Breast Augmentation FAQ

By Thomas Fiala, MD, FRCSC

Women who come to my office to learn about breast augmentation surgery often have many questions about the procedure. Typically, they have been thinking about having the procedure performed for a long period of time, and have many questions about the details of the procedure.

Here are answers to some of the questions most frequently asked regarding breast augmentation.

1. Q: What types of implants are available?

A: Saline (salt-water) filled implants, which are FDA-approved, are the most commonly used implants. They are filled with "normal saline," which is a solution typically used for intravenous lines. If there is any leakage of fluid from the implant, the saline is harmlessly absorbed by the body. A selection of different implant sizes and shapes is available. The choice of implant, which is individualized for each patient, is based on their appearance goals and the anatomy of the chest. I have found that the most popular implants are the standard "round" smooth surface implants, with 360-420 cc fill.

2. Q: What about silicone gel implants?

A: These are available through an FDA-approved study protocol, but only for patients that meet the defined selection criteria. In over 20 major scientific studies since 1992, silicone gel implants have not been statistically linked to any systemic diseases, including breast cancer or autoimmune syndromes. While this is very reassuring, the FDA has not yet approved the gel implants for general usage outside of the current study protocols.

3. Q: Which incision is best?

A: There are a number of approaches. These include the "inframammary" (in the fold underneath the breast), the "periareolar" (around the outside of the nipple), "trans-axillary" (armpit) or the new "TUBA" procedure, which utilizes a belly-button incision. Each has pluses and minuses, which should be explained at the time of the patient's consultation. For example, the transaxillary approach has the potential drawback of an overly wide cleavage, particularly if the endoscopic equipment is not used.

It is important to understand these choices.

4. Q: What about putting the implant under the muscle? What does that mean, and why does it matter?

A: This refers to making a space for the implant behind the main muscle of the upper chest, known as the pectoralis major muscle or 'pec.'

The advantages of this method include: less scar tissue forming around the implant than if the implant were above the muscle, a more natural-looking transition from the chest onto the breast (avoiding what I call the "Baywatch syndrome"), and improved mammography compared to implant placement above the muscle.

Disadvantages include: increased soreness in the first 3-5 days postoperatively, movement of the implant with flexing the muscle, and concern about breast shape in women who have ptosis (droop) of the breasts.

5. Q: How is the size of the implant selected?

A: This depends on what the patient has in mind. Most of the patients we see tell us "they want to look more proportional." For cases like this, matching the width of the implant to the width of the patient's rib cage works very well. While there is no perfect method to demonstrate the postoperative appearance exactly, we have found that the combination of trying implant 'sizers' in a sports bra, and digital computer imaging to work quite well.

6. Q: What about the 'teardrop' shaped implant? Is it more natural looking?

A: There is some considerable debate among surgeons about this issue. In my experience, patients that select an appropriately sized implant can achieve a very natural look with either the teardrop or the standard implant. The teardrop implant does have a little less fullness in the upper part of the breast, compared to the standard implant. The patient's appearance goals and an open discussion process with the surgeon are important for sorting this out.

7. Q: How long do I need to be off work?

A: I usually tell women to set aside one week for recovery, and to be off work during this time. I also recommend avoiding significant lifting or physical activity for the first 3 weeks after surgery, to minimize postoperative soreness.

8. Q: What about 'capsular contracture'? What is that?

A: The layer of scar tissue that each patient's body makes around the implant is called the capsule. This is the human body's normal reaction to an implanted material, and everybody who has an implant has a capsule, to some degree. In some cases, however, the capsule tightens up, squeezing the implant into a firmer, more ball-like shape. This is called a capsular contracture. It is a frustrating problem.

While the exact percentages vary from study to study, this problem occurs on average in 7-8% of patients with saline implants placed underneath the muscle. Currently, there is no test prior to surgery that can predict if or when a woman will develop this problem. A capsular contracture can occur despite the best intentions of the surgeon and patient, even with optimal surgical techniques and postoperative care. It is an as-yet unsolved problem of the augmentation procedure that the patient must understand and accept before undergoing the surgery. In cases of significant contracture, re-operation may be beneficial.

Overall, patient satisfaction with breast augmentation is very high. The operation is one of the most commonly performed in North America, with over 200,000 procedures performed in the year 2000, according to the American Society for Aesthetic Plastic Surgery. As always, choose your surgeon with care. Excellent information sources include the ASAPS and ASPS web pages.