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
human-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 that 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.
