Breast Augmentation - The Essentials
Silicone Breast Implant
Silicone breast implants are filled with a thick viscous gel composed of polymerized silicone. Its internal contents are designed to recreate the feel of a normal breast. Unlike the collapsible saline implant, a silicone breast implant comes from the manufacturer already pre-filled to a fixed volume. Direct surgical access through an infra-mammary or peri-areolar incision is required to position a silicone breast implant. The newest silicone “cohesive” gel breast implants better preserve the desired shape of the breast implant creating a fuller and more natural looking breast. In Montreal, silicone cohesive gel breast implants are the most popular choice among women choosing to have breast augmentation.
Saline Breast Implant
Saline breast implants are silicone rubber external shells engineered to be filled with a salt water solution. The saline breast implant is prepared by the manufacturer and provided to your surgeon as an empty shell. At surgery, the empty saline implant is surgically placed through a short hidden incision and then filled to your desired volume. The advantage of a saline breast implant is its collapsible small size offers the breast augmentation patient a shorter incision, great choice of incision methods, and a precise fill volume. However, the water like qualities of saline leaves many women dissatisfied with the “bag of water” unnatural feel and visible external “rippling” sometimes seen after saline breast augmentation.
Breast Implant Placement
During the initial consultation, your plastic surgeon will explain whether it is best to create a subglandular (over the muscle) or submuscular (under the muscle) pocket.
Subglandular Placement (over the muscle) – An implant pocket created over the muscle by the surgical elevation of the mammary gland is called a subglandular, submammary, or retroglandular breast augmentation. Advantages include less pain, better projection, and a breast implant that does not move with pectoral contraction. This pocket is perfect for women with robust tissues who choose silicone implants. However, the implant is more likely to be visible and palpable through the layer of breast and skin. Therefore, subglandular placement is not recommended for women with thin breast tissue and those who choose to use saline implants.
Submuscular Placement (under the muscle) – Pocket creation under the muscle is also known as submuscular, subpectoral, or retropectoral breast augmentation. The pocket is created between the major and minor pectoralis muscles. Advantages include better implant coverage. Both rippling and palpability are reduced with the added muscle cover. This is a good choice in thin patients or when saline breast augmentation is planned. Substantial postoperative pain and breast implant displacement with pectoral contraction are drawbacks.
Dr. Chen Lee uses measurements of your breast thickness to determine whether an over or under the muscle placement of breast implants is best for your breast augmentation.
Types of Incisions
Dr. Chen Lee primarily uses three incisions to perform a breast augmentation in Montreal.
The inframammary incision is the most common incision used for breast augmentation. This incision is located in the crease where the breast meets the chest and leaves a well-concealed scar below the breast. Direct visual access to the implantation site facilitates accurate breast implant placement with a low likelihood of malpositioning and asymmetry. All sizes of breast implants can be surgically positioned through an infra-mammary incision. This incision is particularly suitable for larger sized silicone breast implants.
The periareolar incision is located on the lower border of the pigmented skin surrounding the nipple (lower margin of the areola). A natural pigmentation change between the areola and normal skin serves to camouflage and conceal the resulting breast augmentation scar. This access incision also permits direct visualization of the surgical pocket for final silicone breast implant placement. The length of the peri-areolar incision is limited by the circumference and size of the areola. Not all sizes of silicone breast implants can be placed through this incision.
The transaxillary incision is hidden in the armpit and is remotely located from the breast. With this incision, a collapsible saline breast implant is preferred. The smaller dimension of the deflated saline breast implant facilitates its positioning through the tight confines of this remote incision. The implant is filled at surgery only after manipulation into its desired position. Modest or smaller sized prefilled silicone smooth breast implants can also be position through the trans-axillary incision. Direct surgical access for pocket creation is not possible. Creation of a well contoured symmetric lower breast pole remains a problem with the remote trans-axillary access. The resulting scar in the armpit might be visible with sleeveless attire. Women who often wear sleeveless apparel might consider another choice of incision for their breast augmentation.
