Breast

Mastopexy (breast lift) and augmentation (breast implants) are two cosmetic surgeries that change the look and size of the breasts. Mastopexy helps reshape breasts that have lost their firmness and sag or droop. Augmentation involves putting breast implants above or below the chest muscle, to make the breasts larger. Together, these procedures change the look and size of the breasts. This sheet tells you more about these surgeries and what to expect. Note: Sometimes these surgeries are done together. But depending on your body and your needs, your doctor may suggest two separate surgeries, so you can heal in between.

Different Kinds of Implants

Breast implants are made of a silicone shell. The shell may be filled with saline (saltwater) or silicone (gel). Different implant sizes, shapes, and textures are available. There are benefits and drawbacks to each type of implant. You and your doctor will discuss which type is best for you.

What to expect

Prepare for the surgery as you have been told. In addition:

• Tell your doctor about all medications you take. This includes herbs and other supplements. It also includes any blood thinners, such as Coumadin, Plavix, or daily aspirin. You may need to stop taking some or all of them before surgery.
• Do not eat or drink during the 8 hours before your surgery, or as directed by your surgeon. This includes coffee, water, gum, and mints. (If you have been instructed to take medications, take them with a small sip of water.) Mastopexy with augmentation takes about 3-5 hours. You may go home the same day. Or you may stay overnight.

Before the surgery begins:

• An IV line is put into a vein in your arm or hand. This line delivers fluids and medications.
• You will be given medication to keep you pain free during surgery. This may be general anesthesia, which puts you into a state like deep sleep. (A tube may be inserted into your throat to help you breathe.) Or you may have sedation, which relaxes you and makes you sleepy. If you have sedation, local anesthesia will be injected to numb the area being worked on. The anesthesiologist will discuss your options with you.

During the surgery:

• For the breast lift, the doctor makes incisions in the skin around your nipples and down your breast. You and your doctor will have discussed incision sites prior to surgery. The doctor moves the breast tissue higher on the chest. Breast skin is tightened to hold the tissue in position. Any excess skin is removed. The areola (dark skin around the nipple) and nipple are moved higher on the breast. If the size of the areola is being decreased, skin is removed. The areola is stitched (sutured) into place. The process is then repeated for the other breast.
• For the breast augmentation, the doctor forms a “pocket” to hold the implant. This may be above or below the chest muscle. The doctor then inserts the implant through the incision and into the pocket. If the implant needs to be filled with saline, that’s done now. The implant is then moved to the right place. If both breasts are being treated, the process is then repeated on the other breast.
• When both stages are done, incisions are closed with sutures, surgical glue, or both. A tube (drain) may be placed into an incision before it is closed. This drains excess fluid that may build up as the wound begins to heal.

After the Surgery

You will be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You will be given medication to control pain. When you’re ready, you will be able to go home with an adult family member or friend. Or, you may be taken to a room to stay overnight.

Recovering at Home

Once home, follow any instructions you are given. Your doctor will tell you when you can return to your normal routine. During your recovery:

• Take any prescribed medications exactly as directed.
• Wear the special bra or Ace bandage you were given before discharge as directed by your doctor.
• Care for your incisions and the dressing (bandage) over them as instructed by your doctor.
• Follow your doctor’s guidelines for showering. Avoid swimming, soaking under water, using a hot tub, and other activities that cause the incisions to be covered with water until your doctor says it’s okay.
• When you shower, gently wash your incision sites. Then pat the incisions dry. Don’t apply lotions, oils, or creams to the incisions until after they are fully healed.
• Don’t raise your arms above breast level for 10 days. And don’t lift, push, or pull anything heavier than 10 pounds for at least 7 days.
• Don’t drive until you are no longer taking prescription pain medication and your doctor says it’s okay. When riding in a car, carefully position the seatbelt so that it doesn’t compress your breasts.
• Be aware that breast swelling may last for 3-5 weeks. If advised by your doctor, use a cold pack wrapped in a thin towel to relieve discomfort and control swelling. It’s important not to leave the cold pack on for too long, or your skin could be damaged. Put the pack over your bandages for no more than 20 minutes at a time. Then, leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don’t fall asleep with the cold pack on. If you’re not sure how to safely use the cold pack, ask your doctor.

Fuller and Natural Breasts

Augmentation mammoplasty, breast augmentation, or breast implant surgery is a popular cosmetic surgery procedure to enhance the size of the breasts. Women who are unhappy with their small breast size may opt for this procedure to achieve fuller, larger, and natural breasts. The procedure has been embraced by many celebrities over the years with amazing results, and now it has grown in popularity among adult women across various age groups.

