With breast implants, as with any medical procedure, you need to consider what the procedure involves. That includes what it can accomplish and what can go wrong with it, whether in general or related to your fitness for diving.
The following recommendations come from two DAN referral physicians who are familiar with plastic surgery and scuba diving. They remind us that:
- Each case is unique.
- You should consult your cosmetic surgeon about any concerns.
- This guidance is general and based on ideal healing.
In addition to the risks associated with this procedure, all surgeries have potential risks include bleeding, reaction to the anesthetic and infection. Risk of complications can be reduced by following your surgeon’s instructions before and after the surgery.
Reasons for Breast Implants
- To have larger breasts
- Balance the size or shape of uneven breasts
- Make the breasts more proportional with the rest of the body
- Enhance breasts that have lost volume and shape due to pregnancy, nursing, weight loss or age
- Reshape or reconstruct the breast after surgery
Individuals ineligible for breast implants include women who are pregnant, nursing or have breast cancer.
Surgeons surgically place a saline or silicone-gel-filled implant in each breast to push the breast tissue forward. Implants are empty sacs made out of silicone elastomer.
With the patient under anesthesia, the surgeon lifts the breast tissue to create a pocket above or below the pectoral muscle. The empty implant is inserted and positioned through a small incision (generally less than 1 inch), then inflated with air to help open and stretch the tissue and the pocket. Next, the surgeon molds and positions the implant manually. After suctioning the air out, saline fills the implant to a predetermined volume (silicone gel implants are pre-filled). At this point, surgeons may situate the patient upright to check for symmetry and balance.
If there are no complications, the surgeon removes the fill tube and seals the valve. Drainage tubes, if necessary, allow removal of the blood and fluids that accumulate during surgery. The surgeon closes the incision with stitches or glue, and the patient may use a special bra or bandages during healing.
Depending on anatomy, breast condition and other factors, the implant can be inserted through four different incision styles:
- Inframammary incision: on the underside of the breast where it meets the chest
- Periareolar incision: on the lower edge of the areola
- Axillary incision: in the folds of the armpit
- Transumbilical (TUBA) incision: on the rim of the navel; the implant is passed under the skin of the abdomen to the breast
Each method has advantages and disadvantages in terms of ease of surgery, healing, scarring and future procedures. You can consult with your surgeon about which option is best.
There are three potential sites for the placement of the implants.
Subglandular surgery places implants on top of the pectoral muscles between the chest wall and breast tissue. This location does not disturb any muscle tissue, has a short surgery and recovery time, less sagging and less pain. The implants are more accessible for replacement and removal than other placements. The disadvantages are that the implants are more palpable and visible if the patient has little breast tissue, and they make mammogram readings more difficult due to obscuring some of the glands. Implants here may develop a scar capsule, which can compress them and cause pain and displacement.
The partial submuscular procedure places all but the lower third of the implant behind the pectoral muscle. This surgery is more invasive than subglandular. Implants here may appear distorted when you flex your pectorals and can displace downward because the lower third is supported only by skin. Being behind the pectorals makes them less palpable and less prone to visible rippling, less obscuring of mammary glands during mammograms, and lowers the risk of scar capsule contraction.
Complete submuscular placement is when the implant is covered and supported by the pectoral muscle and other muscles and tissue. This is a longer and more invasive surgery since it distresses the pectorals, and it involves increased pain and recovery time. The implant is more difficult to access, but is better supported than a partial submuscular. The natural tissue completely covering this implant results in a very natural appearance.
Preparing for Surgery
- Have a mammogram to establish a baseline for postoperative mammograms.
- Stop taking aspirin, ibuprofen, vitamins and herbs at least two weeks (some surgeons recommend 30 days) before surgery. These may increase the risk of bleeding.
- Disclose all medication, vitamins and herbs you use to your surgeon.
- Do not drink alcohol for at least 24 hours before surgery.
- If applicable, quit smoking four to six weeks before surgery.
Procedure and Complications
The surgery will take between one and three hours, depending on the implant placement and the surgeon’s skill and experience. General anesthesia is common, although subglandular placement may require only local anesthesia and sedation. The procedure can be at an office or hospital outpatient facility. A one- or two-day stay at a hospital is occasionally necessary.
After surgery, expect pain and postoperative sensations for days or weeks. The sensations may include sudden chest pains from nerve regeneration, tightness, a burning sensation or sensitivity in the nipples, noises from fluid buildup or air bubbles as the implants settle, itchy skin due to stretching, nausea, constipation, mood swings and depression. The pain and discomfort depends on the patient, the size and placement of the implants, and any surgical complications.
Your surgeon will prescribe medication to manage pain. Patients are often up and moving within one to two days, so they can often return to work within days and resume moderate activity soon after surgery. The stitches are typically removed in seven to 10 days, after which you may require a surgical bra. Sleeping upright and avoiding bending over or straining the breast area following surgery can ease recovery. Your surgeon will recommend further care for scars and healing. You will usually have a postoperative visit within three weeks and additional follow-ups depending on your surgeon’s evaluation.
Complications may include:
- Implant deflation or rupture
- Hematomas (blood pooling) or seromas (fluid from blood) that cause swelling, pain and bruising
- Tissue breakdown (possibly caused by using steroids in the surgical pocket, smoking or excessive heat or cold therapy) and exposure of the implant
- Impeded early detection of breast cancer
- Position creating the appearance of two breasts
- Symmastia (the appearance of one continuous implant) resulting from a surgeon accidentally cutting the muscle attached to the sternum
- Puckering of breast tissue
Diving After Surgery
Physicians do not agree on how long to wait after the procedure before resuming diving. Pressure can affect implants, possibly allowing the release of subcutaneous air, which may be problematic. Some doctors recommend three months; some believe six months is necessary. You should talk with your physician if you are considering breast implants. Having your health care professional, who has evaluated your fitness to dive, consult with your surgeon about diving is wise.
For more information about breast implants and other women’s health issues, see Women’s Health and Diving.
Edward Golembe, M.D., and Ralph Potkin, M.D.