Technique - Keller Funnel
In August 2011, Dr. Chen Lee introduced the use of the “Keller Funnel” into his breast augmentation practice. The advantages of using this new system are no touch technique, reduction of stress on the outer shell of the breast implant, shorter length of skin incision, and less trauma to the tissue. Ask Dr. Chen Lee how the Keller Funnel will benefit you.
Preparation for Breast Augmentation
Prepare mentally… It is important to remain positive, confident, and mentally strong. This is the foundation of your strength needed to prepare your personal (health, family, finances) and professional life.
Weeks before surgery… Your safety is our priority. In the weeks before your breast augmentation surgery, a general medical examination with laboratory tests to evaluate your overall health will be conducted. It is important, to be honest, and openly disclose all aspects of your general medical health in this confidential evaluation. To optimize your surgery and recovery, we have attached a checklist list to start your preparation weeks prior to your breast augmentation.
- Stop smoking! – smoking increases complications and leads to poor scars
- Do not take street drugs
- Eat a balanced diet – a diet rich in vitamin C will promote healing
- Avoid dietary vitamins and supplements
- Avoid herbal medicines
- Avoid aspirin, Advil, Motrin – 2 weeks prior to your surgery
- Continue prescription medications (unless advised otherwise)
Days before surgery… The goal is to create a peaceful receptive home environment that is conducive to healing and recovery. The following are items to consider in the days before your breast augmentation. Take care of last minute errands. Rent some favorite movies. Fill out prescription medications in advance. If you live alone, you may want to stock your shelves with plenty of food. Consider preparing and storing in the freezer meals for the week. Complete household chores. You will not have an interest in cooking, doing household chores, or running errands after your procedure. Secure personal assistance. This will be necessary especially during the first few days after your surgery. Choose your spouse, family member, or close trusted friend. They should dedicate two or more days to your care and needs. Have them plan to accompany you to surgery and to take charge of your safe return home as you will not be able to drive following your breast augmentation.
1 day prior to surgery… Take a shower the night and morning prior to leaving for surgery. You will not have the strength or interest to do so after your procedure. Remove all nail polish from fingers and toes as the polish interferes with the monitor used to measure your oxygen levels during surgery. Do not wear makeup going to surgery. Do not eat or drink anything after midnight the night before your surgery. Having an empty stomach before surgery decreases the risks of anesthesia, so it’s very important to follow this rule. If you eat or drink any fluids, your surgery will be canceled at your expense.
Day of Surgery
The day you have been waiting for finally arrives. Despite all your preparation, you can’t help but be nervous on this day. Most women considering breast augmentation are healthy and have never had any surgery. Anxiety from the unknown journey ahead can be substantial. Our health and breast experts have found the well-informed patient to be more comfortable and confident of their decision to proceed with breast augmentation. To comfort and ally anxiety, we have detailed below the anticipated events on the day of your breast augmentation. Like a carefully choreographed routine, your care will be handled by teams of healthcare professionals with expertise in nursing, technology, anesthesia, and surgery. The grand maestro directing these healthcare teams is your Montreal breast augmentation specialist, Dr. Chen Lee. Let’s familiarize you with the process of outpatient surgery for breast augmentation.
Nursing team: Our office will instruct you to arrive at the surgery center on an empty stomach, accompanied by a member of your family or a close friend. They are there to ensure your safe transportation home. You will be asked to check into the facility well before your scheduled surgery time. Following check-in, you will disrobe and wear the surgical apparel provided by the facility. Members of the nursing team will meet you, review your dossier, and ensure the correct breast implants have been delivered from the manufacturer.
Anesthesia team: Breast augmentation requires general anesthesia. For your safety, a board certified anesthesiologist will meet to review your medical health and ensure conditions are ideal for the operation.
Final markings: Dr. Chen Lee will be there to answer final questions and to mark the location of the incisions.
Operating suite: Your breast augmentation will be performed in a specially ventilated sterile operating room. The breast augmentation procedure requires less than 2 hours of operating time to complete. However, you will have to stay at the surgery center for half a day.
