Augmentation mammaplasty (breast enlargement) is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty is not a substitute for mastopexy, which is a procedure to “lift” breasts that sag significantly.
Augmentation Mammaplasty With Implants
Silicone and saline are the two implant types most commonly used in augmentation mammaplasty. Silicone implants feel more like natural breasts than saline ones. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant has an extracapsular rupture (a rupture to the outer capsule), silicone filler leaks into the body, possibly resulting in inflammatory nodules or enlarged lymph glands.
Implants are placed behind each breast, underneath either breast tissue or the chest-wall muscle. The procedure lasts 1 to 2 hours, and is typically performed with general anesthesia, although local anesthesia combined with a sedative may be used. Incisions are made in inconspicuous places (in the armpit, in the crease on the underside of the breast, or around the areola) to minimize scar visibility. The breast is then lifted, creating a pocket into which the implant is inserted.
Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around implant), and less interference during mammograms. Disadvantages include the possible need for drainage tubes, and a longer recovery period. Advantages of implant placement beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles, and that slight breast sagging is corrected.
Other types of implants include “gummy bear,” round, smooth and textured.
Augmentation Mammaplasty With Fat Transplantation
At Orion Aesthetics, we prefer to transfer fat to the breast as the ideal way of increasing the size of the breasts. we think that unless you dont have enough fat in your body to transfer to the breast, implants are discouraged due to the impermanence of implants that have to be either replaced periodically or have to be taken out due to complications. Once the fat has been taken up by the breasts, then its permanent or as permanent our bodies can be.
- Fat transfer is permanent vs implants
- Fat transfer has less long term complications than implants
- Fat in breasts feels natural to touch but not the implants
- Fat in breasts makes the breasts look more natural in shape than the implants
The process of getting breast augmentation with fat transfer involves:
- Free consultation where Dr Uppal determines how much breast enlargement you desire and if there is enough fat to harvest in your body to transfer to the breasts
- Medical clearance for outpatient elective surgery is required before all procedures
- Labs, EKG, Chest Xrays are to be done
- You are started on topical creams over the areas which will be liposuctioned few weeks before the liposuction plus you are also started on many supplements to help improve the fat uptake in the breasts. Compression garments are ordered before the procedure
- If your breasts are too small to increase the size which you desire, you start using suction cups on the chest wall, 1 month before the procedure, to expand the breasts, and increase the amount of fat they can hold. When the tissue has expanded enough, augmentation using fat transfer can begin.
- On the procedure day, someone drops you off and is supposed to pick you up after the procedure as well, Empty stomach is important and you can get water and juice in the office before the procedure and also during the procedure. The liposuction area should be shaved 48 hours before the procedure.
- First, tumescence anesthesia is used at Orion Aesthetics to numb the area where the fat is harvested from. fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum. Wells Johnson system is used here at Orion Aesthetics to harvest the fat. In the second procedure, which takes place on the same day, the fat is injected into the breast through cannulas again for which small holes are made in the skin. The procedure takes approximately 4 to 5 hours.
Recovery From Augmentation Mammaplasty by Fat Transfer
You will walk out of the office after the procedure. Postoperative nausea and vomiting happens in most patients. The Registered Nurse on duty will administer anti-nausea medications by IV route to help you.
For the next 3 days, you will arrive to the office everyday for dressings change. You are not to change the dressings at home till the liposuction holes stop draining. The liposuction holes stop draining by the 4th day when you can shower. Till then you stay in compression garment all the time with and abdominal binder as well. You can take off the abdominal binder at night if there is difficulty breathing.
You are to be in a compression garment all the times and also wear compression stockings in the your legs to prevent clotting of blood. You will also be walking minimum of 1 mile a day starting the next day after the procedure and you are advised not to rest. The compression stockings in the legs are worn for 2 weeks and the compression garment is worn for 4 weeks.
There will be pain and swelling of the breasts as well as the waist for the first 3 days. You are given prescription pain medications for home use during this period. Women rarely use any pain meds starting the 4th day after the procedure. You wear a snug but not tight sports bra for the next 3 weeks. For 3-4 weeks after the procedure, walking several miles a day is encouraged but any aggressive activity, gym, running, lifting, swimming, sauna, tubs are discouraged and can lead to complications.
Risks Of Augmentation Mammaplasty
In addition to the risks associated with surgery and anesthesia, those related to augmentation mammaplasty using implants include the following:
- Capsular contracture
- Implant leaks and ruptures
- Implant deflation or shifting
- Temporary or permanent change in nipple/breast sensation
- Irregularities in breast contour/shape
- Partial or total loss of nipple/areola
The risks related to augmentation mammaplasty using fat transplantation include those related to liposuction, as well as the following:
- Fat embolism
- Fat necrosis
- Oil cysts
- Loss of volume
Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary. Injections can be performed using local anesthesia.