If You're Considering Breast Augmentation...
Breast augmentation, technically known as augmentation
mammoplasty, is a surgical procedure to enhance the size and
shape of a woman's breast for a number of reasons:
• To enhance the body contour of a woman who, for personal
reasons, feels her breast size is too small.
• To restore breast volume lost due to weight loss or following
pregnancy
• To achieve better symmetry when breasts are moderately
disproportionate in size and shape
• To improve the shape of breasts that are sagging or have lost
firmness, often used with a breast lift procedure
• To provide the foundation of a breast contour when a breast
has been removed or disfigured by surgery to treat breast cancer
• To improve breast appearance or create the appearance of a
breast that is missing or disfigured due to trauma, heredity, or
congenital abnormalities
By inserting an implant behind each breast, surgeons are able to
increase a woman's bustline by one or more bra cup sizes. If
you're considering breast augmentation, this will give you a
basic understanding of the procedure—when it can help, how it's
performed, and what results you can expect. It can't answer all
of your questions, since a lot depends on your individual
circumstances. Please ask your surgeon if there is anything you
don't understand about the procedure.
The Best Candidates For Breast Augmentation
Breast augmentation can enhance your appearance and your
self-confidence, but it won't necessarily change your looks to
match your ideal, or cause other people to treat you
differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.
The best candidates for breast augmentation are women who are
looking for improvement, not perfection, in the way they look.
If you're physically healthy and realistic in your expectations,
you may be a good candidate.
Types of Implants
The choice of implant filler, implant size, shape and other
features will be determined based on your breast anatomy, body
type and your desired increase in size. Your lifestyle, goals
and personal preferences, as well your plastic surgeon's
recommendations and sound surgical judgment are also determining
factors. Implant manufacturers occasionally introduce new styles
and types of implants, and therefore there may be additional
options available to you.
Breast implants are medical devices with a solid silicone,
rubber shell. The implant shell may be filled with either saline
solution (sterile salt water) or elastic silicone gel. Both
saline and silicone gel breast implants are approved by the U.S.
Food and Drug Administration (FDA). Approval means that an
implant has been rigorously researched and tested, and reviewed
by an independent panel of physicians for safety.
The size of a breast implant is measured in cubic centimeters (ccs)
based on the volume of the saline or silicone filler. Breast
implants vary both by filler and in size, but there are
additional features to consider:
• Texture: the implant shell may be smooth or textured
• Shape: the implant may have a round profile or one that is
anatomic (teardrop or tapered shape)
• Profile: the implant may have a low, medium or high projection
(the depth of the implant from the base to the highest point of
the implant curve)
• Diameter: the width of the implant measured across it's base
(the side of the implant that will be positioned over the chest
wall)
Adult women of any age can benefit greatly from the enhancement
breast implants provide. It is usually recommended, however,
that a woman's breasts are fully developed prior to placement of
breast implants. Saline implants are FDA approved for
augmentation in women 18 years of age and older. Silicone
implants are FDA approved for augmentation in women age 22 and
older. Saline or silicone implants may be recommended at a
younger age if used for reconstruction purposes.
You should be aware that breast implants are not guaranteed to
last a lifetime and future surgery may be required to replace
one or both implants. Regular examinations for breast health and
to evaluate the condition of your implants are important whether
you have chosen saline or silicone breast implants.
All Surgery Carries Some Uncertainty and Risk
Breast augmentation is relatively straightforward. But as with
any operation, there are risks associated with surgery and
specific complications associated with this procedure.
The most common problem, capsular contracture, occurs if the
scar or capsule around the implant begins to tighten. This
squeezing of the soft implant can cause the breast to feel hard.
Capsular contracture can be treated in several ways, and
sometimes requires either removal or "scoring" of the scar
tissue, or perhaps removal or replacement of the implant.
As with any surgical procedure, excessive bleeding following the
operation may cause some swelling and pain. If excessive
bleeding continues, another operation may be needed to control
the bleeding and remove the accumulated blood.
A small percentage of women develop an infection around an
implant. This may occur at any time, but is most often seen
within a week after surgery. In some cases, the implant may need
to be removed for several months until the infection clears. A
new implant can then be inserted.
Some women report that their nipples become oversensitive,
undersensitive, or even numb. You may also notice small patches
of numbness near your incisions. These symptoms usually
disappear within time, but may be permanent in some patients.
Breast implants do not generally interfere with a woman's
ability to breast feed, or present a health hazard during
pregnancy to a woman or her baby. However, pregnancy and the
associated changes to a woman's body may alter the results of
any breast surgery, including surgery to place breast implants.
Therefore, it is important to discuss the options of breast
implant surgery with your plastic surgeon if you are interested
in becoming pregnant and breast feeding in the future.
Occasionally, breast implants may break or leak. Rupture can
occur as a result of injury or even from the normal compression
and movement of your breast and implant, causing the man-made
shell to leak.
• If a saline-filled implant breaks, the implant will deflate in
a few hours and the salt water will be absorbed and naturally
expelled by the body.
• If a silicone-gel filled implant leak or break, the elastic
silicone gel may remain within the implant shell, or may escape
into the breast implant pocket (a capsule of tissue that
surrounds the implant). A leaking implant filled with silicone
gel may not deflate and may not be noticeable except through
imaging techniques such as an MRI. For this reason, a woman with
silicone breast implants is advised to visit her plastic surgeon
annually to assess that her implants are functioning well. An
ultrasound exam or MRI screening can assess the condition of
breast implants; after 3 years it is recommended that all
silicone implants be properly screened.