Recovery room: Following the surgery,you will recover from the anesthetic in the recovery room. A specially trained nurse will ensure that you are comfortable and recovering safely. You will be ready for discharge when you are alert and able to pass urine on your own.
- stay fasting prior to surgery (no breakfast, no snacks, no drinks)
- brush your teeth (do not swallow the water used for mouth rinse)
- shower in the morning (before your surgery)
- do not wear cosmetics (make up, eyeliner, perfume)
- remove nail polish (fingers and toes)
- do not apply skin moisturizers
- remove and leave all jewelry at home
- wear loose clothing (easy to change into, able to fit over top of breast dressings)
- be punctual – arrive on time to the surgery facility
- come accompanied with a responsible family member (transportation home)
- plan to be present in the surgery facility for at least half a day
- secure help at home (even better if for two or more days)
- carefully follow Dr. Chen Lee’s postoperative instructions
- notify Dr. Chen Lee promptly of unexpected symptomatology
Everyone will experience a certain amount of pain or discomfort after surgery. Take your medications as prescribed and do not mix with alcohol. You may not resume driving until you have stopped taking prescribed pain medications. Pain medications have their own side effects such as constipation, nausea, vomiting, and drowsiness.
Cold application: Cold compresses and ice packs can significantly diminish the discomfort. After surgery, cold compresses or ice packs (wrapped in a towel) can be applied to the surface of your chest in 10-minute intervals. To avoid skin blisters, ice packs should not make direct contact with the skin. Instead, protect your skin with a soft bath towel when applying ice packs.
Anti-nausea medication: Nausea may occur following breast augmentation surgery and throughout the recovery period. Reducing the use of narcotics will diminish nausea. Occasionally, Gravol is necessary to control nausea.
Skin moisturizers: After breast augmentation surgery, breasts may appear to be discolored, reddened, shiny, or produce stinging sensations. This results from breast implant stretch of the skin. These symptoms are short lived as skin rapidly accommodates to the breast implant over the ensuing week. Some patients have found relief by gently massaging in skin moisturizers on the breast during the recovery period.
Nipple anti-sensitivity aids: In some cases, the nipples become erect and sensitive during recovery. Today’s nursing pads and round band-aids may help with symptoms.
Scar aids: The quality of the final visible breast scar depends on a variety of factors. Initially, scars may appear reddened or raised. They will fade and flatten over time. Our breast augmentation specialists will often use the following scar reduction techniques: Steri-strips or surgical paper tape over a fresh incision, silicone sheeting for the fresh reddened scar, and topical gels to facilitated scar maturation for up to 6 months. It is important to avoid sunlight and salon tanning of the incision site during the first 6 months following your breast augmentation.
Physical activity: On return home, it is important to commence nonstrenuous activities such as walking. Walking should be continued on a daily basis in and around your home. This will help prevent phlebitis and deep vein thrombosis in your legs.
Diet and nutrition: Staying well hydrated is essential for optimal recovery. We encourage you to drink at least eight glasses of water per day. You may resume a regular diet the day after your breast augmentation.
Risks Associated with Breast Augmentation
As much as you may be intrigued and excited about the notion of breast augmentation, you must not forget the potential risks and complications. Surgery and general anesthesia always carry some risk to your general health. Although rare, there even exists the possibility of death. Additionally, complications occasionally arise at the actual site of breast augmentation. A partial list of complications includes asymmetry, deformation, infection, bleeding, delayed healing, reoperation, implant visibility, implant palpability, pain, loss of sensation, scars, capsular contracture, implant rupture, implant malposition, and no guarantee to the final size.
The possible complications…
- Hematoma, seroma, infection
- hematoma: bleeding in the breast pocket can result in an accumulation of blood around the breast implant. Should this complication arise, it usually is apparent the early hours after surgery. Often a return to the operating room is necessary to evacuate the hematoma.
