Details of Breast Augmentation and Implant Procedures
Consultation
Dr. Andrade encourages patients considering breast augmentation to have at least two preoperative consultations before proceeding with surgery. During the visits, patients will gain an overall understanding of the operation, and the risks, benefits and healing time. Important considerations include the type and size of implant, location of the incision, and position of the implant in the body.
For a 3D demonstration of breast augmentation click here.
Choosing Breast Implants
Selecting a saline versus silicone cohesive gel filled implant: Some of the advantages of saline implants include lower cost, the ability to adjust the implant volume in the operating room, and insertion of the implant through a slightly smaller incision. However, disadvantages include a higher implant rupture rate and possibly a higher chance of seeing or feeling ripples in the shell of the implant. Advantages of silicone implants include a softer feel and decreased tendency to cause rippling. They also have a lower rupture rate. However, disadvantages include increased cost, and a slightly longer incision on the breast.
Selecting a round versus teardrop-shaped implant:
The shape of the breast implant is chosen based on each patient’s physical features, such as the amount of breast tissue covering the implant, and whether there is any breast sagging (ptosis) that requires correction.
Determining implant size:
The correct implant for a patient depends on their own preferences, their unique anatomy, and the surgeon’s recommendations. Patients can get an idea of their desired implant size by looking at preoperative and postoperative photos, talking to others who have had breast augmentation, or trying on breast implant sizers during their consultation. Dr. Andrade will also provide advice based on the patient’s anatomy including their breast dimensions and the amount of tissue covering the implant.
Location of the Incision:
The 3 most common locations for the surgical incision are on the lower border of the breast (inframammary), around the edge of the areola (periareolar), and through the armpit (transaxillary). In Dr. Andrade’s practice the majority of patients choose an inframammary incision, and it is also preferred by Dr. Andrade because implants can be positioned very accurately under direct vision with this approach.
Location of the Implant Within the Chest:
Submuscular placement (deep to pectoralis muscle)
Subglandular placement (superficial to pectoralis muscle)
The breast implant can be inserted either superficial or deep to the pectoralis major muscle on the chest (these are called “subglandular” and “subpectoral” pockets, respectively).
Dr. Andrade chooses the location of the implant based on the patient’s unique anatomy. For example, a patient with sagging or loose breast skin may have improved shape if the implant is inserted in a subglandular pocket.
On the other hand, a patient with small breasts will have a thicker layer of tissue covering the implant if it is inserted in a subpectoral pocket. These surgical considerations are discussed with patients before surgery.
Preoperative Preparation:
Prior to any surgical procedure, a general physical examination by a family physician is recommended. Dr. Andrade is pleased to send a consultation letter to the family physician if the patient wishes to keep them informed of their operation. Routine preoperative blood tests and other tests usually need to be arranged prior to surgery. It is very important to inform Dr. Andrade about all medications, vitamins, and herbal supplements. Some of these substances can increase the risk of bleeding and must be stopped prior to surgery. Do not have anything to after midnight the evening before surgery. Water (no other liquids) may be consumed up to 4 hours before surgery. Bring a sports bra without an underwire, with clips in the front or back (not needing to be pulled over your head). Dr. Andrade and a registered nurse will review all of these details prior to the operation.
Day of Surgery:
Breast augmentation surgery is performed under a general anesthetic, either in Dr. Andrade’s private facility in Newmarket, or at Southlake Regional Health Centre. The anesthetic is delivered by a board-certified Anaesthesiologist. The operation takes less than 2 hours but total time spent in the facility is approximately 4-5 hours.
Postoperative Recovery:
Patients are given a prescription for an analgesic and antibiotic. Most patients are doing their own self-care and other their light activities the day after surgery, but Dr. Andrade recommends patients avoid heavy lifting or vigorous excercise involving the chest muscles for 4-6 weeks following surgery. There may be bruising and the breasts will be quite firm for at least several weeks following surgery. The breasts will soften and the implants may settle for several months following surgery. Scars take 6-12 months to completely mature and soften.
Benefits and Risks of Surgery:
The majority of patients are satisfied with the size and shape of their breasts following breast augmentation surgery, and the results will generally last for years. Potential problems immediately following breast augmentation surgery include but are not limited to bleeding, infection, wound healing problems, implant malposition, pain, or changes in breast sensation. Long-term problems include implant rupture, formation of scarlike tissue around the implant (capsular contracture), implant rippling, visible or symptomatic scars, and the need for additional surgery. Rarely, life-threatening complications can arise during or after any operation. Dr. Andrade will discuss other specific risks and answer any questions during the consultation.
Common Questions About Breast Implant Procedures
Will my breast implants need to be replaced in the future?
Like any prosthetic device, breast implants may need to be replaced at some point. Reasons for requiring implant replacement include implant rupture or deflation, implant shifting, or capsular contracture. Other patients simply wish to have different-sized implants, or to have them removed for personal reasons.
If I decide to have breast augmentation, how long will I have to wait for the operation?
The timing of surgery varies but often it is possible to have surgery within 4-6 weeks of booking the procedure.
How much time will I need off work?
Dr. Andrade recommends taking at least 1 week off work for patients with employment not involving heavy lifting (although some patients feel well enough to return to work after only 3-4 days). Those with more strenuous jobs, particularly involving heavy lifting or pushing, may require 3-4 weeks or more of light duties before returning to their regular work duties. Do not drive a car, operate machinery or go to work if you are taking narcotic analgesics to diminish your pain.
