Background Information:

What are the other Names for the Procedure?

• Augmentation Mammoplasty
• Augmentation Mammaplasty without Prosthetic Implant

What is Breast Augmentation surgical procedure?

A Breast Augmentation procedure involves reshaping the size of female breasts using artificial implants or fat grafts.

What part of the Body does the Procedure involve?

Breast Augmentation involves the female breasts and muscles supporting the breast.

Why is the Breast Augmentation surgical procedure Performed?

A Breast Augmentation procedure can be performed for any of the following reasons:

• Correcting asymmetrical breasts
• Reconstruction of breasts
• Enlargement of breasts in ladies with less breast tissue
• Correct the loss of breast volume, post pregnancy
• Cosmetic purposes

What are some Alternative Choices for the Procedure?

Alternate choices may include use of external padding or prosthetics to increase the size of the breast. Alternatively, the patient may choose Fat Grafting for Breast Augmentation surgery.

What are the Recent Advances in the Procedure?

The recent advances in Breast Augmentation are related to the use of implants that do not rupture or deform easily.

What is the Cost of performing the Breast Augmentation surgical procedure?

The cost of  Breast Augmentation surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Breast Augmentation and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation.html?sub=Breast%20augmentation%20recovery#content

http://surgery.med.umich.edu/plastic/patient/adult_procedures/breastaug/

http://www.nnuh.nhs.uk/docs%5Cdocuments%5C15.htm

Prior to Breast Augmentation surgical procedure:

How is the Breast Augmentation surgical procedure Performed?

• A Breast Augmentation procedure is performed, once the size and type of the implant has been decided by the person who is receiving the implants. The surgeon uses this information to finalize on the type of surgery and analyze other aspects of the procedure
• The incision could be below the breast, around the nipple, under the armpits, and in rare cases near the navel
• After an incision is made, a pocket is created by raising the breast tissue from the chest muscles or raising the muscles around the chest
• The implant is inserted and placed in position. The skin is sutured and bandaged. The same procedure is followed with the second breast

Where is the Procedure Performed?

Breast Augmentation procedure is usually performed in an out-patient surgery center facility or a physician’s office. In normal cases, the patient can go home the same day. In some cases, if the procedure is performed in a hospital; the patient may be kept under observation for a day and then discharged.

Who Performs the Procedure?

The surgery is performed by a well-qualified plastic surgeon.

How long will the Procedure take?

The procedure may take anywhere between 1-2 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

A physician will request your consent for the Breast Augmentation procedure using an informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Breast Augmentation procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Breast Augmentation surgical procedure?

• Before a Breast Augmentation is performed, the patient may need to take a mammogram
• Additionally, some blood tests may be necessary prior to the procedure; the extent of tests needed, shall be determined by the physician

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Breast Augmentation procedure?
• How is the surgery performed?
• What shape and size of implants are recommended for me based on my height and weight?
• Will a Breast Augmentation help me?
• How will my breast look after the surgery?
• How will the breast look after pregnancy and breastfeeding?
• Do I have to replace the implants periodically or would they last a lifetime?
• What are the choices available, if I am unhappy with the implants?
• What will happen if I choose to remove the implants?
• Will the implants affect milk formation and breastfeeding?
• Will the procedure cause any loss of sensation in the breasts or nipples?
• What are the risks involved?
• What are the possible complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Breast Augmentation surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Usually local anesthesia is administered. Whether general anesthesia is required is dependent on the patient’s condition and this shall be decided by the surgeon. In such cases, the procedure is usually performed at a hospital surgery facility.

How much Blood will you lose, during the Procedure?

The amount of blood loss is generally minimal, but if complications arise during the procedure, it could lead to a further loss of blood.

What are the possible Risks and Complications during the Breast Augmentation surgical procedure?

The possible risks that may arise during a Breast Augmentation surgery are:

• Excessive bleeding
• Formation of blood clots
• Infection

What Post-Operative Care is needed at the Healthcare Facility after the Breast Augmentation surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Breast Augmentation surgical procedure:

What are the possible Risks and Complications after the Breast Augmentation surgical procedure?

The possible risks and complications that may arise after a Breast Augmentation are:

• Scarring; sometimes excessive scarring called keloid formation, might occur
• Surgical wound infection
• Hematoma (a pocket of blood in the wound)
• Seroma (collection of fluids around the implant)
• Wound separation
• Mondor’s Disease, which is inflammation of blood vessels in the breast
• Altered sensation in the breast and nipple
• Implant rupture or deflation
• Capsular contraction
• Wrinkling of the skin

What is the Prognosis after the Surgery?

The prognosis after the procedure is generally excellent.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Swelling & redness
• Bleeding or Drainage
• Fever
• Dizziness
• Signs of Infection

What Post-Operative Care is needed at Home after the Breast Augmentation surgical procedure?

At home, the following post-operative care is recommended, after a Breast Augmentation procedure:

• Wash the incision site with soap
• Use ice packs to reduce swelling
• Wear a well supporting bra, day and night till the physician ensures that the healing is complete
• Complete the course of prescribed medications
• Avoid non-prescription medication or pain killers
• Avoid strenuous activity for 6 weeks
• Resume daily activity as soon as possible (per your physician’s instruction)

How long does it normally take to fully recover, from the Procedure?

It takes about two weeks to recover completely from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Breast Augmentation does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Breast Augmentation surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• A plastic surgeon
• An anesthesiologist (if anesthesia was administered) 

The patient is advised to inquire and confirm the type of billing, before the Breast Augmentation procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA