Breast augmentation, also called augmentation mammaplasty or a “boob job”, is one of the most common cosmetic surgery procedures performed. The surgery is done to increase the size of the breasts or to restore the normal contour of the breast after mastectomy. A breast lift, or mastopexy, is a surgical procedure to change the appearance of the breasts without implants, by redistributing the breast tissue and sometimes moving the nipple. A breast lift can also be performed in conjuction with a breast augmentation.

When considering Breast Augmentation, there are a number of different possible choices that the patient needs to consider:

• the different types of breast implants available
• the position that the implant will be placed
• and the incision that the surgeon makes to insert the breast implant

What should I ask when consulting with a Cosmetic Surgeon who does Breast Augmentation or Breast Lift surgery?

• Ask whether he or she is board certified by the American Society of Plastic Surgeons and whether or not they have had specific training in this procedure.
• How much experience has the surgeon had performing breast augmentations, breast implants or breast lifts?
• You will want to find a surgeon who is well trained and experienced and with whom you feel a rapport.
• What complications are possible, and how would they be handled?
• Ask to see some breast augmentation before and pictures of patients following surgery.
• Am I a good candidate for breast augmentation, and what sort of breast implants and placement would the surgeon recommend?
• What will be the entire cost of breast augmentation procedure, including all fees for the anesthesia and hospital or clinic?

What should I expect to discuss in my initial consultation for Breast Augmentation or Breast Lift Surgery?

• The surgeon will ask you about your expectations for the procedure and you will discuss whether or not you are a good candidate for the surgery.
• Most surgeons will be reluctant to operate at all if you are under 22 years of age. Silicon implants are not recommended for patients under age 22.
• You should be in good general health. They will want to know your past medical and surgical history, what medications you take if any, and whether you have any allergies to medicines or past complications with surgeries.
• You will discuss the types of implants available and what you would prefer. Breast implants are either silicon based, water based or in some cases the surgeon can use some fat taken from another area of your body for small augmentations or modifications of shape.
• You may want to discuss the possibility of a breast lift in conjunction with the breast augmentation.

What are the different types of Breast Implants and the options for their placement?

The majority of breast implants used today are saline based. Silicon implants are regaining in popularity after the FDA re-approved them in 2006. The silicon implants are considered slightly more natural looking and feeling, but they must be placed whole, through an inframammary incision, whereas the saline implants are inserted empty through a comparatively smaller incision, and then inflated with saline. Saline is considered entirely harmless to the body if there should happen to be a rupture of the implant.

Breast implants may be placed:

• Subglandularly – below the breast gland tissue, which allows the most aesthetic result. However there is a slightly higher risk of contracture, and if the patient has a thin pectoral muscle, the implant may show ripples or wrinkles.
• Submuscularly – under the pectoralis muscle, which is good for patients with more breast tissue and thicker pectoralis muscles.

There are five different incisions that are used in Breast augmentation:

Boob Job - Breast Implant Surgery

• Inframammary (below the breast) – This is the preferred incision for placing silicon implants. It allows the best access for precise placement of the implant. This is one of the most common incisions along with the periareolar incision.
• Periareoloar (around the nipple) – This incision is useful to adjust an implant that has been placed with an inframammary incision and useful for implants that will subsequently be expanded such as saline implants. It is difficult to initially place silicon implants using this incision. There is a greater incidence of breast capsular contracture with this technique, and it can result in altered sensation around the nipple and problems with breast feeding.
• Transaxillary – This incision is made in the armpit, and the surgeon tunnels towards the breast underneath the skin to place the implant. The surgical scar is therefore not obvious, but it is difficult to place the implants with good symmetry, and they often require revision later on using either the inframammary or periareolar incision.
• Transumbilical – This is an uncommon and technically difficult technique using an incision made in the navel. The surgeon tunnels upward from this incision towards the breast to place the implant. This technique is abbreviated “TUBA”. It is not appropriate for placing pre-filled implants since the incision is very small and they would be damaged in the process of insertion and placement. The advantage of this is the very small, hard to notice incision made in the navel.
• Transabdominal – Abbreviated as TABA, this is similar to TUBA in that the incision is made in the abdomen and the surgeon tunnels upward towards the breast to place the implants. When done, it is usually accompanied by an abdominoplasty (“tummy tuck”).

What is the typical Breast Augmentation cost?

The cost of the surgery varies considerably by country and region. In the U.S., the average cost varies from between $3000 to $9000 depending on a number of factors. This cost includes the cost of the implants, the fee for anesthesia, the fee for the surgeon and the fee for the clinic or hospital. The portion of this cost that is the surgeon’s fee averaged $3,406 in 2005 according to the American Society of Plastic Surgeons.

What are some of the risks or possible complications involved in breast augmentation surgery?

• Rupture of the breast implant, requiring a revision surgery
• Bleeding, which may require removal of the implants in the operating room
• Infection, which would require removal of the implants, antibiotics and possibly a surgery to remove infected tissue
• Numbness, including decreased nipple sensitivity
• Hardening of scar tissue around the incision
• Contracture of the tissue around the breast implant
• The general risks common to all surgeries, including the risks of anesthesia

You should talk to your surgeon in detail about these possible complications so that you fully understand them and how they would be dealt with. Some of these complications are addressed by a repeat operation to change or modify the implants. It is also important to discuss with your surgeon what your options will be if you are unsatisfied with the cosmetic result of the surgery.

Breast augmentation recovery – what can I expect?

Immediately after surgery you will need someone to accompany you home, and you will be discharged with pain medications. If the implant was placed submuscularly, there may be more pain initially in the recovery period than the subglandular placement. You will probably return to see the doctor for a follow up visit around one week after surgery to check on the healing. Most activities can be resumed within about one week but vigorous exercise should be avoided for about 6 weeks. The incisions will heal within 6 weeks and the scars will gradually fade over the following several months