It is considered you are in surgery from the moment you arrive to the surgical area until the moment you have sufficiently recovered from anesthesia. Before surgery, your surgeon, anesthesiologist and the nursing staff will meet you in the pre-operative area to discuss your medical condition and answer any question.
What kind of anesthesia is used for breast augmentation surgery?
Breast augmentation surgery is performed under general anesthesia with intravenous induction and inhalation anesthesia. You will sleep through the entire operation, feeling no pain and remaining absolutely relaxed.
The section about Anesthesia provides complete information on this medical practice along with recommendations and instructions.
How long does breast augmentation surgery take?
Breast augmentation surgery usually takes 2 hours to complete, but it may take longer if other procedures are also being performed at the same time.
Patient preparation before surgery
Before surgery, you will be asked to remove your underarm hair by using depilatory cream instead of razor. The use of razors prior to surgery increases the incidence of wound infection.
Patient preparation includes treating the surgical site before surgery, using appropriate antiseptic agents for skin preparation.
In the operating room the intravenous therapy or IV will be initiated. The IV is the giving of liquid substances directly into a vein. Through a needle you will receive saline solution, anesthesia, and other medications you may need during surgery.
Once you have moved over the operating table, you will be placed in a supine position with arms in abduction. This means that you will be lying down with the face up and open arms. The elbows are cushioned with pillows to prevent any postoperative discomfort.
Breast augmentation surgery usually takes from 1-2 hours. The length of your hospital stay depends on your health condition after surgery.
Breast augmentation procedures
What types of procedures do exist for breast augmentation?
Once the patient is under anesthesia, the surgeon may perform one of the following surgical techniques:
Periareolar breast augmentation
The periareolar approach is the most common procedure of breast augmentation in Colombia. Most surgeons consider that periareolar approach has several advantages for patients, since wound-healing conditions are better. Also, the incision scar is the smallest one and is extremely favorable and blends well with the areola.
During surgery, patient remains in supine position on the surgical table with face up and open arms. Then the patient is surgically marked with a special pen and the surgeon creates a half-circle incision around the bottom of the nipple-areola complex following the natural border of the areola skin. In the periareolar approach, incisions may penetrate the mammary gland or may be performed through the subcutaneous plane. Blood loss can be significantly reduced with meticulous electrocoagulation. For the implant fixation curved forceps are used and the wounds are carefully closed in layers. Final closure of periareolar incision is accomplished with subcuticular sutures and external adhesive surgical tapes, in such a way that there are not visible external sutures, just a knot. Postoperative compression is applied to the front of the chest. Because of periareolar approach, alteration of nipple and areola sensitivity may occur as a result of nerve injury. This condition may be temporary or permanent. For many surgeons, periareolar approach provides difficult access to subpectoral planes. Periareolar approach is more used to access the subglandular plane. The remaining sutures are removed during the next 2 weeks.
Inframammary breast augmentation
Inframammary breast augmentation is the second procedure most used in Colombia. For those larger breasted women who undergo breast surgery, it is easier to hide the Inframammary incisions within the natural crease where the bottom of the breasts meets the chest wall than women with small breasts. During the procedure, a 3-4 cm long curved line incision is made, located 7-9 cm from the nipple, according to the implant´s size. Then the surgeon approaches the subcutaneous tissue and the superficial muscles of the chest or under the pectoralis major muscle (submuscular placement). Then a pocket for placement of the breast implant is created. The aim is to create a well-proportioned pocket for the implant to produce a natural appearance in the breasts. A poorly proportioned pocket may result in unpleasant breast appearance. While an excessive wide pocket may result in implant migration.
Careful Hemostasis is performed. The cavity is irrigated with sterile saline as antibacterial method. For the implant fixation curved forceps are used and the wounds are carefully closed in layers. Today´s physicians use surgical adhesive tape for the closure of incisions instead of sutures. However, every surgeon performs his/her own technique. You might need drainage tubes to carry away blood and fluids. Once the procedure is complete you´ll be wrapped in a surgical bra or larger size bra.
Transaxillary breast augmentation
This method of breast augmentation does not leave any noticeable scars, since the incision is placed in the crease of the armpit and can be hidden in the axillary region. Surgeon approaches through a small incision in the underarm to create a pocket under the pectoral muscle or over the muscle.
