Procedures and technique will vary among surgeons, including differences in the type and placement of the implant and the location of the incision sites, but on the whole you can expect the following: Breast augmentation surgery generally takes between one and three hours and can be performed in a hospital, surgical center, or office. Though the surgery is most typically performed as an outpatient procedure, allowing the patient to return home several hours after completion, the surgery can be performed on an inpatient basis, requiring an overnight stay. General anesthesia is most commonly used, though local anesthesia combined with sedation is also an option.
The surgeon will begin by making an incision. The incision is most typically located either under the armpit, within the crease below the breast, or around the nipple. In very rare situations, the incision is made through the navel, or belly button. The surgeon will then lift the breast tissue, thereby creating a space, or “pocket”, within the breast for the insertion of the implant. The implant can be placed either directly below the breast tissue or beneath the chest muscle. To permit the smallest possible incision, and thus scarring, the implant is typically inserted empty and then filled with a saline solution. Once the implant has been inserted and positioned, the incision will be closed, usually with stitches, and possibly taped.
Following surgery, the breasts are usually wrapped with gauze bandages along with a tighter bandage providing additional protection and support. A small drainage tube may be temporarily placed at the incision site to drain any excess fluid.
There are several possible placements for the incision and these include the following:
- Axillary, or beneath the armpit. Though this incision, and thus the resulting scar, will be more visible than an incision made around the nipple, patients are likely to experience fewer problems with future breast feeding.
- Inframammary, or within the crease beneath the breast. As with the axillary incision, this incision is more visible than those made around the nipple, though less likely to cause problems with future breast feeding.
- Periareolar, or around the nipple. This incision tends to be the least visible, but it is associated with an increased inability to successfully breast feed.
- Umbilical/endoscopic, or through the navel or belly button. This incision is rarely performed and, due to the fact that it has not been sufficiently studied, is not recommended.
Implants are typically placed in one of the following two positions:
- Subglandular, or directly beneath the chest, between the breast tissue and chest muscle. Implants placed in this location are generally associated with shorter surgery and recovery times, along with potentially less pain. If future re-operation becomes necessary, implants in this location are typically more easily accessed. However, this placement may also increase the chance of being able to see and feel the actual implant through the skin following surgery. In addition, capsular contracture (see risks) is more likely to occur, along with difficulties in the imaging of the breast through mammography.
- Submuscular, or beneath the chest muscle. Implants placed in this position may result in less palpable (obviously seen or felt) implants, along with a possible decreased risk of capsular contracture and easier imaging of the breast through mammography. However, this placement may involve longer surgery and recovery times, and can prove more painful. In case of future re-operation procedures, implants in this location may be more difficult to access.
For breast augmentation surgery, the implant used is generally a sac or shell comprised of silicone, a rubber-like substance. Implants can come in a variety of shapes, most commonly either round or contoured. The surface of the implant can vary as well, being either smooth or textured. While those implants with a textured surface were designed to reduce the risk of capsular contracture, there is little evidence to prove that this is true. Implants can come in a variety of sizes as well. For many candidates, the size of the implant, and thus the desired size of their breasts, can be the most difficult aspect of breast augmentation. Patients must have sufficient tissue in order to accommodate a larger implant, otherwise the implant may be more palpable following surgery, the edges more easily seen and felt through the skin. Furthermore, implants that are too large for the amount of tissue may increase the risk of surgical complications. Excessively large implants may cause the breasts to prematurely droop or sag.
There are two basic types of breast implants and these include the following:
- Saline-filled implants, the choice of implant being used for nearly all breast augmentation surgeries. These are implants which are inserted and filled, typically through a valve, with a saline or salt-water solution (similar to the fluid which comprises most of the human body). The location of the valve can vary, typically on either the front or the back of the implant. There are also saline-filled adjustable implants which are relatively new to the market and allow the surgeon, through an additional small connector tube, to adjust the size of the breast following surgery through a simple injection. Saline fluid can either be added or drained to increase or decrease the size of the breast, possibly for up to several months following surgery. Saline-filled adjustable implants are not offered by all surgeons and require an additional incision, and thus an additional scar.
- Silicone Gel-Filled Implants. These implant are filled with silicone gel, a soft-solid substance. Due to concerns about these implants and their correlation to autoimmune diseases, silicone implants are rarely used except under certain conditions such as reconstructive surgery. For further information, click on the following links:
While price may be important, the quality of the breast augmentation, along with the expertise and experience of the surgeon, is tantamount. Choosing a surgeon based upon the lowest possible price may very well prove to be the most expensive, particularly if another surgery, and another surgeon, is required to repair the original work.
Pricing can vary based on several factors, including the surgeon and his or her technique, and the difficulty of the specific case. The national average can run anywhere from $3000 to $5000, but this can very dramatically depending upon your geographical location, proving significantly lower or higher.
Be sure to find out what exactly is included in any quoted price, such as the cost of anesthesia, the facility fee, the surgeon’s fee, and the cost of the implants. Because resulting surgeries following breast augmentation can occur, you may also want to ask in advance about any provisions in case you are unhappy with the results.
Being a cosmetic surgery, breast augmentation is generally not covered by insurance. It is each patient’s responsibility to check with their own insurance carrier concerning the degree or availability of coverage.