- seroma: an accumulation of clear straw-colored lymphatic fluid around the implant is called a seroma. It is a frequent complication and is often associated with considerable swelling. It gives rise to a temporary increase in the volume of a single breast or both breasts. This complication usually resolves spontaneously by gradual dissipation.
- infection: rare after breast augmentation. If the infection does not rapidly resolve with antibiotics, then surgical drainage and implant removal may be necessary. A new breast implant may be reinserted at a later date when the infection has fully resolved. It is advisable to have a 3-6 month infection-free interval before planning the subsequent implant replacement.
- Three other three other specific forms of infection deserve comment:
- low-grade subclinical infection: this has few symptoms and can occur several years after implantation. This is significant as it is believed to be a possible process that gives rise to capsular contracture.
occurs with a moderate degree of frequency. This presents as 1-2 mm abscess surrounding a retained skin suture. Removal of the offending suture will immediately remedy this problem.
- Toxic shock syndrome: rare cases of this condition have been reported. It is caused by a rare toxin-secreting bacteria and is mentioned because of its severe morbidity.
- Skin necrosis:
- occurs when the overlying skin has an insufficient blood supply. This may result from the skin excessive tension associated a large untreated hematoma, an infection, or decreased blood flow to the skin from the nicotine in cigarette smoke. It is a rare but serious complication. The underlying breast implant is at risk of exposure and extrusion. Revision surgery with breast implant removal may be necessary.
- Abnormal scar:
- the process of scarring and healing is not entirely predictable. Following breast augmentation, incisional scars may become wide, abnormally pigmented (pale or dark), hypertrophic, or rarely keloid.
- Sensory changes:
- this usually is temporary, lasting several months and diminishes spontaneously. Infrequently, residual sensory alterations persist (heightened or diminished sensitivity) around the areola and nipple.
- Thrombosed veins:
- this condition occasionally presents several weeks after breast augmentation. One (or more) vertically oriented 2cm to 5cm length(s) of vein below the breast may become thrombosed, tender, and may resemble a cord. It is also known as Mondor’s Cord Disease. No medical or surgical treatment is necessary as the condition heals on its own and causes no permanent damage.
- Galactorrhea/milk secretion :
- rare cases of unexplained postoperative hormonal stimulation and milk stimulation have been reported. The secreted milk may accumulate around the implant.
- very rare, has a specific treatment.
- Specific implant-related risks:
- wrinkling or rippling: breast implants are designed to be soft and flexible. Implant malleability permits undesirable creases and folds to form on the external implant envelope. In turn, these creases can form unnatural wrinkles and ripples that are visible on the surface of the breast.
- Rupture: synthetic prostheses designed for biological implantation all suffer a risk of failure. When a breast implant fails, its contents are spilled into the breast pocket. Rupture of saline implants results in resorption of the physiologic salt solution and loss of breast volume. In contrast, silicone gel cannot be absorbed by the human body. The gel of a ruptured implant will often remain in the soft confines of the breast pocket. Consequently, rupture of silicone gel-filled implants frequently go unnoticed and are coincidentally diagnosed during routine breast studies (i.e. mammography). Dr. Chen Lee recommends the prompt exchange of implants once the diagnosis of rupture had been made.
- Capsular Contracture: can follow infection or hematoma, but more often has no identifiable cause. Modern surgical techniques with meticulous attention to anti-bacterial detail have lowered the incidence and severity of capsular contracture following breast augmentation. Treatment of capsular contracture usually requires revisional surgery with possible implant exchange.
- improper positioning or secondary displacement of a breast implant is the prime cause malposition, Correction usually necessitates reoperation.
- rarely occurs. Rotation of an anatomical shaped implant is theoretically possible and may affect the aesthetic result.
- Deformation of the chest wall:
- arises from the imprint left in the chest wall by a hardened implant capsule severely affected by capsular contracture. Following removal of the offending hardened implant capsule, a residual chest wall deformity remains.
The risks associated with cosmetic breast augmentation are low and should not be overstated. Even seemingly simple surgeries have risks. During your consultation, Dr. Chen Lee will further elaborate on the risks and complications associated with breast augmentation.