Following the placement of breast implants mammography is
technically more difficult. Obtaining the best possible results
requires specialized techniques and additional views. You must
be candid about your implants when undergoing any diagnostic
breast exam. In many cases, an ultrasound exam or MRI may be
recommended in addition to mammography.
While the majority of women do not experience these
complications, you should discuss each of them with your
physician to make sure you understand the risks and consequences
of breast augmentation.
Planning Your Surgery
In your initial consultation, your surgeon will evaluate your
health and explain which surgical techniques are most
appropriate for you, based on the condition of your breasts and
skin tone. If your breasts are sagging, your doctor may also
recommend a breast lift.
Be sure to discuss your expectations frankly with your surgeon.
He or she should be equally frank with you, describing your
alternatives and the risks and limitations of each. You may want
to ask your surgeon for a copy of the manufacturer's insert that
comes with the implant he or she will use—just so you are fully
informed about it. And, be sure to tell your surgeon if you
smoke, and if you're taking any medications, vitamins, or other
drugs.
Your surgeon should also explain the type of anesthesia to be
used, the type of facility where the surgery will be performed,
and the costs involved. Because most insurance companies do not
consider breast augmentation to be medically necessary, carriers
generally do not cover the cost of this procedure.
Preparing For Your Surgery
Your surgeon will give you instructions to prepare for surgery,
including guidelines on eating and drinking, smoking, and taking
or avoiding certain vitamins and medications. A mammogram may be
recommended prior to your procedure to ensure breast health and
serve as a baseline for future comparison.
In addition to explaining your surgical procedure, you plastic
surgeon will discuss anesthesia, the recovery process and your
obligations as a patient. You will also discuss where your
procedure will be performed. You will be asked to sign consent
forms to ensure that you fully understand the procedure you will
undergo and any risks and potential complications of your
surgery. There may be a waiting period of several days to weeks
from the time of your consent to the day of surgery.
While making preparations, be sure to arrange for someone to
drive you home after your surgery and to help you out for a few
days, if needed.
Where Your Surgery Will Be Performed
Your surgeon may prefer to perform the operation in an office
facility, a freestanding surgery center, or a hospital
outpatient facility. Occasionally, the surgery may be done as an
inpatient in a hospital, in which case you can plan on staying
for a day or two.
Types of Anesthesia
Breast augmentation can be performed with a general anesthesia,
so you'll sleep through the entire operation. Some surgeons may
use a local anesthesia, combined with a sedative to make you
drowsy, so you'll be relaxed but awake, and may feel some
discomfort.
The Surgery
The method of inserting and positioning your implant will depend
on your anatomy and your surgeon's recommendation. The incision
can be made either in the crease where the breast meets the
chest, around the areola (the dark skin surrounding the nipple),
or in the armpit. In addition, a saline implant may be placed
through an incision at the navel. Every effort will be made to
assure that the incision is placed so resulting scars will be as
inconspicuous as possible.
Working through the incision, the surgeon will lift your breast
tissue and skin to create a pocket, either directly behind the
breast tissue (submammary or subglandular placement) or may be
placed beneath the pectoral muscle and on top of the chest wall
(submuscular placement). Once the implant is positioned within
this pocket, the incisions are closed with sutures, skin
adhesive and/or surgical tape. A gauze bandage may be applied
over your breasts to help with healing.
The surgery usually takes one to two hours to complete. You'll
want to discuss the pros and cons of these alternatives with
your doctor before surgery to make sure you fully understand the
implications of the procedure he or she recommends for you.
After Your Surgery
You're likely to feel tired and sore for a few days following
your surgery, but you'll be up and around in 24 to 48 hours.
Most of your discomfort can be controlled by medication
prescribed by your doctor.
Within several days, the gauze dressings, if you have them, will
be removed, and you may be given a surgical bra. You should wear
it as directed by your surgeon. You may also experience a
burning sensation in your nipples for about two weeks, but this
will subside as bruising fades.
Your stitches will come out in a week to 10 days, but the
swelling in your breasts may take three to five weeks to
disappear.
Getting Back to Normal
You should be able to return to work within a few days,
depending on the level of activity required for your job.
Follow your surgeon's advice on when to begin exercises and
normal activities. Your breasts will probably be sensitive to
direct stimulation for two to three weeks, so you should avoid
much physical contact. After that, breast contact is fine once
your breasts are no longer sore, usually three to four weeks
after surgery.
Your scars will be firm and pink for at least six weeks. Then
they may remain the same size for several months, or even appear
to widen. After several months, your scars will begin to fade,
although they will never disappear completely.
Routine mammograms should be continued after breast augmentation
for women who are in the appropriate age group, although the
mammographic technician should use a special technique to assure
that you get a reliable reading, as discussed earlier. (See All
surgery carries some uncertainty and risk.)
Your New Look
For many women, the result of breast augmentation can be
satisfying, even exhilarating, as they learn to appreciate their
fuller appearance.
Even if you believe your implants are functioning well, it is
important that you follow-up as directed with your plastic
surgeon to assess the condition of your breast implants. In
addition, whether you choose to have breast implants or not, it
is essential to your health that you practice a monthly breast
self-exam and schedule regular diagnostic breast screenings.
Your decision to have breast augmentation is a highly personal
one that not everyone will understand. The important thing is
how you feel about it. If you've met your goals, then your
surgery is a success.
