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How Breast Implant Surgery Is Performed

If you are thinking about getting breast implants, you should have a complete understanding of how the procedure is performed. Your breast implant surgery may differ from what we describe here depending on what incision is used and where your implants are placed, but this description is the usual experience.

Generally, breast implant surgery can take up to 4 hours to perform, depending on the technique used, the skill of your surgeon and other factors, including how much reshaping of your natural breast tissue you need. More extensive surgery takes longer; less complicated surgeries can be done quicker. You can have other cosmetic procedures—such as liposuction or breast lift —done during your breast augmentation, but this will extend the length of your surgery. If you are having implants removed and replaced, the surgery usually takes less time than your original breast implant surgery.

Breast augmentation surgery can be performed in a cosmetic plastic surgeon’s office, a freestanding surgical clinic, or in a hospital. It is usually done on an outpatient basis same day surgery which means that you arrive in the morning and go home that night. You will not be allowed to drive yourself home or go home by yourself that night.

Inserting the Breast Implants

During breast augmentation surgery, an implant can be inserted in several ways, all of which will augment your natural breasts and give you similar results. Unless there is no breast tissue--in other words, after a mastectomy--a breast implant is almost always placed underneath the glandular and fatty tissue that is the natural breast or underneath the natural breast and some of the muscles in the chest wall. Implants that are placed under just the breast tissue are often called “overs,” because they are over the muscles. This is also called subglandular placement. Implants placed under the muscles are called unders or full unders, or submuscular implants.

You can find out more about breast implant placement at Breast Implant Placement Options. There are advantages and disadvantages to each and you should discuss these with your surgeon to determine which breast implant placement is best for you.

In addition to deciding on the location for your breast implants, there are several locations for the incisions through which the implants are to be inserted. Breast implant incisions can be made under the arm or in the armpit (transaxillary), around the nipple (aureola), in the crease just under the natural breast (the inframammary fold), or around the navel (transumbilical breast augmentation). You can find out more about breast implant incision placement at Incision Options. Again, there are advantages and disadvantages to each type of insertion that you will have to discuss with your surgeon.

Silicone-gel filled implants require larger incisions than do saline breast implants. Silicone breast implants are already at their final size and shape when they are inserted, whereas saline implants are often inserted empty and filled after they are in position. A good cosmetic plastic surgeon can often insert a saline implant through an incision that is only an inch long. You simply can’t get a silicon-gel implant through an incision that size, but the incisions for silicone breast implants are still only about 2 to 3 inches long.

Your surgeon or a staff member will tell you of how long before your breast implant surgery that you need to stop eating or taking in anything by mouth. He or she will also tell you if you need to stop using any medications you usually take (such as aspirin). Usually, you will be told to avoid aspirin, ibuprofen, and anything else that might increase bleeding at least a week before the surgery. If you smoke, you will also be told to stop smoking before your breast implants surgery.

Before your breast augmentation, your surgeon will go over your general health with you. Make sure that the surgeon and the anesthetist or anesthesiologist have a complete list of all medications that you take and that they know about any health problems you may have, such as asthma, heart problems, allergies—everything. Tell them about all medications you take regularly or semiregularly and this includes all health supplements, vitamins, and herbal products that you take. Be honest about all the drugs you use and your medical history. Your health depends on it.

After you arrive at the site for the surgery, you will be “prepped” for breast augmentation. You’ll change into a hospital gown. Usually, this is when your surgeon will mark you with a marker pen to indicate where the breast implant incisions will be made. You will be scrubbed with an antimicrobial soap to minimize the risk of infection. You will also be hooked up to several monitors so that the surgical team can monitor your vital signs, like your blood pressure and heart rate. The staff may clip a little device onto your finger or an earlobe. This is a pulse oximeter and it measures how much oxygen there is in your blood.

Your legs may be placed in inflatable plastic sleeves called compression sleeves. These will inflate and deflate periodically during your cosmetic surgery procedure and help prevent a condition called deep venous thrombosis, which is the formation of blood clots deep in the veins of your legs. These clots, if they form, could break loose and lodge in the lungs or brain and cause serious problems.

You will have an IV line inserted. This will usually be inserted on the inside of your elbow, but occasionally will be placed in the 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 to hold it in place and will be 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, or local anesthesia. You can read more about these choices at our Anesthesia Options page.

After you are anesthetized, your surgeon will make the breast implant incisions. He or she will create a pocket behind the breast tissue or under the pectoral muscle tissue by a process called dissection, which is the term used when tissues are separated or cut apart. After the pocket is created, the breast implant is inserted into the pocket. A silicone-filled implant is put in place already filled. Saline breast implants are usually inflated after the silicone elastomer shell is put in place.

If you have very small breasts, or if you are having implants inserted some time after a mastectomy, you may need to have what is called a tissue expander inserted for a period of time before getting a permanent breast implant. A tissue expander looks pretty much like a regular saline implant but it has a port through which additional saline can be added. This allows the tissues to stretch and grow to the breast size that is wanted without caused the skin or other tissues to tear or develop severe stretch marks.

Expandable saline breast implants work similarly to tissue expanders, but they are permanent. A filler port is left near the incision and more saline is added every week or so until you are at the size you desire. At that time, the filler port is closed off and removed and the saline implant seals itself. More saline can be added to expandable saline implants up to 6 months after surgery, but most surgeons will usually add more saline for just a few weeks after your breast implant surgery before removing the fill port.

After the breast implants are in place, your surgeon will check their symmetry. You will be sat up on the operating to see how your breast implants look in an upright position and to ensure that they look the same on both sides. If everything is fine, the incisions are then closed. Usually, a dressing will be applied to protect the wounds, to keep the tissue and implant securely in place, and to reduce swelling.

Right after your breast implant surgery, you will be awakened and moved to a recovery room where staff members keep an eye on you for usually about 2 hours. During this time, you will be coming out of the anesthesia and feeling groggy and a bit out of it. You may feel a number of sensations during this time, including pain and nausea. You may feel very hot or very cold. Some patients become very emotional as they come out of surgery; sometimes to the point of weeping. This is normal. The staff can provide you with pain relievers, antinausea medications, and warm blankets if you need them. If you feel that you are in distress, let someone know immediately.

After your breast implant surgery, your cosmetic plastic surgeon will give you a card containing information about your implants, including the manufacturer, the model type or number, and the lot information. This is called the device card. Keep this card in a safe place because you may need it in the future. When you get home, put this card in the same spot where you keep important papers such as insurance policies.

After a couple of hours, if everything goes well, you will be released to go home. You must have a responsible adult drive you home and you should have a responsible adult stay overnight with you at least the first night. You will not be allowed to drive yourself home after breast implant surgery.