoying the initial stages of your new appearance within a few weeks after surgery. If you have any questions or concerns during your recovery, or need additional information at a later time, please contact us.

The results of your breast surgery may be dramatic or subtle, depending on how you looked before surgery as well as the specific goals that you and Dr. Minoli establish. Since the healing process is gradual, you should expect to wait at least several weeks before being able to appreciate your “new look.” Modest changes may continue to occur over several months to a year.

When healing is accomplished, breast augmentation (breast implantation / augmentation mammaplasty) surgery will have enlarged your breasts and enhanced their shape. You may find it easier to wear certain clothing styles. It may take some time to adjust to your new body image, but you are likely to feel a boost in self-confidence as you progress in your healing. Still, it is important to remember that various healing factors may prolong the final result. Fluid retention and prolonged swelling are typical in the months following surgery. The healing process is gradual, so you should expect to wait a while before fully enjoying the outcome. Nevertheless, the results of your surgery should be long-lasting. Unless you gain or lose a significant amount of weight or become pregnant, your new breast shape should remain fairly constant.

However, aging, gravity & weight-fluctuation can take their toll; and they will eventually alter the size and shape of virtually every woman’s breasts. Furthermore, implants are not your own flesh-and-blood. ~25% of women undergo another breast surgery years later. If, after a period of years, you again become dissatisfied with the appearance of your breasts, you may choose to undergo a second breast procedure to restore their more youthful contour and appearance.

Scars will fade over time; but no matter what, incisions create scars – and scars are permanent. Most incisions heal nicely; but some scars are more noticeable. Fortunately, breast augmentation (breast implantation / augmentation mammaplasty) surgery scars are usually concealed by natural body creases or actual clothing. Occasionally, a touch-up revision may be desired to further improve a contour or a scar. The additional treatment can usually be performed under local anesthesia in Dr. Minoli’s office. You will return to Dr. Minoli’s office for follow-up care at prescribed intervals, at which time your progress will be evaluated. This postoperative period typically spans the first year following surgery, and certainly beyond if needed. Please remember that the relationship with Dr. Minoli and his staff does not end when you leave the operating room, but continues. If you have questions or concerns during recovery Dr. Minoli and his staff will be available to respond.

(Dear reader, please note: Aging, gravity & weight-fluctuation can take their toll. If your body changes even after surgery, secondary procedures are still available.)