Breast Implant Surgery

• Breast Implant Surgery
• Surgical Consultation
• Before Surgery
• During Surgery
• After Surgery
• Questions to Ask Your Doctor (Available in text and PDF)

• Things to Consider Before Getting Breast Implants (Available in text and PDF)

---

Breast Implant Surgery

Breast implant surgery can be performed in a hospital, surgery center or doctor’s office. Breast implant surgery patients may have to stay overnight in the hospital (inpatient surgery) or may be able to go home afterward (outpatient surgery). The surgery can be done under local anesthesia, where the patient remains awake and only the breast is numbed to block the pain, or under general anesthesia, where medicine is given to make the patient sleep. Most women receive general anesthesia for this surgery. Breast implant surgery can last from one to several hours depending on the procedure and personal circumstances.

If the surgery is done in a hospital, the length of the hospital stay will vary based on the type of surgery, the development of any complications after surgery and your general health. The length of the hospital stay may also depend on the type of coverage your insurance provides.

 

Surgical Consultation

Before surgery you should have a consultation with your surgeon. Be prepared to ask questions about the surgeon’s experience, your surgery and expected outcomes. The FDA has provided a list of questions that may help guide your discussion. The surgeon should be able to discuss whether you are a good candidate for breast implants, the different type of implants, options for size, shape and placement based on your particular circumstances, as well as the risks and benefits of implant surgery. The surgeon should also be able to provide you with before and after pictures of other patients to help you better understand your expectations and potential outcomes from surgery.

During the consultation you will need to discuss your medical history, including any medical conditions or drug allergies you may have. You should also discuss any previous surgeries you’ve had, especially to the breast, and what drugs you are currently taking, including supplements, herbal and over-the-counter (OTC) medications.
It is important to tell the surgeon if you think you may be pregnant.

If you are undergoing breast implant surgery for reconstruction, you will also need to speak with your surgeon about your personal circumstances, including being treated with chemotherapy and/or radiation therapy, as these can affect your risks of complication and the appearance of the reconstructed breast. The surgeon should also speak to you about the amount of breast tissue that will remain after surgery and future screening for breast implant ruptures and breast cancer.

During the consultation be sure to ask the surgeon for a copy of the patient labeling for the breast implant s/he plans to use. You have the right to request this information, and your physician is expected to provide it. Be sure to read the patient labeling entirely prior to surgery. It will provide you with information specific to your breast implants, including how to take care of them. Make sure you read and understand the informed consent form before you sign it.

Breast implant manufacturers are currently conducting clinical studies to evaluate new types of breast implants and to understand the long term experiences of women who receive breast implants. If you are interested in participating in a clinical study, be sure to ask your surgeon what specific steps you will need to take.

 

Before Surgery

Your surgeon may ask that you have a mammogram or breast X-rays prior to surgery in order to identify any breast abnormality and so the surgeon has a preoperative image of your breast tissue.

You will usually be asked to not eat or drink anything after midnight the night before surgery and to bring loose clothing, including a loose-fitting bra without underwire, to wear after surgery. If you are going home the same day as the surgery, you will need to plan for someone to drive you home.

Your surgeon should discuss with you the extent of surgery, the estimated time it will take and how they plan to treat for pain and nausea.

 

During Surgery

Once you have been given anesthesia and it has taken effect, the surgeon will make an incision (cut) in one of the following areas:

• along the underside of your breast (inframammary)
• under your arm (transaxillary)
• around the nipple (periareolar)
• through the mastectomy scar (for reconstruction)

The FDA-approved labeling warns surgeons NOT to place breast implants through the belly-button (peri-umbilical approach).

Illustration from INAMED Patient Labeling.

The location of the incision can affect how visible the scars are, as well as any complications you may experience after surgery.

Cutting the underside of the breast is the most common location used since it is where the skin naturally folds. Your scarring with this type of incision may be a bit more visible, especially if you are younger, thin and have not yet had children.

Placing the implant through an incision under the arm will likely require your surgeon to use an endoscope, a tool with a camera and other surgical instruments inserted into the incision site to help the surgeon guide the implant into place. While there will likely be no visible scar around your breast, you may have a scar on the underside of your arm.

Cutting around the edge of the nipple (areola) may cause problems with loss or change of sensation in the nipple.

The surgeon will place the implant above (subglandular) or below (submuscular) the chest wall muscles. Be sure to discuss the pros and cons of the implant placement selected for you with your surgeon prior to surgery.

If you are getting silicone-gel filled implants they will already be filled with silicone gel when inserted. If you are getting saline-filled implants and the implant is not pre-filled, the surgeon will insert the silicone shell and then fill the implant to the desired level with saline.

The incision is then closed with stitches. Your surgeon may place temporary drains in the incision prior to closing it to prevent fluid or blood accumulation. Catheters to deliver pain medicine at the site of the incision may also be placed prior to closing the incision. The drains or catheters would be removed during a follow-up visit after surgery.

 

After Surgery

After surgery you will be taken to a recovery area to be monitored. Your breasts will be wrapped in gauze or a surgical bra.

Your surgeon should describe the usual after surgery (postoperative) recovery process, the possible complications that may occur, and the recovery period. Following the operation, as with any surgery, you can expect some pain, swelling, bruising and tenderness. These effects may last for a month or longer, but should disappear with time. Scarring is a natural result of surgery. Prior to surgery, ask your surgeon to describe the location, size and appearance of any expected scars. For most women, scars will fade over time into thin lines. The darker your skin, the more prominent the scars are likely to be.

