How is a breast augmentation performed?
Breast augmentation can be preformed using one of three types of incisions; transaxillary (arm pit), periareolar (around the nipple) or inframammary (in the fold under the breast).
In the majority of cases Dr. Schwarz prefers the transaxillary approach. An incision of about 4 centimeters is made in the hair bearing area of the axilla. The implants, usually silicone gel are placed behind the muscle.
The advantages of this procedure are:
- No scars on the breasts.
- No change in nipple sensation.
- Mammograms can be done normally.
- Less frequency of hardening of the scar around the implant (capsular scar contracture).
A breast augmentation takes about 1 hour to complete, incisions are closed with absorbable internal stitches, leaving only a fine line at the incision site. These are covered with a simple and comfortable dressing. After awakening from anesthesia, our patients are brought to the recovery room where they are cared for until they are comfortable and alert.
They leave the clinic with oral and written indications for their care at home as well as a prescription for pain management.
Breast implants are placed over the muscle in patients who are body builders, gymnasts, or weightlifters, where powerful use of the chest muscles can shift breast implant position during contraction.
Types of Implants
Implants are either Silicone gel or Saline filled and they come in different sizes. The surface of the implant can be smooth or texturized and the shape round or teardrop.
Silicone and saline implants both have very similar safety profiles. They both have pros and cons as well as differences which are important to discuss with the doctor during consultation. Some of these differences are the following:
Silicone implants provide a more natural look and feel, because they are filled with a soft, silicone gel.
Before surgery an evaluation of the breasts will be done in order to decide which is the best implant for you. Dr. Schwarz will guide you through this process and provide you with “sizing breast implants” to help you choose the appropriate size. It is important to choose an implant that will give a natural shape to your breasts.
There are no implants that last a lifetime. Dr. Schwarz recommends replacing the implants after 10-15 years when chances of breakage are possible. If an implant does break, it can be changed easily.
Do breast implants affect breast-feeding?
This is a myth and patients who plan on having surgery done before having a baby should not fear. Patients who undergo breast augmentation can expect to breast-feed normally, with no effect whatsoever on the breast milk or the baby.
Breast Augmentation + Lifting
In some patients the breasts are somewhat droopy and the augmentation is combined with a breast lift. Dr. Schwarz will determine during the consultation whether or not you would benefit from such a procedure.
Breast augmentations are all done under general anesthesia.
Post operative care and Recovery
Patients keep the dressing over their breasts dry 48 hrs, after which the bandages are removed.
Patients are allowed to shower normally once the dressing is removed and wearing a brassiere depends on the patients comfort.
Daily activities can be resumed as soon as they are comfortable, avoiding cardio exercises, strenuous activity, or heavy lifting during the first week only.
Dr. Schwarz recommends patients take one week off work. Resting and relaxing ensures better healing.
Follow-up appointments are scheduled at one week, three weeks, three months and then in one year.
Breast augmentation is a safe predictable procedure. As with any surgery there are associated risks and complications which Dr. Schwarz will discuss with you.
Removal of breast implants with en block capsulectomy
After Implant Removal
It is obvious that once the implants are removed there is a loss of volume of the breasts, which necessary will look deflated and empty with various degrees of droopiness. An alternative is to have a breast lift at the same time as the implant removal.
Simultaneous Breast Lift
Some patients will decide to undergo a breast lift simultaneously. This will lead to smaller breasts but with a more youthful shape and position. There are many surgical alternatives which can be discussed at the time of the consultation. The convalescence after implant removal, with or without simultaneous breast lift is, on average, two weeks. The bandages stay on for 48 hours and no drains are necessary, return to mild exercise is allowed one week after surgery and full activity after two weeks.
Removal of Breast Implants with Capsulectomy
Recently an association of a rare lymphoma called Anaplastic Large Cell lymphoma (ALCL) has been established with textured implants. The FDA (Food and Drug Administration in the USA) reports that its frequency is between one in 3800 to one in 30,000. It is important to note that this does not happen with smooth implants, which Dr. Gaston Schwarz uses exclusively. Whenever a foreign body is inserted in the human body, it reacts by forming a smooth envelope or internal scar around it called the capsule. Textured implants produce a rough, irregular capsule which, through an inflammatory reaction may lead to this rare lymphoma. This is usually manifested clinically by the accumulation of fluid (Seroma I) between the capsule and the implant on average from two to eight years after surgery. Examination of this fluid under the microscope, as well as a CD 30 test, may show evidence of the lymphoma in the capsule. More rarely it may show as a lump in the breast. The majority of seromas seen clinically, however, are benign.
Evidence Based Medicine (EBM)
It is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. You are welcome to request consultation with Dr. Gaston Schwarz to discuss all aspects of your breast implants.
Removal of Breasts Implants
If a patient reaches the decision to have their implants removed it is an operation which includes the complete removal of the capsule around the implant. This capsule is routinely sent to the pathology department at McGill University for examination.
The final result of any treatment or esthetic procedure may vary from patient to patient.