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          A Step-by-Step Guide to Breast Augmentation

          Breast augmentation is the No.1 cosmetic surgical procedure performed in the United States. In 2009, 311,957 women opted for cosmetic breast augmentation, according to the latest statistics compiled by the American Society for Aesthetic Plastic Surgery (ASAPS).

          Understanding the stages involved in breast augmentation will better prepare you for what to expect. To help, has broken it down into three steps. Breast augmentation is not a cookie-cutter surgery by any means, but the basic steps involved in most procedures are often very similar.

          Breast implant surgery can take up to four hours, depending on the technique used, your surgeon's skill and how much reshaping of your natural breast tissue is required. Breast augmentation surgery can be performed in a cosmetic plastic surgeon's office, a freestanding surgical clinic, or in a hospital. The surgeon's office should be an accredited facility, as this means it is considered a safe place to have surgery. In many states, operating rooms in doctors' offices do not have to be accredited. Breast augmentation is usually done on an outpatient basis.

          You should make all of the decisions about your surgery, including breast implant type, implant size, incision pattern and implant placement in advance of your breast augmentation surgery.

          Step I: Surgery Prep

          After you arrive at the site of the surgery, you will be "prepped." You will start by changing into a hospital gown. Most likely, this is when your surgeon will use a marker to indicate where the breast implant incisions will be made. You will be scrubbed with an antimicrobial soap to minimize the risk of infection, and then you will be hooked up to several monitors so that the surgical team can keep an eye on your blood pressure, heart rate and other vital signs. A nurse may clip a pulse oximeter onto your finger or earlobe to measure how much oxygen there is in your blood. Additionally, your legs may be placed in inflatable plastic compression sleeves. These will inflate and deflate periodically during your cosmetic surgery procedure and help prevent deep venous thrombosis (DVT), or the formation of blood clots deep in the veins of your legs. These clots, if they form, could break loose and become lodged in your lungs.

          You will have an IV line inserted on the inside of your elbow or possibly your hand. A nurse will clean the spot with alcohol and then insert a syringe that will be removed, leaving a thin plastic tube behind. This will be taped in place and connected to a bag of solution that will help keep you hydrated. The IV line can also be used to administer other medications, including sedatives and anesthesia.

          There are several choices for anesthesia during breast implant surgery. These include general anesthesia, conscious sedation and local anesthesia. If you elected to be "awake" during your breast augmentation surgery, your surgeon will inject some local anesthesia into the breast area to make it "numb" before he or she begins the surgery. You may feel pressure, but you will not feel discomfort. Make sure that the surgeon and anesthesiologist have a complete list of all the medications you take, and that they are aware of all your pertinent health information.

          Step II: The Surgery

          Your surgeon will now make the breast implant incisions you discussed during your consultation. He or she will create a pocket behind the breast tissue or under the pectoral muscle tissue based on the implant placement position the two of you chose during your consultation. Once the pocket is created, the breast implant will be inserted. If you opted for silicone-filled implants, the already-filled implants will be put in place; saline breast implants are usually filled after the shell is put in the pocket.

          If you have very small breasts, or if you are having implants inserted after a mastectomy (surgical removal of one or both breasts), you may need a tissue expander inserted for a period of time before receiving your permanent breast implant(s). A tissue expander looks like a regular saline implant, but it has a port through which additional saline can be added. This allows the surgeon to stretch the breast and make room for the implant.

          Expandable saline breast implants work in a similar manner to tissue expanders, but are permanent. A filler port is left near the incision, and more saline is added every week until you are satisfied with the size of your new breasts. At that time, the filler port is removed and the saline implant seals itself shut. More saline can be added for up to six months after surgery.

          After the breast implants are in place, your surgeon will check for symmetry. He or she will place you in an upright position to see how the implants look when you are seated. If everything looks good, your surgeon will close the incisions. Usually, a dressing will be applied to protect the wounds, keep the tissue and implant securely in place, and to reduce swelling.

          Step III: Waking Up

          When your breast augmentation procedure is finished you will be awakened and moved to a recovery room. The staff in the recovery area will keep an eye on you for about two hours. You may feel groggy and out of it.

          After a couple of hours, if everything goes well, you will be allowed to go home. You must have a responsible adult drive you home and stay overnight with you for at least the remainder of the day and overnight.

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            Joseph A. Mele, MD, FACS

            130 La Casa Via
            Building 2, Suite 206
            Walnut Creek, CA 94598
            (925) 943-6353
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          • 95 Scripps Drive
            Sacramento, CA 95825
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            Charles Lee, MD

            Enhance Medical Center
            462 N Linden Dr
            Beverly Hills, CA 90212
            (877) 868-1772
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