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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.
Back to Procedures
Information provided by American
Society of Plastic Surgeons. |
