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
Augmentation mammaplasty with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Augmentation mammaplasty is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible.
For a number of weeks prior to augmentation mammaplasty, tissue expanders may be placed below the muscles of the chest wall 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. First, 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 or a cannula-attached syringe. The harvested fat cells are then purified. In the second procedure, which takes place on the same day, the fat is injected into the breast through small incisions. The procedure takes approximately 4 to 5 hours.
Recovery from Augmentation Mammaplasty
After augmentation mammaplasty with implants, drainage tubes may be inserted; incisions are stitched, taped and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days postsurgery, most patients feel tired and sore, but many return to work within a week. Stitches are removed in 1 week to 10 days; postoperative pain, swelling and sensitivity diminish during the first few weeks. Scars begin to fade in a few months.
After augmentation mammaplasty with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction.
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.