Breast augmentation involves the use of an implant to increase the volume of the breasts. It is one of the most common aesthetic procedures.
During the evaluation appointment, the patient will be asked to fill in a targeted questionnaire and have a physical examination so she can receive proper guidance in her undertaking. Four important questions will be addressed:
- The type of implant to be installed: silicone-based or saline-based
- The incision site for implant insertion: below the breast, around the areola or in the armpit area
- The site of the implant: in front of the pectoral muscle or behind
- The size of the implant
A mammography and some laboratory tests may be necessary before the procedure. Instructions related to medications, smoking, alcohol, and some natural products will be addressed in order to minimize the risks of complications.
Conduct of the Procedure
The procedure is an hour-and-a-half day surgery. It is carried out under general anesthesia to maximize patient comfort. An incision of a few centimeters in length is made to create a pocket for the implant. At the end, the incision is closed with absorbable sutures and another strand which must be removed one week after the surgery. A small dressing is applied. The patient can be taken home after spending some time in a recovery room. She will receive follow-up information when leaving.
Patients may feel some pain after the procedure, but it is generally of short duration. Showers are allowed a few days after the surgery. It is strongly encouraged to gradually return to an active lifestyle, even though six weeks are necessary before strenuous physical activities can be resumed. Wearing a bra is recommended for comfort, but underwire bras must be avoided. The patient will learn how to do massage exercises; she must follow the given instructions to achieve optimal result.
Regular follow-up visits will be scheduled to ensure no complications occur. These visits are an opportunity to assess the result and give further instructions. There is no restriction to having a mammography as part of a breast cancer screening program; a radiological examination should be performed every five years to detect implant abnormalities if a silicon implant was used.
A Matter of Choice
The main reasons why women engage in this procedure are the following:
- To improve their self-esteem
- To have their small breasts increased in size
- To restore breast volume lost after pregnancy or weight loss
- To correct an asymmetry
Several options will be discussed when meeting with your surgeon.
The surgeon will guide the patient in making choices by clarifying the differences between all the options and by reviewing every steps of the procedure.
While breast augmentation is a very safe procedure, some complications may occur soon after the procedure or later.
Hematoma: A build-up of blood that may appear within a few hours to several days after the surgery. In the vast majority of cases, another surgery is needed to treat it, and a temporary small drainage tube is installed as well. A hematoma occurs in less than 5% of all cases.
Infection: Two types are found. The first type, called cellulitis, is a superficial infection found around the incision. It is easily treated with antibiotics. The second type, called abscess, is an infectious collection found around the implant. Another surgery is needed to treat it, and a temporary small drainage tube is installed as well. Implant removal is necessary in the most severe cases. The patient must be treated with antibiotics prior to any new surgery. These complications occur in less than 2% of all cases.
Implant rupture: may occur in various ways, depending on the type of implant used (silicone-based or saline-based). Silicone implants can rupture without being noticed by the patient since most of the silicone gel remains in the shell. The new “cohesive” gel implants are now way more stable than older implants. A diagnosis of rupture can be made through different types of radiological examination, including echography. As for saline implants, a rupture results in quick deflation, which prompts the patient to see the doctor since it is easily noticeable. The lifespan of both silicone and saline breast implants is about 10 to 15 years.
Capsular contracture: as a foreign material, the implant is isolated from the surrounding tissues by the body, which forms a capsule around it; this is a normal process. However, a scar may develop in this capsule, resulting in hardening of the breast and squeezing of the implant. Contracture is associated with various risk factors: type of implant, position of the implant, or postoperative infection or hematoma. The likelihood of a contracture occurring vary from 8 to 15% depending on the abovementioned factors. The treatment requires surgery in a small proportion of cases.
Asymmetry: a slight asymmetry is normal, especially if the patient was showing a breast asymmetry before the surgery.
Changes in nipple sensation: breast augmentation may result in an increase, decrease or complete loss of sensation. In the vast majority of cases, these changes in sensation are temporary.
Scarring: skin scarring can be a problem. A hypertrophic (thick) scar may occur. It appears as a red, raised scar. Several techniques can be used to treat this complication.
Implant displacement: various factors may cause the implant to move from its intended position. It can migrate upwards, downwards, or sideward. Although rare, this complication may require a new surgery if non-invasive procedures prove insufficient.
Rippling: occurs generally in the lower outer area of the breast, where the implant is less well protected by surrounding tissues. Rippling relates to saline implants.
Large cell anaplastic lymphoma: this type of cancer is extremely rare in women with breast implants. It presents with one swollen breast as a result of an accumulation of fluid around the implant. Diagnosis is made through analysis of the fluid. In general, this cancer is easily treated.
After the Surgery
Breastfeeding is possible after breast augmentation.
There is no increased risk of breast cancer after breast augmentation, apart from a very low risk of large cell anaplastic lymphoma.
It is possible to have a mammography after breast augmentation. However, it is important to ensure that the mammography center is familiar with the particular techniques to be used. Breast cancers are not detected at a later stage in women with breast prosthesis.
There is no increased risk of connective tissue disease or autoimmune disorders.
Implants have a limited lifetime. They are not lifetime devices. Both saline and silicone implant must be replaced in case of rupture.
Allergan and Mentor, the manufacturers of the breast implants used in Quebec, offer a lifetime warranty on their implants.