1. Are breast implants and breast augmentation covered by Régie de l’assurance maladie du Québec (RAMQ) or private insurance?
Unfortunately, RAMQ does not cover cosmetic surgery expenses. Breast augmentation surgery is not insurable by RAMQ. Additionally, it is also unusual for private insurance companies to extend medical coverage to include services for cosmetic surgery. Directly contact your medical insurance carrier to learn about your umbrella of services. You should always inquire about your medical covered if you are uncertain.
Dr. Chen Lee sets global fee for surgical breast augmentation services. This “global fee” for breast augmentation includes breast implants, use of a private surgical facility, professional services rendered by a board certified anesthetist, as well as Dr. Lee’s professional services. Contact us by phone if you wish to explore packages to finance your breast augmentation procedure. We will work to see if you qualify for a financial package.
2. How long can I expect my enhanced bust line from breast implants to last?
Most patients find that their breasts are augmented permanently with a single surgery. However, implantable synthetic prostheses should not be considered lifetime medical devices. All synthetic implantable medical devices (such as heart valves, brain shunts, orthopedic joints, and breast implants) can malfunction and fail.
3. Will my breast implant surgery leave a big scar?
Most breast implants can be surgically positioned through a 3.5 to 5 cm incision hidden in a natural skin crease of the body. The resulting scar is short in length and well camouflaged. Scars from breast augmentation are easily covered by beachwear and often imperceptible when nude. Your body morphology will determine the optimal incision for your breast augmentation. A personal consultation with Dr. Chen Lee will provide you with the information to make the best choice for your breast augmentation.
4. Will I have pain after following breast implant surgery? What duration of time can I expect the discomfort to last?
Patients undergoing submammary breast augmentation (implants over the muscles) do not experience as much pain as with submuscular breast augmentation (implants under the muscle). Discomfort from submammary breast augmentation is often mild, lasting less than 1 week, and usually well controlled with Tylenol. However, patients undergoing submuscular placement of breast implants may experience a greater degree of pain and discomfort. Usually an opiate medication is prescribed to control this discomfort. Fortunately, the pain subsides rapidly in the two weeks following breast augmentation. During your consultation, Dr. Chen Lee will use your body morphology to recommend the best implant position to yield the best aesthetic outcome and least degree of discomfort expected following breast augmentation.
5. When can I return to work following breast augmentation surgery?
Most patients are able to resume light office work 2 to 4 weeks following their breast augmentation. A temporary 6 week absence is advisable for patients engaged in strenuous occupations that require extensive physical effort.
6. When may I resume sexual activity following breast implant surgery?
Wound healing is sufficiently mature to resume normal sexual intimacies and breast stimulation approximately 1 month after breast implantation surgery.
7. Will my breasts and/or nipples become oversensitive or numb following the surgery?
Following breast augmentation, patients often experience temporary loss of erotic and general sensitivity to the breasts and nipples. In most instances, normal sensation returns spontaneously and naturally within a month after breast augmentation surgery.
8. Can I breastfeed following a breast augmentation procedure?
Modern techniques of breast augmentation do not harm the breast tissue and will not alter your ability to lactate and produce breast milk. Your ability to breastfeed following surgical placement of breast implants should not be affected.
9. Will I have a greater risk of breast cancer following breast augmentation?
There is no scientific evidence that relates breast implantation to breast cancer. Thus, your risk of developing breast cancer is not altered.
10. How will breast implants affect my ability to screen for breast cancer?
While the risk of breast cancer is not elevated following breast augmentation, screening is still necessary and encouraged. Common methods for detecting breast cancer include mammography, ultrasound, and magnetic resonance imaging (MRI). Mammograms can still be performed, however, modified techniques such as breast compression to enhance the view of the breast tissue is often necessary for an effective breast mammogram. To better plan your breast investigations, the physician managing your breast cancer prevention routine should be made aware of your breast augmentation.