What is a Breast augmentation?
The Breast augmentation, or Augmentation mammoplasty procedure, enlarges your breast. This can be done with either silicone or saline implants, as well as using your own fat. The procedure can also change the shape of your breasts or make them more symmetrical. Lack of symmetry can be a result of natural anatomy, the aging process, or changes in the breast size following lumpectomy or mastectomy procedures.
While most patients focus on implant size, you should consider the implant profile type (moderate, moderate plus, high profile, extra high profile) before focusing on the volume when discussing your goals with your surgeon. Be sure to also discuss capsular contracture complication rates during consults. The average among all plastic surgeons ranges between 10-15%, my capsular contracture rate is 5%.
This outpatient procedure can be performed under either monitored IV sedation or General anesthesia. We prefer to use IV sedation as it almost completely eliminates the risk of pulmonary embolism. Most patients take one week off from work.
What problems does a Breast augmentation address?
I've always felt that my breasts were not in proportion to my body
Most women who undergo Breast implant surgery in our Baltimore office fall into one of three groups. The largest group consists of women in their thirties with children. They have noticed a loss in skin tone and a decrease in the size of the breast (most noticeable in the upper and outer portion). The second group consists of women in their twenties who want larger breasts to balance the rest of their body. The third group are those who want to address breast asymmetry, tuberous breast deformity, or need reconstruction following mastectomy or lumpectomy. Candidates usually have these signs or symptoms:
- lack of upper pole fullness of the breasts
- lack of projection of the breasts
- not enough cleavage
- asymmetry of the breasts
- disproportionate balance of overall figure
- tubular (tuberous) breast shape
Patients should be aware that a breast augmentation in itself will generally NOT improve sagging or drooping breasts. To address sagging and drooping, you'll want to consider the Breast augmentation procedure combined with a Breast lift. The straight Breast augmentation works best when the nipple is positioned above the inframammary fold line, also called IMF. This fold line is the the point where the bottom of the breast projects out from the chest wall. If your nipple sags below that point, you would likely need a breast lift with your implants. If implants are added to a breast with a nipple position below the IMF, there is a good chance that your nipples will point down. For this reason, do not discount the recommendation for a breast lift with your implants!
How is a Breast augmentation performed?
I perform Breast augmentations under monitored IV anesthesia in our AAAASF accredited surgery center located right next to my office here in Baltimore, Maryland. I use IV sedation instead of General anesthesia to make your recovery as quick as possible and to eliminate the pulmonary risks associated with General anesthesia. For the utmost safety, your anesthesia is administered only by board certified anesthesiologists. By using IV anesthesia instead of General anesthesia, much, if not all, of the post op nausea is eliminated. The procedure takes up to two hours and you can go back to work in one week.
To perform the procedure, implants are inserted typically below the muscle. Patients do choose the insertion point at the pre-op appoinment, so the patient knows in advance where the incision will be.
Alternatively, you can augment your breast by one cup size by using your own fat extracted from your stomach and flanks. This is a different procedure, but worth mentioning that it is a option if do not want synthetic breast implants.
What are the preoperative requirements?
Patients undergoing Breast augmentation have a lot of decisions to make and will need to undergo medical clearance prior to surgery. You will also have a preoperative appointment with Dr. Rodriguez to make the final decisions about size, surgical plan, and to discuss the informed consent forms. Specific preoperative requirements are as follows:
- Within 30 days of your surgery date get an H&P (history and physical) as well as a CBC blood test in your preoperative medical clearance. The H&P can be done with your primary care doctor or a walk-in medical clinic. However, an M.D. must sign your surgical clearance.
- STOP smoking at least two weeks prior to surgery.
- No aspirin or herbal products two weeks prior to surgery.
- Schedule a pre-op appointment with your surgeon to make final implant selection, discuss the surgical plan, and discuss the Informed Consent document. This document outlines the risks and complications of the Breast Augmentation procedure.
- Get all of your post op prescriptions filled out before the day of surgery.
- On the evening before surgery, do not eat or drink anything after midnight (NPO).
What decisions will I need to make before surgery?
All of the decisions you need to be make before your surgery are listed below. To help you make the right decisions for you I have made this Youtube video. The final choices should result after a dialogue between you and your surgeon:
- saline or silicone implants
- implant volume (the size in cc's)
- round or oval (shape of implants)
- textured or smooth (surface of implants)
- under or over the muscle (placement of implants)
- location of incision site (placement of implants)
- moderate profile, moderate plus profile, high profile, extra high profile
- with or without a breast lift
Breast implant sizes and styles
Women considering Breast augmentation often focus on the size of the implant. Your breast size after surgery depends on two main factors: how big you were before surgery and the volume of the implant inserted.
The volumes of the breast implants are measured in CCs, (30cc = 1 oz). You can get a rough idea of how big you might look after surgery by placing the desired volume of water in a freezer bag and then placing it in the lower part of your bra.
I have breast aug patients try on actual implants by placing them inside different bra sizes to try during your consult. You should bring two different types of tops (a blouse and a tank top) with you to your consultation. This will help you make your decision about the implant size.
The most popular type of breast implant in our practice is high profile (HP) silicone. We recently did an analysis of our last 125 cases to determine the most popular implant size is 400 cc. Learn more about our findings in this case analysis blog post. While the selection of implant size and shape is always customized for each patient, average metrics are worth noting. The top 3 implants in our analysis were:
- 400 cc HP Silicone
- 350 cc HP Silicone
- 450 cc HP Silicone
The difference between Moderate profile and High profile implants
High profile implants are usually selected if you want a lot of projection or if you are a small framed woman with a small chest wall. I wrote about this in further detail explaining the difference between moderate and high profile implants in this blog post.
