Breast enlargement is performed as an outpatient at a hospital center under anesthesia by an MD anesthesiologist.
The small cut for insertion of the implant can be made around the areola, but also in the armpit/below the breast, or even through the belly button. Where the implant is placed, either underneath the pectoralis (chest) muscle, or on top behind the breast tissue only, depends on how the patient looks after weight loss. In most cases after weight loss, there is much ptosis or droopiness of the breasts which would require some uplift, and probably placement of the implant on top of the muscle. However, underneath the muscle hides the implant more and allows better visualization of the breast tissue by the radiologist.
Also, the type of implant used, either saline(smooth or textured and various shapes and profiles) or silicone(smooth or textured)(and various shapes and profiles), depends on how the patient looks. The surgery takes about one to two hours.
Drains may be used as well as a pain pump if the patient wishes. It is more uncomfortable (and frankly can be painful) if the implant is placed underneath the chest muscle. The patient is prescribed something for pain and sleep, as well as an antibiotic.
Usually you can return to light activity within several days and full activity after two weeks. Usually you are able to take a shower, drive, go back to school/work in several days.
Complications such as bleeding (about 4%), infection (3%), loss of sensation (no matter where the incision is placed- 1%), and deflation with the saline implant (about 5%) occur. The scars usually heal well and breast feeding is possible wherever the incision is placed.
A breast uplift (mastopexy) is performed as an outpatient. There are three basic types. The first is a crescent shaped removal of breast skin only above the areola. This is frequently performed in conjunction with a breast enlargement in someone whose breast are ptotic (droopy because of pregnancy or weight loss). Separately, it can even be done under a local anesthetic in the office. This lifts the nipple-areola up to one inch only. It does not reshape the breast. The scars usually heal well but can be red, raised and spread and in a small amount of the patients can even elongate the areola.
The second, more extensive uplift is one that results in a scar around the areola("donut uplift"). The areola is marked smaller. The main negative is that this may result in a minimal uplift/reshaping of the breast and may result in a flattening of the breast with bad scars and stretched out areola.
The final or full uplift (mastopexy) results in a scar at least around the areola, down the breast and possibly even around it (like an anchor type and as in a breast reduction). All of the above can be done either as an outpatient or inpatient under local anesthesia with IV sedation or a general anesthetic.
Minimal breast tissue is removed but primarily skin with reshaping of the breast and uplifting it. The procedure takes about two hours and the patient is placed into a bulky bandage for about five days and then into a bra which she wears day and night for two weeks.
Light activity is permitted after several days and full activity after two weeks. The pain is usually minimal.
The usual complications like infection, bleeding, and loss of sensation can occur but are minimal. Scarring is the main negative and the scars heal well in about 80% of the patients (flat, minimally spread and white). In 20% though, the scars are red, raised off the surface and the scars are spread. Something can be done to minimize them though. Usually, breast sensitivity or the ability to breast feed is not interfered with.
A breast reduction can be done as an outpatient or inpatient, in a hospital under general anesthesia administered by an MD anesthesiologist.
It usually takes about two or more hours. What type of a reduction is performed depends on what the patient wants, and especially on how much breast tissue is removed and how much of a reshaping of the breast after the removal and uplift is necessary. Naturally, the more uplifting and reducing, the longer the scars.
Sometimes, liposuction can be used alone to reduce the breast, or sometimes it may end up with a scar around the areola and down and around the bottom (anchor type) scar.
The recovery period is about two weeks, but light and normal activity one can do within several days, and heavy activity after two weeks, and all activity shortly thereafter. The patient is in some sort of dressing for about two weeks and may be in a bra within about 5-7 days and possibly able to bathe.
Nipple sensation and breast feeding is possible in about half of the patients. Other problems like infection, unequalness of the breasts and bad scars(even red, raised and spread) may occur and the latter depends on the individuals healing.
This surgery may be covered by your insurance. This also depends on how much is removed, and usually at least a pound off each breast is required.