Breast Augmentation



Who is a good candidate for breast augmentation?  One group of women who often ask for breast augmentations are young women who never developed adequate breast size. They want to have larger breasts to be proportional with the rest of her body, to look good in their clothing and to enhance their sexuality. Another group of women who frequently ask for breast augmentation are women who have had children and have subsequently lost volume in her breasts.

What is the breast augmentation consultation like?  In my practice, the consultation will take about one hour. After a review of the past medical history is done and an examination is performed, the procedure of breast augmentation will be discussed in great detail. This discussion will consider all aspects of the procedure including potential risks and complications as well as total costs. Photographs are often taken in this initial consultation.

What incisions are used?  The most common incision is a small incision line in the lower crease of the breast or inframammary fold. This incision offers direct accessibility, avoids incisions in the breast tissue itself and can be used over again if needed. And incision can be made in the armpit or axilla which has the advantage of leaving no scar on the breast itself. However, it can typically be used only once. The third possible incision is around the nipple areola. This leaves a good scar and can be used again, but can possibly lead to problems in nursing. All of these approaches tend to leave excellent scars which fade to thin lines within one year.

Should the implants be placed above or below the muscle?  For the best results, the breast implant should be covered with enough tissue so that implant ripples cannot be felt or visualized. Sometimes this requires placement of the implant underneath the pectoralis major muscle, but not always. This determination is typically based on the examination of the patient.

What are the different types of implants available?  All breast implants have silicone shells. The shell may be smooth or textured and the implant may be filled with saline or silicone gel. All of silicone gel implants are now cohesive, meaning that they are a true gel rather than liquid. One implant known as the
“ Gummy Bear” has a rather thick gel and is only available to patients who fit the protocol of a research study.

Can I breast feed after having a breast augmentation?  Breast implants themselves do not interfere with nursing. This is especially true when the incisions are either in the fold or armpit. Incisions through the nipple areola can sometimes damage ductal tissue.

Are the new silicone gel implants safe?  Yes. The new silicone gel implants were approved by the FDA three years ago after 15 years of research. I have personally been involved in the research for since 1994 and am currently involved in the research on the “Gummy Bear” implant. This research overwhelmingly proves the safety of the implants, but as with all medically implant material there can be certain risks and complications. These will be discussed thoroughly in the consultation.

What about the recent news about the link between breast implants and a rare form of cancer?   The FDA recently announced a possible association between breast implants, both saline and silicone, and anaplastic large cell lymphoma, also known as ALCL. There have been 60 cases of this disease discovered worldwide among an estimated 10 million women with breast implants. This is much rarer than other forms of breast cancer. The majority of these cancers have been found in capsules surrounding the implants. Most of these patients had sought medical care for pain, lumps or swelling of their breast. In 27 years of performing breast augmentation, I have never seen this condition although I will certainly be on the lookout. The FDA says there is no need for women with implants to change their routine medical care or follow-up exams.

How do you determine which size implant to use?   First, I listen to the patient; because I believe she has a pretty good idea about what she wants to look like once she has her implants.  The patient will look at pictures of models or former patients in order to show me the final result she is after. In the operating room, sizer implants are used and adjusted until the proper and exact size determination is made. Only then are the new implants opened and inserted.

How much time does the surgery take? Is an overnight stay necessary? The procedure usually takes about an hour of actual surgery.  It is typically performed as an outpatient procedure.

Where do you do this procedure and what kind of anesthesia is used? Most commonly I perform breast augmentation at the Austin Surgical Hospital which is a fully licensed and accredited facility. Anesthesia is given by a board certified Anesthesiologist.

What kind of anesthesia is used and is the anesthesia safe?  Typically general anesthesia is used and with a board certified anesthesiologist administering the anesthesia, it is extremely safe.

What is the recovery like and are there limitations?  Most patients are able to return to work within 3 to 5 days after the surgery. In order to assure the best results, some limitations will be placed on activity for several weeks postoperatively. However, walking, elliptical trainer, stationary bicycle and light weights are allowed early on.

What medications will I be required to take?  You will be given a prescription for an antibiotic, pain medication and other medications as needed.

What risks and complications are associated with breast augmentation? All surgical procedures carry some expected symptoms such as swelling, bruising, discomfort and pain, temporary numbness, itching and redness of scars. Common risks associated with any operation include possible bleeding or hematoma, inflammation and infection, unsightly scars, delayed healing and injury to deeper structures. The incidence of these risks is rare. Even more rare would be medical complications such as pulmonary embolism, allergic reactions to medications cardiac arrhythmias and hyperthermia. Complications related to breast implants include capsular contracture, wrinkling or rippling, asymmetry, deflation and reported autoimmune disorders.

What is capsular contracture? Is there anything I can do to prevent it?   Breast implants are recognized by the body as foreign material. The normal response of the body to foreign material is to place a layer of scar around it. The scar is typically a thin membrane but may sometimes thicken and contract around the implant. This results in a “shrink wrap” effect and makes the breast feel firm.
Usually, 95% of the time, capsular contracture can be prevented.  The other 5% may require surgical treatment.

What does it cost to have a breast augmentation?        The fee for this procedure has several variables such as type of implant used, anesthesia options, surgical facility. Typically the total cost will be somewhere between $5000 and $6500.


Article by
Austin Plastic Surgeon