If you are having Breast augmentation, you should first consider the implant profile type before you select the size of the implant. See me talk about the two types of breast implant profiles and what body types each is most suitable for in a YouTube video I made.
The Difference between silicone and saline breast implants
Silicone implants have a much more natural feel than saline implants. I've worked extensively with silicone implants and believe they are the best choice for many women. To understand the differences further, please see this blog post.
Are silicone implants safe?
The short answer is yes, but I would like to share some of the history of the silicone implant controversy with you to comfort any concerns you may have:
Between 1992 and 2006, silicone breast implants were banned for use for cosmetic reasons while the FDA gathered information regarding their safety. The only patients who received silicone implants during the ban were reconstructive patients and patients with problems such as capsular contracture and breast asymmetry. These patients were required to enroll in a study where they were followed for 5 years post operatively.
All of the FDA studies led researchers to conclude that silicone breast implants did not cause any kind of disease. Studies showed that there was no greater incidence of any type of disease in women with silicone breast implants compared to the general female population and silicone implants were determined to be medically safe.
I am very experienced with silicone implants, I have been using them since 1988. Prior to the ban in 1992, I used silicone implants as the implant of choice for cosmetic patients because of their natural feel. Since 1992 I've had scores of patients involved in the FDA study. Read even more about the historical perspective on the silicone implant controversy.
The difference between Over or Under the muscle
Each approach offers some benefits, however I generally recommend going under the muscle. Placing the implants under the muscle provides the most natural and long term result. Additionally, it is usually easier to obtain a mammogram.
Breast incision locations
During breast augmentation, there is an incision made to insert the actual implant. There are three main choices of incision locations: inframammary, infraareolar, and axillary. I rarely performs the TUBA as I prefer to work through the nipple, especially since most of our patients select silicone implants. For more information, please see my blog post on breast augmentation incision choices.
What is Breast augmentation Post-Op recovery like?
Following your procedure, you will experience pain and discomfort. But the combination of pain pills and the Exparel injection should greatly relieve these symptoms. You should plan for the following post op instructions:
- bed rest for the first 2 days following surgery
- Drink plenty of fluids in the first few days following surgery, and continue drinking extra fluids as long as you are taking pain medicine.
- 1 week off from work
- no driving for 1 week
- wear breast bandeau or ace wrap for first week
- drains for 2 or 3 days, removal of drains at first post op appointment
- Call your surgeon immediately if you develop a fever greater than 101 degree F during the first 10 days post operatively, as this could be indicative of an infection.
- some swelling for 4 - 6 weeks
- exercise: resume lower body activities at 10 days, upper body activities at 4 - 5 weeks
- post op appointments at: day 2, one week, one month, four month
Is there a way to reduce the pain after surgery?
The use of Exparel injection greatly reduces the pain felt following surgery!
- Dr. Rodriguez
Instead of a pain pump, we now use Exparel injection for pain control. This injection is administered at the end of the procedure and keeps the area numb for 2-3 days following your surgery. You will be able to stand up straighter sooner, and it will shorten the number of days in recovery. The pain pump delivers local numbing medication to dull the pain. It does not contain narcotics, so the prescription pain pills can be taken at the same time and work to complement the pain pump in your recovery. They work in different ways and it is not too much to do a pain pump and pain pills together.
The Exparel injection works in a similar fashion to how pain pumps work. Both of these reduce pain by keeping the area numb. Neither of them contain narcotics. I've written more about why pain pumps help in Breast augmentation and all of the same principles apply to the Exparel injection.
What are the risks and possible complications?
Breast implants have been used for well over 60 years. Most women have no problems. However, your plastic surgeon should review the list of possible complications during your consultation. Possible complications following Breast augmentation surgery include:
- capsular contracture
- deflation of the implant
- seroma (fluid accumulation)
- implant wrinkling
- implant leakage/rupture
- undesirable scarring
Capsular contracture complication rates
The most common complication that we see after surgery is capsular contracture. This is tightening of the capsule that surrounds the implant. The area often responds to massage, but may need surgery to eliminate the capsule. Lately there has been increasing success with Fat Grafting as a technique to reduce the severity of capsular contracture. A recent study about the use of Fat grafting to relieve symptoms of capsular contracture following Breast augmentation surgery was published in 2018.
The average incidence of capsular contracture in Breast augmentation among all plastic surgeons ranges from 10 - 15%.
I recently reviewed my last 200 Breast augmentation cases to calculate that my capsular contracture rate is 5%, which is well below the average! While deflation of the implant is less likely than capsular contracture, should it occur, the deflated implant would need to be removed and replaced. Both Mentor and Allergan, the US implant manufacturers, do offer warranty programs.
How much does Breast augmentation cost?
The total cost for breast implant surgery depends on the implants you select. Silicone implants are more expensive than saline implants. A pain pump, which is highly recommended, is an elective addition available for $250. Here are 2022 prices with and without the pain pump:
|2023 Cost with Exparel injection|
Total costs include the surgeon's Fee, operating room / recovery room fee, anesthesia fee (board certified anesthesiologist), implants (saline or silicone), breast garment post op garment, and all follow up office visits.
We believe that these are the best implant prices in the Baltimore area! To understand how great our prices are, please see our survey of local plastic surgeons to find out the average cost for implants in Baltimore. Similarly, if you do any comparison shopping, be sure to get quotes for total cost which should include the surgeon's fee, operating room and recovery room fee, the silicone or saline implants, board certified anesthesiologist fee, and all follow-up office visit fees. You should also receive a quote for both with and without a pain pump.
Can I finance my Breast augmentation surgery?
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Board Certified Plastic Surgery, ASPS Member
Patients depicted in our before and after galleries have provided their written consent to display their photos online. Every patient is unique, and surgical results may vary. Please contact us if you have any questions.