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BREAST AUGMENTATION
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.
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.
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.
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.
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 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.
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.
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