What happens in breast augmentation surgery?
Preparation before the surgery
During the preoperative or preparation phase at a hospital or clinic, a series of medical examinations are performed to determine whether breast surgery is an option for the candidate. Once this is decided and breast augmentation can be done, the plastic surgeons will discuss the realistic expectation from the surgery and help choose the best breast implant type. The medical examinations may include
- Review of candidate’s medical history
- Complete physical examination of the breasts – to plan the changes
- Blood tests and radiology studies
- Assessment by the anesthesiologist to determine and minimize the anesthesia-related risks
After the surgery is confirmed and scheduled, the patient is asked to quit smoking, if she is a smoker. The doctor will also ask to stop taking medications that may increase the risk of bleeding. The patient must inform the doctor about the prescribed as well as over-the-counter medications, herbal products and supplements they are taking. They will have to stopped if required.
The medical team will also instruct when to stop eating and drinking before the surgery. All the instructions must be strictly followed in order to undergo the surgery at the scheduled time. The pre-operative instructions are also important for having a safe and healthy recovery. Patients are advised to plan the discharge, post-operative accommodation and travel after the consultation in order to have a hassle-free postoperative period.
Surgery and early postoperative period
Breast enlargement operation involves the placement of breast implants inside the breast tissue. The appropriate implant type, size and shape are chosen based on the patient’s expectations from the surgery. The methods used for the surgery will be determined on the basis of implant type and body proportions and may vary with incision type and implant placement.
The incision options for breast enlargement surgery are:
- Periareolar incision: The surgeon makes the cut on the outer edge of the areola, nipples.
- Inframammary incision: The incision is made in the crease, inframammary unfold underneath the breast. It leaves a thin scar that can be easily concealed in the fold underneath the breast. This incision allows the surgeon to place a larger silicone implant with precision.
- Transaxillary incision: The incision is made under the armpit. The surgeon places the implant using a specialized camera and surgical instruments. It results in a small scar on the armpit but no scar on the breast.
There are 2 ways in which a breast implant can be inserted after making the incision:
- Subglandular placement: In this, the breast implant is positioned between the tissue of the breast and the chest muscle
- Submuscular placement: The breast implant is placed just behind the chest muscle
A breast augmentation operation is performed under general anesthesia and the patient will remain unconscious during the surgery, without feeling any pain. The entire procedure takes about 1 to 1.5 hours. The plastic surgeon will place the breast implants using minimal incision considering the ideal implant type and size according to factors such as the chest dimension, tissue capacity, and patient’s expectations as well as daily lifestyle.
The incision is made as per the plan discussed with the patient before the surgery. The surgeon then creates a pocket or cavity between the breast and the rib cage. Based on the type of placement pre-decided, the breast implant is placed in this pocket. Once the implant is centralized and positioned properly, the incision is stitched back with sutures. The incision site is covered with a gauze dressing. The plastic surgeon may also place small draining tubes, If necessary, to prevent the accumulation of excess fluid and/or blood around the incision line.
After the surgery
As breast augmentation surgery is an outpatient procedure, patients can usually go home on the same day after the surgery. Some patients might need to stay in the hospital for a night or two. Once the effects from anesthesia subside, and they are ready to walk, patients are mobilized under the supervision of the medical team.
There might be slight pain and recognizable swelling on the breast(s) after the surgery. Some patients may also notice some bruising in the skin of the breast. These are normal symptoms that will disappear on their own within several weeks following the surgery. Scar tissue will form along the incision line, but it will fade over time. However, the color left behind may never be identical to the skin tone.
Sometimes, patients are advised to use need compression bandage and wear a sports bra to support the breasts. This also helps ensure the correct positioning of breast implants post-surgery. The pain is usually minimal and tolerable by most patients. The plastic surgeon will prescribe pain medications, if needed, to manage the pain.
If the sutures are made with non-absorbable stitches and a drain is placed, the doctor will remove them during the first postoperative follow-up visit or schedule a date for their removal.
At home, patients have to allow all the post-discharge instructions given by the plastic surgeon or healthcare team. They will advise the time period for rest and when to start non-strenuous exercises or daily activities, which is usually after 1 week postoperatively. For the next 2-3 weeks after the boob job, swelling and soreness will be there and it is normal. It will subside over time.
The doctor will advise avoiding strenuous activities for a particular time and If the patient has a physically demanding job, they will need to take time off for 3 or more weeks. No heavy lifting and activities like running are allowed during this time.
Following all these instructions is very important for a healthy recovery and to achieve the best outcome from the surgery.
If symptoms such as warmth and redness in the incision line or breast, fever or other symptoms associated that may occur due to surgery are experienced after the discharge, contact the plastic surgeon immediately.