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 correct a reduction in breast volume after pregnancy.
- To balance a difference in breast size.
- As a reconstructive technique following breast surgery.
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.
Breast augmentation is usually done to
balance a difference in breast size, to
improve body contour, or as a reconstructive
technique following surgery.
Types of implants
A breast implant is a silicone shell filled with either silicone gel or
a salt-water solution known as saline.
Because of concerns that there is insufficient information demonstrating
the safety of silicone gel-filled breast implants, the Food & Drug
Administration (FDA) has determined that new gel-filled implants, at the
present time, should be available only to women participating in
approved studies. Some women requiring replacement of the implants may
also be eligible to participate in the study.
Saline-filled implants continue to be available to breast augmentation
patients on an unrestricted basis, pending further FDA review. You
should ask your doctor more about the specifics of the FDA decisions. (Above
guidelines are current as of July 1992.)
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.
There is no evidence that breast implants will affect fertility,
pregnancy, or your ability to nurse. If, however, you have nursed a baby
within the year before augmentation, you may produce milk for a few days
after surgery. This may cause some discomfort, but can be treated with
medication prescribed by your doctor.
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 harmlessly absorbed by the body.
If a break occurs in a gel-filled implant, however, one of two things
may occur. If the shell breaks but the scar capsule around the implant
does not, you may not detect any change. If the scar also breaks or
tears, especially following extreme pressure, silicone gel may move into
surrounding tissue. The gel may collect in the breast and cause a new
scar to form around it, or it may migrate to another area of the body.
There may be a change in the shape or firmness of the breast. Both types
of breaks may require a second operation and replacement of the leaking
implant. In some cases, it may not be possible to remove all of the
silicone gel in the breast tissue if a rupture should occur.
A few women with breast implants have reported symptoms similar to
diseases of the immune system, such as scleroderma and other
arthritis-like conditions. These symptoms may include joint pain or
swelling, fever, fatigue, or breast pain. Research has found no clear
link between silicone breast implants and the symptoms of what doctors
refer to as "connective-tissue disorders," but the FDA has
requested further study.
While there is no evidence that breast implants cause breast cancer,
they may change the way mammography is done to detect cancer. When you
request a routine mammogram, be sure to go to a radiology center where
technicians are experienced in the special techniques required to get a
reliable x-ray of a breast with an implant. Additional views will be
required. Ultrasound examinations may be of benefit in some women with
implants to detect breast lumps or to evaluate the implant.
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.
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. Every effort
will be made to assure that the incision is placed so resulting scars
will be as inconspicuous as possible.
Incisions are made to keep scars as
inconspicuous as possible, in the breast
crease, around the nipple, or in the armpit.
Breast tissue and skin is lifted to create a
pocket for each implant.
Working through the incision, the surgeon will lift your breast tissue
and skin to create a pocket, either directly behind the breast tissue or
underneath your chest wall muscle (the pectoral muscle). The implants
are then centered beneath your nipples.
Some surgeons believe that putting the implants behind your chest muscle
may reduce the potential for capsular contracture. Drainage tubes may be
used for several days following the surgery. This placement may also
interfere less with breast examination by mammogram than if the implant
is placed directly behind the breast tissue. Placement behind the muscle
however, may be more painful for a few days after surgery than placement
directly under the breast tissue.
The breast implant may be inserted directly under the
breast tissue or beneath the chest wall muscle.
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.
The surgery usually takes one to two hours to complete. Stitches are
used to close the incisions, which may also be taped for greater
support. A gauze bandage may be applied over your breasts to help with
healing.
After surgery, breasts appear fuller and more
natural in tone and contour. Scars will fade
with time.
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.
Your new look
For many women, the result of breast augmentation can be satisfying,
even exhilarating, as they learn to appreciate their fuller appearance.
Regular examination by your plastic surgeon and routine mammograms for
those in the appropriate age groups at prescribed intervals will help
assure that any complications, if they occur, can be detected early and
treated.
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.
copy
and photos courtesy of
Certified,
The American Board of Plastic Surgery
Certified, The American Board of Surgery
©2000
Ramsey J. Choucair, M.D.
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