Breast Implant Surgery

Breast implant surgery can be performed in a hospital, surgery center or doctor’s office. Breast implant surgery patients may have to stay overnight in the hospital (inpatient surgery) or may be able to go home afterward (outpatient surgery). The surgery can be done under local anesthesia, where the patient remains awake and only the breast is numbed to block the pain, or under general anesthesia, where medicine is given to make the patient sleep. Most women receive general anesthesia for this surgery. Breast implant surgery can last from one to several hours depending on the procedure and personal circumstances.

If the surgery is done in a hospital, the length of the hospital stay will vary based on the type of surgery, the development of any complications after surgery and your general health. The length of the hospital stay may also depend on the type of coverage your insurance provides.

Surgical Consultation

Before surgery you should have a consultation with your surgeon. Be prepared to ask questions about the surgeon’s experience, your surgery and expected outcomes. The FDA has provided a list of questions that may help guide your discussion. The surgeon should be able to discuss whether you are a good candidate for breast implants, the different type of implants, options for size, shape, surface texture, and placement based on your particular circumstances, as well as the risks and benefits of implant surgery. The surgeon should also be able to provide you with before and after pictures of other patients to help you better understand your expectations and potential outcomes from surgery.

During the consultation you will need to discuss your medical history, including any medical conditions or drug allergies you may have. You should also discuss any previous surgeries you’ve had, especially to the breast, and what drugs you are currently taking, including supplements, herbal and over-the-counter (OTC) medications.
It is important to tell the surgeon if you think you may be pregnant.

If you are undergoing breast implant surgery for reconstruction, you will also need to speak with your surgeon about your personal circumstances, including being treated with chemotherapy and/or radiation therapy, as these can affect your risks of complication and the appearance of the reconstructed breast. The surgeon should also speak to you about the amount of breast tissue that will remain after surgery and future screening for breast implant ruptures and breast cancer.

During the consultation be sure to ask the surgeon for a copy of the patient labeling for the breast implant s/he plans to use. You have the right to request this information, and your physician is expected to provide it. Be sure to read the patient labeling entirely prior to surgery. It will provide you with information specific to your breast implants, including how to take care of them. Make sure you read and understand the informed consent form before you sign it.

Breast implant manufacturers are currently conducting clinical studies to evaluate new types of breast implants and to understand the long term experiences of women who receive breast implants. If you are interested in participating in a clinical study, be sure to ask your surgeon what specific steps you will need to take.

Before Surgery

Your surgeon may ask that you have a mammogram or breast X-rays prior to surgery in order to identify any breast abnormality and so the surgeon has a preoperative image of your breast tissue.

You will usually be asked to not eat or drink anything after midnight the night before surgery and to bring loose clothing, including a loose-fitting bra without underwire, to wear after surgery. If you are going home the same day as the surgery, you will need to plan for someone to drive you home.

Your surgeon should discuss with you the extent of surgery, the estimated time it will take and how they plan to treat for pain and nausea.

During Surgery

Once you have been given anesthesia and it has taken effect, the surgeon will make an incision (cut) in one of the following areas:

  • along the underside of your breast (inframammary)
  • under your arm (transaxillary)
  • around the nipple (periareolar)
  • through the mastectomy scar (for reconstruction)

The FDA-approved labeling warns surgeons NOT to place breast implants through the belly-button (peri-umbilical approach).
The location of the incision can affect how visible the scars are, as well as any complications you may experience after surgery.

Cutting the underside of the breast is the most common location used since it is where the skin naturally folds. Your scarring with this type of incision may be a bit more visible, especially if you are younger, thin and have not yet had children.

Placing the implant through an incision under the arm will likely require your surgeon to use an endoscope, a tool with a camera and other surgical instruments inserted into the incision site to help the surgeon guide the implant into place. While there will likely be no visible scar around your breast, you may have a scar on the underside of your arm.

Cutting around the edge of the nipple (areola) may cause problems with loss or change of sensation in the nipple.

The surgeon will place the implant above (subglandular) or below (submuscular) the chest wall muscles. Be sure to discuss the pros and cons of the implant placement selected for you with your surgeon prior to surgery.

If you are getting silicone-gel filled implants they will already be filled with silicone gel when inserted. If you are getting saline-filled implants and the implant is not pre-filled, the surgeon will insert the silicone shell and then fill the implant to the desired level with saline.

The incision is then closed with stitches. Your surgeon may place temporary drains in the incision prior to closing it to prevent fluid or blood accumulation. Catheters to deliver pain medicine at the site of the incision may also be placed prior to closing the incision. The drains or catheters would be removed during a follow-up visit after surgery.

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