Your surgeon may prescribe medications for pain and/or nausea. If you experience bleeding, fever, warmth, redness of the breast, or other symptoms of infection, you should immediately report these symptoms to your surgeon. Your surgeon should tell you about wound healing and how to care for your wound.

You may need a postoperative bra, compression bandage or jogging bra for extra support as you heal. At your surgeon’s recommendation you will most likely be able to return to work within one to two weeks, but you should avoid any strenuous activities that could raise your pulse and blood pressure for at least two weeks.

Ask your surgeon about a schedule for follow-up visits, limits on your activities, precautions you should take, and when you can return to your normal activities, including exercising. If you received silicone gel-filled breast implants, the FDA recommends that you receive MRI screening for silent rupture 3 years after receiving your implant and every 2 years after that.

Continue to get mammograms to screen for breast cancer. Be sure to tell the person giving your mammogram that you have breast implants. Breast implants may make it difficult to see breast tissue on standard mammograms, so they may need to use different techniques.

If you are enrolled in a clinical study, be sure to ask your surgeon for a schedule of follow-up examinations set by the study plan.

 

Questions to Ask Before Having Breast Implant Surgery

When choosing a surgeon for a breast implant procedure, you may want to consider their years of experience, their board certification, their patient follow-up, and your own comfort level with the surgeon. Most breast implant procedures are performed by board-certified plastic and reconstructive surgeons. The following questions can help guide your discussion with your surgeon regarding breast implant surgery.

Questions to Ask…

About Your Surgeon

1. How many breast implant procedures do you do each year?
2. What percentage of your practice is dedicated to breast augmentation? To breast reconstruction?
3. What type of implants do you use? Saline or silicone? What is your experience with each?
4. What is the most common complication you encounter with breast implant surgery?
5. What is your rate of complications in general (capsule contracture, infection, etc.)?
6. What is your reoperation rate?
7. What is the most common type of reoperation you perform?

 

About Breast Implants and Expected Outcomes

1. What shape, size, and surface texture are you recommending for my implants?
2. Why are you recommending one type of breast implant over another? Why do you recommend this one for me?
3. How long will my breast implants last?
4. What incision site and placement are you recommending for me?
5. Do you have before and after photos I can look at for each procedure?
6. What results are reasonable for me to expect?
7. How will breast implants feel? Will they alter my breast skin or nipple sensation?
8. What are the risks and complications associated with having breast implants?
9. Can I still get breast implants for augmentation if I have a strong family history of breast cancer?
10. How many additional operations on my breast implants can I expect to have over my lifetime?
11. How will I be able to tell if my breast implant has ruptured or if there is a problem with my breast implants?
12. How will my breasts look if I decide to have the implants removed and not replaced?
13. How easy or difficult is it to remove the implants?
14. How easy or difficult is it to increase the size of the implants after the breast implants have been placed?
15. What can I expect my breasts to look like over time? What do I need to do to maintain them?
16. What kind of additional follow-up will I need?
17. What are the long term consequences of breast implants?
18. What will my breasts look like after pregnancy? After breastfeeding?
19. Will the breast implants affect my ability to breastfeed a baby?
20. What are my options if I am dissatisfied with the outcome of my breast implants?
21. Can I still get mammograms with breast implants in place?
22. Will the mammogram rupture my breast implant?
23. What alternate procedures or products are available besides breast implants?

 

About the Breast Implant Operation

1. How long will I be in pain after the surgery?
2. What is my expected recovery time?
3. Will I need help at home for normal activities after the surgery and if so for about how long?
4. How long do you expect my operation to take?
5. What (if any) secondary procedures associated with my breast augmentation/breast reconstruction will be required?
6. How likely is it that I will get an infection after the surgery?
7. How much risk is there from the anesthesia?
8. What can I do to minimize the risk of short-term and long-term complications?
9. Where will my scar be?

 

Things to Consider Before Getting Breast Implants

There are several important things to consider before deciding to undergo breast implant surgery, including understanding your own expectations and reasons for having the surgery. Below are some things the FDA thinks you should consider before undergoing breast augmentation, reconstruction or revision surgery.

• Breast implants are not lifetime devices; the longer you have your implants, the more likely it will be for you to have them removed.
• The longer you have breast implants, the more likely you are to experience local complications and adverse outcomes.
• The most common local complications and adverse outcomes are capsular contracture, reoperation and implant removal. Other complications include rupture or deflation, wrinkling, asymmetry, scarring, pain, and infection at the incision site.
• You should assume that you will need to have additional surgeries (reoperations).
• Many of the changes to your breast following implantation may be cosmetically undesirable and irreversible.
• If you have your implants removed but not replaced, you may experience changes to your natural breasts such as dimpling, puckering, wrinkling, breast tissue loss, or other undesirable cosmetic changes.
• If you have breast implants, you will need to monitor your breasts for the rest of your life. If you notice any abnormal changes in your breasts, you will need to see a doctor promptly.
• If you have silicone gel-filled breast implants, you will need to undergo periodic MRI examinations in order to detect ruptures that do not cause symptoms (“silent ruptures”). For early detection of silent rupture, the FDA recommends that women with silicone gel-filled breast implants receive MRI screenings 3 years after they receive a new implant and every 2 years after that. MRI screening for implant rupture is costly and may not be covered by your insurance.
• If you have breast implants, you may have a very low but increased risk of developing a rare type of cancer called anaplastic large cell lymphoma (ALCL) in the breast tissue surrounding the implant. ALCL is not breast cancer. Women diagnosed with ALCL in the breast may need to be treated with surgery, chemotherapy and/or radiation therapy.