Breast Augmentation Surgery
A breast augmentation is performed as an outpatient procedure. Placement of a breast implant is uncomfortable for a few days after enlargement. The patient’s chest feels quite tight and painful on deep breathing because the muscles are sore after chest wall surgery. Most patients recover at home and do not stay overnight in the hospital, however. Occasionally, in a complicated revision of an old breast augmentation, the patient may be admitted overnight for pain control.
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YOUR CHOICES
There is no one way or perfect way to perform a breast augmentation. There are different surgical techniques and different implants. All have advantages and disadvantages. You are provided with this information to help you decide, with me, the method most likely to please you. You must consider your desired breast size, incision site and implant placement (in front or behind muscle).
DESIRED BREAST SIZE
A useful method to determine the size of the breast implant is to place different sized implants into your brassiere, prior to surgery, to estimate your likely postoperative cup size and to measure the width and height of the desired breast on your chest prior to surgery. Larger sizes are associated with more postoperative pain, an unnatural “look”, and more late problems with tissue thinning, wrinkling, and longterm complications. Women should think “longterm” and try to avoid later problems by choosing implants that are not too large.
INCISION SITE
Most often, breast implants are placed through an incision around the nipple or in the fold under the breast. They are not often placed through an axillary (armpit) incision because the risk of misplacement of the implant and later breast shape distortion is higher with this approach. The type and size of the implant you desire, the visibility of the scar position, and the size of your nipple areolar complex will determine the incision.
IMPLANT POSITION
1. Behind Breast Tissue and in Front of the Pectoral Muscle is the most anatomic and traditional site to place breast implants. Subglandular implant position is associated, however, with a higher risk of capsular formation, wrinkles and implant visibility. Active use of the chest wall muscles does not cause distortion of the breast if an implant is placed in front of the muscle.
2. In Back of the Pectoral Muscle. If a smooth silicone implant is placed behind the pectoral muscle, the risk of capsular formation is decreased. This is a significant advantage.
Positioning the breast implant behind the pectoral muscle is useful in the thin patient with little subcutaneous fat or breast tissue. When the muscle covers the implant, it helps to hide the breast implant edge or any wrinkling of the implant surface. This creates a more natural and gentle breast shape and less palpability of the implant. Because saline implants are more likely to be palpable along the edges or to have “ripple” folds when the patient leans forward (especially without a brassiere), saline implants are usually put behind the muscle layer to minimize these problems. However, the placement of the implant behind the breast muscle can be associated with postoperative breast distortion with exercise. The muscle squeezes the implant into an unnatural shape for a moment, when exercising. But returns to a normal shape immediately when the muscle is relaxed.
TYPES OF IMPLANTS
1. Saline Implant (silicone bag filled with saltwater). This implant has been used for approximately 30 years. A saline implant can leak. Saline (salt water) occasionally leaks out through the injection port, which was used to fill it, or due to a micro fracture in the silicone bag. This causes the implant to leak and go “flat”. Another operation will be needed to place a new implant. These manufacturing problems have been minimized with newer implants and the risk of leakage has been significantly decreased, but not eliminated. The risk is probably 1% per year. The risk of capsular formation with saline implants is less than that of a silicone implant.
2. Smooth Silicone Gel Implant (silicone bag filled with silicone jelly). This was the first type of implant developed and has been used for more than 25 years. Studies have found that silicone implants are safe, and the overwhelming view of the medical profession is that silicone implants do not cause disease. The FDA supports this conclusion.
Many surgeons, in the past, have preferred gel-filled implants in all patients because the implants feel more like breast tissue and cause less skin rippling. Modern saline implants, however, can create a very satisfactory result. Most patients are happy with saline or with silicone implants.
3. Smooth Implants (saline or silicone). Traditionally, implants had a smooth outer surface. They have been used successfully for 30 years.
4. Textured implants (saline or silicone). These implants are similar to regular implants except that their surfaces are rough, like sandpaper. Scientific studies suggest that a textured implant may be less likely to cause capsular scar contraction, but skin rippling is more common. Many surgeons continue to prefer smooth implants.
SURGERY
1. Breast augmentation is a common procedure and most women are pleased with the results. Because the skin, muscle and bone of the chest are normal, the objective is to increase the size of the breast mound. This is accomplished by placing a saline implant (or a silicone implant if appropriate) behind normal breast tissue or behind breast tissue and the underlying pectoral muscle.
2. Breast augmentation is performed as outpatient surgery, under general anesthesia. Someone must drive the patient home and care for her overnight until all effects of the sedatives given in the operating room have passed. The patient is seen the next day in the office for a postoperative check and the ace bandage, which was placed at surgery, is removed. Then, she may wear a brassiere or wear the ace bandage for a few days. She may shower the day after surgery. All sutures are placed internally and do not need to be removed after surgery. A piece of tape is placed over the incision, which loosens and spontaneously falls off in approximately one week. Significant breast discomfort is gone in 24 to 48 hours, although some soreness and tightness remains for 3 to 14 days and “you don’t forget you had an operation” for several weeks. Patients can usually return to work in 48 to 72 hours, although heavy lifting, aerobics and tennis, etc., should be avoided for three weeks.
3. There are a number of facts about which you should be aware. Breast surgery does not cause breast cancer. However, it should be noted that a mammogram (x-ray taken of the breast to detect breast cancer) may be more difficult to read after any breast surgery and, specifically, after a breast augmentation. If a breast cancer were to develop, it may be harder to diagnose with a mammogram after augmentation. The patient should continue self-breast exams, just as before surgery, and should be examined yearly by a qualified physician. When a mammogram is performed, she should notify the radiologist that she has had a breast augmentation so that he/she can alter the examination as necessary. Breast augmentation does not interfere with breast – feeding or pregnancy. The results of breast augmentation are long lasting and usually the size and the shape of the breast will be maintained without significant change over the years, although age and multiple pregnancies do affect the long-term result. Additional breast augmentation surgery may be required to increase or decrease breast size, treat capsular contraction (” hard feeling” of the breast due to scar tissue), implant rupture, or a less than desired result.