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:
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. (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 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.
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.
Frequently Asked Questions About
Dr. Jerome Edelstein, MD, FRCSC
Breast augmentation is a cosmetic procedure that uses implants to enlarge and shape the breasts.
The female breast has become a symbol of nurturing, femininity, and sexuality. Some women feel dissatisfied because their breasts never developed to a size that meets their expectations. Others want to restore their natural breast volume which may have decreased after pregnancy / breast feeding, weight loss, or aging.
Improving the size or shape of one’s breasts often leads to improved self-image and confidence, looking better in clothing, and better body proportions.
What type of anesthesia is used during the operation?
This procedure is usually performed under General Anesthesia. An Anesthetist is always present. If you have any particular problems with anesthesia, please let us know.
How long is the operation?
The actual surgical time varies depending on the amount of surgery necessary for each patient, but usually is about 2 hours.
Where are the incisions made?
The incision for breast augmentation can be made in one of three places. The first type of incision is placed at or slightly above the crease under the breast (infra-mammary incision). This is one of the most common incisions because it allows for accurate placement of the implant. The second incision type is placed along the lower border of the pigmented skin around the nipple (peri-areolar incision). This incision usually heals quite well, but this approach is not suitable for women with very small nipples. The third incision is placed high in the armpit (trans-axillary incision) eliminating scars on the breast.
What else is done during the procedure?
A pocket is made for the implant. The pocket can either be made under the breast itself (sub-mammary) or under the chest muscle (sub-pectoral). Sub-mammary placement is usually used in women who already have some breast tissue and are slightly droopy, since it helps to improve the shape. Sub-pectoral positioning is usually used when a woman has little or no breast tissue so the implant will be less "feelable".
The implant is a solid silicone shell filled with liquid saline (salt water, a natural body fluid also used for intravenous solutions). Implants filled with silicone gel or cohesive silicone gel have become available again.
If droopiness or sagging of the breast is advanced, it may be necessary to tighten up or ‘lift’ the breast in addition to the augmentation.
How long is the hospital stay?
Breast augmentation is an outpatient procedure, meaning you can go home the same day once you have recovered from the anesthetic.
When are the stitches removed?
Stitches are removed between 10-14 days. Sometimes dissolving stitches are used that don’t have to be removed.
What happens after the surgery?
Most people feel tender and bruised after surgery, but are not in a great deal of pain. Pain medication will make you comfortable. Immediately after surgery, you will have bandages and / or a surgical bra on. Once the dressing is removed, a support brassiere should be worn day and night for the first two weeks, and then during the day for another two weeks.
You should plan to be off work for 5-7 days. Mild exercise may be resumed after two to three weeks, but strenuous exercise (for example, upper body weight training) should not be started before six weeks. Special breast massage exercises will be done to keep the breasts soft and help prevent excessive hardness (scar capsule) from developing.
Drains are rarely used (in about 1 in 25 patients) to remove excess fluid and will be removed within two or three days. Showering is permitted on the 2’nd day after surgery. Scars will initially be red and a little raised, but over 3-6 months they usually get lighter in colour and flatten out.
What are the results?
Enlargement of the breasts with improvement in shape. The scars are usually well hidden. Most patients are very happy with their results.
Some additional points:
Make sure you let me know your complete medical history as well as any medications, drugs, vitamins, or natural herbs you are taking. For example, diabetes is known to affect wound healing.
Smoking also affects your ability to heal, and I recommend that you stop smoking at least 2 weeks before
surgery. Aspirin, anti-inflammatory pills (like anaprox or motrin), and vitamin E also should be stopped 2 weeks before surgery because they can cause extra bleeding.
I strive to make sure all my patients are well informed. Your questions are more than welcome.
This symbol designates surgeons who are active members of the American Society of Plastic Surgeons. They are certified in the specialty of plastic surgery by the American Board of Plastic Surgery and are dedicated to the highest standards of patient welfare and surgical excellence.