Most often breast augmentation takes place in an outpatient surgical clinic or hospital under general anesthesia. In some cases, the surgery is done using a local anesthesia combined with sedation so you are awake but drowsy and relaxed. You and your doctor will discuss these options. The surgery usually takes from one to two hours. After surgery, you’ll be taken to the recovery room for several hours before you are able to go home. Plan to have someone accompany you; you’ll be drowsy and feel discomfort. Pain medication will be prescribed which you will probably want to take for a few days.
The Implant
A soft, pliable implant—(imagine a clear plastic pillow filled with Jell-O or salt water) is placed in a pocket the surgeon has formed in your tissue either behind the pectoral muscle or in front of the muscle wall.
Placement of the Implant
Your own anatomy helps determine what placement position is right for you. As a rule, implants behind the muscle are less likely to form a hardening called capsular contracture and less likely to show a rippling on the skin. They usually result in a more natural, softer looking bosom, and this placement is often preferable because it can allow for a better mammogram. Most implants are placed behind the chest muscle.
On the other hand, women with very droopy breasts may have better results when the implant is placed on top of the muscle because that can give their bust a rounder and firmer appearance where the chest was once flattened out.
The Incision
In order to place the implant in your breast tissue, the surgeon will need to make a surgical incision. The incision can be made around the areola (periareolar )— the darker skin that surrounds your nipple; in the armpit; or directly under your breast.
When the incision is made in the areola, usually the scar is barely noticeable, the tiny line blends into the surrounding skin. An incision made under the breast (inframammary) can be inconspicuous as well because the breast itself will hide the scar. Armpit (axillary) incisions may be noticed when the arm is raised, and some surgeons find that it is more difficult to accurately form the pocket that the implant is tucked into from this entry point. Some surgeons use an endoscope, a surgical instrument consisting of a long, thin, lighted tube, to aid them in the insertion of breast implants.
TUBA Method
Some newer endoscopic procedures involve making an incision in the navel (“TUBA” or “transumbilical” or periumbilical method). One tiny half-moon incision is made in the navel and the surgeon then creates a tunnel to the breast area. A "pocket" in the breast tissue is formed that will hold the saline implant. (Endoscopically-assisted surgery allows the surgeon to see on a video screen the pathway and placement site.)
When the pocket is ready, the surgeon will guide the implants-which at this point are empty thin sacs that are rolled up like a cigar-into place. The implants are filled with sterile saline solution; when the surgeon removes the filling tube, the saline implant port self-seals.
"The big advantage is there is no visible scar and it appears that patients have less pain. They seem to recover rapidly," reports Dr. Robert Gerson, a board-certified plastic surgeon who practices in Illinois and Wisconsin and is one of the few doctors in the US trained to perform the procedure. He believes that the TUBA method results in less chance of damaging nerves that can lead to loss of feeling in the breasts.
With this technique, breast implants are most successfully placed on top of the muscle wall. That may be a drawback for some: Many women, including very flat-chested patients, have better, more natural-looking results when their implants are placed behind the pectoralis muscle. But for the patient who is very concerned about any visible scarring-TUBA might be a technique to investigate and consider.
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