The patient is placed in a semi-sitting position on the surgical table with arms in right angle. A vertical or oblique skin incision about 4 cm long is made in the axillary region. Although vertical incision allows an easy access to the pectoral muscle, the oblique incision provides a superior cosmetic result. This may give a better appearance than a vertical closure, but the surgeon which type of incision is needed depending on your individual circumstances. Then, after penetrating the subcutaneous tissue, a tunnel is made over the pectoralis major and a pocket is created. Subsequently, the implant is passed through the tunnel and placed into the newly formed breast pocket. The implant is placed into the bottom of the pocket. Then surgeon sutures the incisions and topical antibiotics are applied, which are also prescribed immediately. Once the procedure is complete, the patient is wrapped in a surgical bra.
Transabdominal and transumbilical breast augmentation
The Transabdominal breast augmentation method may be performed along with abdominoplasty through the same incision site. Also, it is possible to make a small incision in the upper fold of the navel to create a tunnel through the abdominal tissue. Then a tissue expander is pushed and situated where the pocket will be made to separate the tissues. Subsequently, a pocket for the breast implant is made. The surgeon utilizes an endoscope to increase the vision inside the chest cavity. Once the breast implants have been positioned inside the pockets either in submuscular or in subglandular position, implants are filled with saline. The transumbilical breast augmentation incision is well hidden and will leave no noticeable evidence of scar once healed. Although this is a good option for women with no visible surgical scar, some surgeons consider that transumbilical placement increases the risk of implant rupture because of intense manipulation of the implant during the procedure.
Postoperative recommendations – Breast augmentation surgery
Part of the success of surgery depends on the postoperative care. It is very important to follow the surgeon´s recommendations to achieve the desired outcome. Dr. Nieto closely observes her patient´s convalescence and healing. Please do not hesitate to contact her if you have questions or concerns. Written instructions will be given for your postoperative care to you and your family.
How should I care for myself following breast augmentation?
A surgical dressing or soft bra must be worn for the following 2 weeks both day and night. Please do not remove it.
Drainage tubes will be removed usually within 24-48 hours.
Sutures are removed within the first two weeks following the surgery.
Massage therapy may be recommended to reduce risk of capsular contracture. Your doctor may advise you, from the fourth day following surgery, a gentle massage in all directions. This prevents scar tissue from tightening around the implant. However, capsular contracture must be understood as body´s response condition, and it has nothing to do with the surgeon´s skills.
Massage therapy must be done softly compressing and rubbing the tissue around the implant as tolerated. Repeat the massage therapy as frequent as possible.
You must rest at home for the first 48 hours following surgery.
You will be given a prescription with antibiotics and pain medication to minimize any discomfort.
Inform immediately to your physician if you develop an unexpected reaction to the prescribed medication.
Prior to surgery, you must make arrangements for a responsible adult friend or family member to take you home and take care of you during your convalescence.
You have to sleep on your back and keep your head elevated. You may elevate your body on two pillows.
Avoid taking any medication that has not been prescribed by your doctor, especially aspirin (acetyl salicylic acid) or aspirin-like products (Ibuprofen, Advil, Motrin or Aleve). These medicines have anticoagulant adverse effects and may increase the risk of bleeding or scarring complications.
You should expect some bruising and swelling as a natural effect of surgery.
Avoid any activity for 2 weeks after surgery.
Do not remove your bandages or surgical bra.
Do not raise your arms above your head for two weeks.
You should also be careful about lifting your arms over your head.
You will not be able to drive a vehicle for the following weeks.
Lifting heavy things, animals or children may affect the area of surgery. You must avoid any activity that increases risk of hitting.
Do not allow sutures or dressing to get wet until they have been removed.
You must avoid shaving the axillary area for 2 weeks after surgery.
Do not lie face down for the first 4 weeks or during the time indicated by your physician.
Protect yourself from sun exposure for the following 2 months.
You should resume your normal daily activities after 2 weeks.
Exercise can be resumed 3 months after surgery.
Patient must return to the office for general check up as indicated by the physician.
You should keep examining your breasts as usually. Ask your doctor to teach you how to do a breast self-exam after breast augmentation.
It is important to understand that complete healing and final results after breast augmentation surgery may take from several months to one year.
You should see your gynecologist for breast exam as usually.
Please inform Dr. Nieto if you present heavy bleeding from the wound, severe pain or chest pressure, high fever (more than 38 degrees), significant redness or severe discomfort.