Procedure

Breast augmentation surgery involves the placement of an implant underneath the breast muscle or the breast tissue. Silicone or saline implants are commonly used to provide breast enhancement. The surgery begins with an incision made at the lower crease of the breast or the lower edge of the nipple areola or the armpit. The incision is used to insert and position the implant under the chest muscle below the breast or under the breast tissue.

Once the implant has been adjusted appropriately to achieve the desired breast shape, size and position, the incision will be closed with sutures. In some cases, the breast augmentation surgery may be performed together with breast lift, to improve the position and firmness of sagging breasts and nipples. The entire procedure is typically performed as an outpatient surgery. General anesthesia is preferred for this procedure, and the surgery may be completed between one to two hours.

Recovery

A special bra may have to be worn for several weeks to provide support to the breasts. Soreness, bruising, and swelling may be experienced for a few days after the procedure.

The surgeon may recommend pain relieving medications to manage the pain. Except for strenuous exercises or heavy lifting, the patient may resume normal work routine within a few days. A skilled plastic surgeon will ensure that scars remain minimal and well-concealed after the surgery.

Purpose of Surgery

Breast implant surgery may be considered for the following purposes:

• Increase the size of the breasts.
• Restore breast size following pregnancy or sudden weight loss.
• Make both the breasts evenly proportioned.
• Reconstruction of breasts following mastectomy.

What is breast enlargement surgery?

Breast augmentation, or augmentation mammoplasty, is a procedure to reshape the breast in order to make it larger. The procedure can also be performed to reconstruct the breast following breast surgery.

About the procedure

Although each procedure varies, breast augmentation surgeries generally cover the following considerations:

Location options may include:

• Hospital outpatient

Anesthetic options may include:

• General anesthesia
• Local anesthesia, combined with an intravenous sedative (allows the patient to remain awake but relaxed)

Average length of procedure:

• One to two hours

The method of inserting and positioning the implant depends on the patient’s anatomy and the surgeon’s recommendation. The incision can be made:

• In the crease where the breast meets the chest.
• Around the areola (the dark skin surrounding the nipple).

Working through the incision, the surgeon lifts the breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath the pectoral muscle in the chest wall. The implants are centered beneath the nipples.

Recovery period:

• When the dressings are removed, the patient may be given a surgical bra or wrapped with an ace bandage

Breast reduction surgery is also called reduction mammoplasty. Fat, tissue, and skin are removed from the breasts to make them smaller. The size of the areola (dark skin around the nipple) may be reduced. And the nipple may be moved higher on the breast. This sheet explains the procedure and what to expect.

What to expect

Prepare for the surgery as you have been told. In addition:

• Tell your doctor about all medications you take. This includes herbs and other supplements. It also includes any blood thinners, such as Coumadin, Plavix, or daily aspirin. You may need to stop taking some or all of them before surgery.
• Do not eat or drink during the 8 hours before your surgery, or as directed by your surgeon. This includes coffee, water, gum, and mints. (If you have been instructed to take medications, take them with a small sip of water.)

The Day of Surgery

The surgery takes about 2-4 hours. You may go home the same day. Or you may stay overnight.

Before the surgery begins:

• An IV line is put into a vein in your arm or hand. This line delivers fluids and medications.
• You will be given medication to keep you pain free during surgery. This may be general anesthesia, which puts you into a state like deep sleep. (A tube may be inserted into your throat to help you breathe.) Or you may have sedation, which makes you relaxed and sleepy. If you have sedation, local anesthesia will be injected to numb the area being worked on. The anesthesiologist will discuss your options with you.

During the surgery

• The doctor makes one or more incisions in your breast. Incisions are mostly made around the areola. You and your doctor will have discussed incision sites prior to the surgery.
• The doctor removes fat, tissue, and skin from the breast. In some cases, fat is removed using liposuction. This involves inserting a cannula (hollow tube) into the breast. A special vacuum pulls fat through the cannula.
• If needed, the areola and nipple are removed and positioned higher on the breast as a free nipple graft. To reduce the size of the areola, excess skin is removed. The areola is then stitched (sutured) into place.
• The process is repeated on the other breast.
• The incisions are closed with sutures (stitches), surgical glue, or both. A tube (drain) may be placed into the incisions before they are closed. This drains excess fluid as the wound begins to heal.

