Augmentation surgery is performed to increase the size of a woman's breasts. Most commonly, it is performed as a stand alone procedure although sometimes, it is combined with a mastopexy (breast lift) if the patient has excessively ptotic (droopy) breasts.
To place an implant beneath the breast, a cut in the skin has to be made somewhere. Each surgeon has his/her own preference as to the location of the incision. Common places are either around the areola (the pigmented part of the nipple) or under the breast (the inframammary crease). Other surgeons will use an incision in the armpit. Then, a pocket is created for the implant. In most cases, this pocket is made beneath the pectoralis major muscle (submuscular). Infrequently, the implant is placed above the muscle (subglandular) and occasionally, some surgeons place implants under the thin layer of tissue between the breast and the muscle (subfascial). With the implant in place, the skin is closed and the patient is awakened from her operation.
The biggest advantage of placing an implant beneath the muscle layer is that it reduces the risk of the most frustrating potential complication of implant surgery – capsular contractures. Why some patients develop these contractures is unclear. What is known is that a patient will always produce a wall around any foreign body. Thus, all implants will develop a wall or a shell around them. In most cases, this shell remains very thin and undetectable. In some circumstances however, this shell hardens and can resemble the consistency of an egg. This process is termed a capsular contracture. There is some compelling evidence that these contractures are the result of a very low grade, subclinical infection but other theories about their cause are also debated. Regardless, empirically it is known that placing an implant behind the muscle layer reduces the risk of developing a capsular contracture around the implant. The additional advantage of placing an implant in the submuscular plane is that the muscle camouflages the upper pole of the implant giving a smoother appearance to the breast instead of a bubble look. The downsides of submuscular implants are that they hurt more because the muscle has to be released from the rib cage and in some patients, as the muscle contracts, small movements of the implant can be seen.
Implant choices have expanded in the last 5 years from saline implants to either saline or silicone gel implants. In the 1990's, there was a scare about the safety of silicone gel implants. With time and exhaustive studies, it was determined that there has never been a health risk with silicone implants so they were reintroduced in Canada several years ago. Shaped and circular implants are available and each surgeon has his/her own preferences in this regard.
Choosing your Implants
Before the operation, the woman chooses the size of the implant which she wishes. This is usually done by placing sizers inside the woman's bra and then changing the sizers until the desired look is achieved. Many women are initially surprised by the change seen with the sizers and some women will return for another visit to retry the sizers before committing to a particular size. Women are always reminded to go to the size that they wish to be.
The recovery course for a woman with implants is usually quite quick. The first night is always a bit sore but by the next day, most women are back doing reasonably light tasks with their arms. Commonly, women are back to work in 3-7 days. All women will notice that their implants will sit high initially after surgery as the breasts will be swollen and the tissues take a while to stretch. This resolves over a few weeks as the implants assume their desired shape and position. Most women will feel a bit tired for a few weeks after surgery but this always resolves.
Please contact Dr. Campbell's office should you have any questions or if you wish to book a consultation appointment.