How It's Done

When you arrive at the office, you may be given a sedative like Valium to help you relax. Once you're in the surgery room, you likely will be given an intravenous drip of stronger medications. A lot of breast surgery today is still done under general anesthesia, but this isn't necessary for doctors expert in tumescent anesthesia. If tumescent anesthetic is being used, it is injected at this point. This has the dual purpose of numbing the area and inhibiting bleeding (see chapter 13 on tumescent anesthesia). When tumescent is not used, there may be more bleeding during surgery and more swelling and bruising during recovery. With general anesthetic and without tumescent, more "cauterization" or electrical burning is often necessary to control bleeding.

In any case, the doctor will make an incision, usually about one to two inches long (the navel incisions are smaller). Through this incision, the doctor will have access to the inside of the breast. With his fingers and with instruments, he will create a "pocket" either behind the muscle or behind the breast tissue.

Once the doctor makes the pocket, he inserts the implant. For silicone gel, these are pre-filled, and they have to be squeezed through the incision. Saline implants, which are like thin plastic bubbles, come packaged and filled with air. The doctor first deflates the shell, and then inserts it into the pocket. Once it's in position, he fills it with saline solution, using a syringe connected to a tube leading into the shell. The breast puffs up like a balloon as the implant fills with saline. When both breasts are filled, the doctor can make minor adjustments if needed. The back of the table is raised so that the patient is in an upright position, allowing the surgeon to look at her straight on to make sure the breasts look as even as possible. The incisions are left open so he can go back in and adjust the implants if necessary. When the doctor is satisfied with the appearance, the fill tubes are removed, and small valves automatically close when the tube is pulled. Finally, the incisions are closed with stitches. These will be removed in about one to two weeks, depending on the surgery. It all takes about 30 to 90 minutes. Most surgeons prescribe antibiotics for a week or two after the surgery in order to prevent infections.