After the Surgery

You will be taken to a room to wake up from the anesthesia. You may feel sleepy and nauseated. If a breathing tube was used, your throat may be sore at first. You will be given medication to control pain. When you’re ready, you will be able to go home with an adult family member or friend. Or, you may be moved to a room to stay overnight.

Recovering at Home

Once home, follow any instructions you are given. Your doctor will tell you when you can return to your normal routine. During your recovery:

• Take any prescribed medications exactly as directed.
• Wear the special bra or Ace bandage you were given before discharge as directed by your doctor.
• Care for your incisions and the dressing (bandage) over them as instructed by your doctor.
• Follow your doctor’s guidelines for showering. Avoid swimming, soaking under water, using a hot tub, and other activities that cause the incisions to be covered with water until your doctor says it’s okay.
• When you shower, gently wash your incision sites. Then pat the incisions dry. Don’t apply lotions, oils, or creams to the incisions until after they are fully healed.
• Don’t raise your arms above breast level for 10 days. And don’t lift, push, or pull anything heavier than 10 pounds for at least 7 days.
• Don’t drive until you are no longer taking prescription pain medication and your doctor says it’s okay. When riding in a car, carefully position the seatbelt so that it doesn’t compress your breasts.
• Be aware that breast swelling may last for 3-5 weeks. If advised by your doctor, use a cold pack wrapped in a thin towel to relieve discomfort and control swelling. It’s important not to leave the cold pack on for too long, or your skin could be damaged. Put the pack over your bandages for no more than 20 minutes at a time. Then, leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don’t fall asleep with the cold pack on. If you’re not sure how to safely use the cold pack, ask your doctor.

Improving Shape and Size

Many women tend to have oversized breasts. Sometimes this is congenital or due to weight gain. If the breast size is disproportionate to the rest of the body, it can compromise the aesthetic appearance and cause undue stress on the neck or shoulders. Breast reduction surgery is an effective solution to correct this condition. The procedure can safely reduce the size of the breasts, improve the shape, and even reduce the size of the areola.

Indications

Breast reduction surgery for one or more of the following reasons:

• Improve the physical appearance: Oversized breasts, particularly when they are disproportionate to the weight and height, can cause difficulty in bra fitting or finding appropriately sized clothes. Patients often can be self-conscious of breast size which can cause stress in social situations.
• Eliminate discomfort: Large and heavy breasts can not only cause constant discomfort, but may also result in pain in the back and neck, posture problems, and skin irritation.
• Enhance physical activity: Patients with large breasts may have to curtail their participation in sports and other vigorous physical activities or exercises. Breast reduction procedure can allow more freedom to carry out the choice of physical activities. Procedure

Breast reduction is performed under general anesthesia as an outpatient, usually taking about 2 to 4 hours depending on the extent of tissue that needs to be removed. In almost all cases, the nipple and areola are moved to a more desirable position. If the reduction is on the smaller size, incisions can be confined to around the areola and a small vertical incision on the bottom portion of the incision. If the reduction is larger, a horizontal or “anchor” type of incision will be needed.

Recovery

• Take any prescribed medications exactly as directed.
• Wear the special bra or Ace bandage you were given before discharge as directed by your doctor. Wear a snug sports bra for 6 weeks post-operatively.
• Care for your incisions and the dressing (bandage) over them as instructed by your doctor.
• Follow your doctor’s guidelines for showering. Avoid swimming, soaking under water, using a hot tub, and other activities that cause the incisions to be covered with water until your doctor says it’s okay.
• When you shower, gently wash your incision sites. Then pat the incisions dry. Don’t apply lotions, oils, or creams to the incisions until after they are fully healed.
• Don’t raise your arms above breast level for 10 days. And don’t lift, push, or pull anything heavier than 10 pounds for at least 7 days and no strenuous exercise for 6 weeks.
• Don’t drive until you are no longer taking prescription pain medication and your doctor says it’s okay. When riding in a car, carefully position the seatbelt so that it doesn’t compress your breasts.
• Be aware that breast swelling may last for 3-5 weeks. If advised by your doctor, use a cold pack wrapped in a thin towel to relieve discomfort and control swelling. It’s important not to leave the cold pack on for too long, or your skin could be damaged. Put the pack over your bandages for no more than 20 minutes at a time. Then, leave it off for at least 20 minutes. Repeat this as often as needed during waking hours until swelling starts to improve. Don’t fall asleep with the cold pack on. If you’re not sure how to safely use the cold pack, ask your doctor.