Breast implant techniquesOver the years, breast augmentation has been tremendously popular because the results have been predictably good. The only real way to improve this procedure was to make it easier on the patient. This article explains small but significant changes in breast augmentation that have achieved just that. For years, breast enlargement was an operation performed under sedation or "twilight" anesthesia, where a breast implant was frequently not so carefully inserted beneath a woman's breast. Typically, the surgery took about two hours. Postoperative bleeding, often described as "swelling," caused significant and often severe pain, which could last for several weeks. This swelling was often treated by either placing drains or tightly binding the breasts, both of which generally added to the patient's discomfort. To make matters worse, bathing was usually forbidden for the first week until such time as the sutures were removed. In retrospect, it is amazing that this procedure gained popularity.


Twilight or sedative anesthesia has largely been abandoned in favor of general anesthesia, much to the relief of patients and surgeons alike. Patients no longer perceive the unpleasant sensations and sounds that are part of a breast augmentation. From the surgeon's standpoint, the patient under general anesthesia is much more relaxed and the procedure usually goes more smoothly. This allows the surgeon to pay better attention to the surgery; and operative times for a breast augmentation are considerably shorter now than in years past, often well under 1 hour. Shorter operative times mean the patient receives smaller doses of drugs, which frequently leads to a faster recovery.


The technique used to create the space for a breast implant has also materially changed over the last several years. Prior to this time, the space or the "pocket" was dissected bluntly. This was associated with more bleeding which has two negative consequences. In the short run, swelling often resulted, which caused increased pain through increased pressure inside the breast. This type of pain is usually resistant to pain relievers. In the long run, postoperative bleeding around the implant generally made the patient, at least in theory, more likely to develop scar tissue around the implant. Known as capsular contracture, this scar tissue could be uncomfortable, distort the shape of the breast, and ruin the final result. To prevent this accumulation of blood, plastic surgeons would either place rubber drains that needed to be removed several days after the surgery, or they would bind the patient's breasts tightly, often with an ACE wrap. Neither maneuver was well-tolerated by patients.


Today, more progressive breast augmentation techniques seek to prevent bleeding during and after the surgery. Rather than bluntly separating the tissues, a cautery or electrical device is used to coagulate blood vessels so they never have a chance to bleed. Similarly, tissues are cut rather than tom in an effort to minimize the trauma of the surgery and thus decrease pain and discomfort. Further along these lines, many plastic surgeons use some type of local anesthetic in the breast during surgery to provide pain prevention and relief long after the procedure has been concluded.


A return to normal life as soon as possible is one of the goals for the breast augmentation patient. To facilitate this, dissolvable sutures are substituted for standard sutures making the discomfort of suture removal unnecessary. Since there are no drains, bindings~ or sutures, normal bathing can commence the :first day after surgery. Most surgeons place no activity restrictions on their patients; rather, early motion is encouraged to prevent stiffness and muscular spasms. Patients are usually able to drive within a few days and return to an active lifestyle usually well within a week.


Breast augmentation is still surgery and definitely associated with some amount of postoperative pain. However, changes in the procedure have clearly lessened the impact of the operation on the patient. If you consult with a plastic surgeon about breast augmentation, make sure to inquire about how he or she seeks to minimize postoperative pain and enhance the chance for a rapid return to your normal lifestyle.


Paul G. Pin, M.D.

Board Certified,

American Board of Plastic Surgery Dallas, Texas Breast augmentation is real surgery and involves risks such as bleeding, infection, and scarring. Results vary. Dr. Pin will be happy to discuss these and other risks of breast augmentation.