Considering Breast Augmentation? (Part II)

September 12, 2014 Joshua M Cooper

Intra-Operative Steps of Breast Augmentation
We perform our breast augmentation procedures with an anesthesiologist who provides a general anesthetic to our patients.  Prior to our patients falling asleep, they receive intravenous antibiotics to help prevent an infection. 
After local anesthetic is given to help with post-operative pain, an incision is made, most commonly in the crease under the breast called the infra-mammary fold.  Next, a pocket is made to accommodate the implant.  Most commonly, the implant is placed in the dual plane position.  This means that a portion of the pectoralis major muscle is divided where it inserts onto the chest wall.  Dual plane refers to the fact that most of the implant will be covered by the muscle to help give a more natural look to the breast, and the inferior and lateral most part of the implant will be covered by breast tissue only. 
We take special care, and use specialized instrumentation, to create a pocket that involves hardly any bleeding.  After the pocket has been created, it is washed with a triple antibiotic solution, and the implant is then placed.  Special sutures are placed to help prevent the implant from migrating too far downward, and then the incision is closed.
Sometimes the crease below the breast, the infra-mammary fold, needs to be lowered to accommodate the appropriate sized implant.   If this is not performed the implant will not end up in the appropriate position, centered behind the nipple and areola.  If the crease is surgically lowered, it will be reinforced with internal sutures as well.
When using shaped implants, a small drain is usually left in place as well to prevent fluid build up and rotation of the implant.  This is removed a week later, and is painless when removed. 
All absorbable sutures are used (no sutures need to be removed after your operation), and steri-strips (specialized band-aids) are placed over the incision, as well as a gauze dressing and surgical support bra and “pec strap.”
Post-Op Care
We ask our patients to wear their surgical support bra day and night, and they may shower the next day.  Often times we also have patients where a “pec strap” which goes around the chest and helps keep the implants in the correct position.
There are no special exercises that we recommend.
We do ask our patients to take it easy for a few days, avoiding any really strenuous lifting or activities as this may prolong swelling and cause pain.
We see our patients back one week later, but we are always happy to see our patients back any time before that if desired, and of course we are always available by cell phone after hours.
What to Expect Right After the Breast Augmentation Operation
Pain is usually not as severe as a lot of women expect, and most patients will take prescribed narcotic medication for a few days as well as Ibuprofen.  Most of our patients return to work a few days later.  If your job entails a lot of heavy lifting, you may wish to wait longer before returning to your full duties.  
Nausea from the general anesthetic or pain medication can occasionally occur, but our anesthesiologists will provide you with medication to prevent this.
Nipple sensation may be altered right after the operation, with some women having numbness for a few days, and others having nipples that are very sensitive.  Within a few days to a week, this usually resolves.
What About the Size of My new Breasts?
It is not uncommon for patients to question the size of their new breasts!  Some women may feel that their implants are too big, and others may feel that they are not big enough.  There are a few causes for patients to be anxious about the size of their new breasts during the first few weeks after breast augmentation. 
Sometimes this is related to swelling or the position of the implants.  With time swelling fades away, and the implants do also settle a bit meaning that almost always the shape improves over the first few months.   Additionally, the pectoralis muscle that covers most of the implant may be in spasm causing the implants to ride a little higher than they will once everything relaxes.
Lastly, some women, who have had small breasts their whole lives, and suddenly have much larger breasts, go through a period of adjustment.  This isn’t really that surprising because your new breast shape and size can really have a big impact on your body image.  It can take a little while for your mind, which is perceiving the new implants as something large and foreign in your chest, to accept them as your own.
We ask you to remain patient and wait several months for everything to heal, the implants to settle, swelling to resolve, and your mind and body to work again in tandem before worrying about your size!  In almost all cases, women are extremely happy with the choice they made several months after the breast augmentation operation. 

To learn more about breast  augmentation, please visit or call (206) 729-2248 for a free breast augmentation consult in our Seattle clinic located adjacent to University Village. 

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