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DESCRIPTION
Breast augmentation (augmentation mammoplasty) is the implantation of artificial material inside the female breasts to enlarge them or give them a different shape for cosmetic or reconstructive purposes (such as after a mastectomy after cancer has been removed from a breast. Male to female transsexuals may use breast implantation to achieve the physical appearance of a female.
Breast implantation is a surgical procedure that takes breast-shaped pouches that are saccular in shape and made of a silicone outer shell, and filled with silicone gel or saline (salt water).
Breast enlargement is the second most common cosmetic surgical procedure practiced on women in the United States. It increased by 306% between 1992 and 1998. According to the American Society of Plastic and Reconstructive Surgeons, more than 125,000 breast augmentation procedures are performed each year. Presently, more than two million, or approximately 8%, of women in the United States have breast implants. The majority of breast implant recipients are Caucasian women (95%), followed by African-American women (4%). The remaining women that have breast implants are Asian (0.5%) and other non-specified races (0.5%).
Cosmetic breast enlargement or augmentation is usually performed as an outpatient procedure. It may be done under local or general anesthesia, depending on patient and physician preference. The incision is typically made through the armpit (axilla), along the fold line under the breast, or around the areola (the darkened area around the nipple); these techniques create the most inconspicuous scars. The implant is placed in one of two locations: between the breast tissue and underlying chest muscle, or under the chest muscle. The operation takes approximately one to two hours. The cost of a cosmetic procedure is rarely covered by insurance. However, if enlargement is part of breast reconstruction after a mastectomy, health plans may pay for some or all of it. The surgeon's fee ranges from $3,500 to $5,000, and up. The procedure may also be called breast augmentation or augmentation mammoplasty.
During a breast implant procedure, a local injection of anesthetic is administered at many points around the breast (A). An incision is made under the areola (B). The surgeon uses his fingers to create a pocket for the implant (C). The implant is placed under the pectoralis muscle of the chest (D), and is inflated to full size with saline injections (E).
REASONS FOR PROCEDURE
Restoration of normal breast appearance following a mastectomy.
Enlargement of the breasts in patients who have less breast tissue than they desire.
Correction of asymmetry of the breasts.
RISK INCREASES WITH
Smoking.
Obesity.
Excess alcohol consumption.
Use of drugs such as antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
Use of mind altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.
POST SURGICAL RISKS
Risks associated with this procedure are similar to those of any surgical procedure. These risks include bleeding, infection, reaction to anesthesia, or unexpected scarring. A breast enlargement may also result in decreased sensation in the breast or interference with breastfeeding. Implants can also make it more difficult to read and interpret mammograms, possibly delaying breast cancer detection. Also, the implant itself can rupture and leak, or become displaced. A thick scar that normally forms around the implant, called a capsule, can become very hard. This is called capsular contracture, and may result in pain and possible altered appearance of the breast. The chances that these problems will occur increase with the age of the implant.
There has been intermittent publicity about possible health risks associated with breast implants. Most concerns have focused on silicone gel-filled implants that leaked or ruptured. In 1992, the Food and Drug Administration (FDA) restricted the use of this type of implant and ordered further studies. Today only saline-filled implants are used for cosmetic breast surgery. Recent studies have shown no evidence of long-term health risks from intact silicone implants. However, research on possible links between these implants and autoimmune or connective tissue diseases is continuing.
DESCRIPTION OF PROCEDURE
DIAGNOSIS & PREPARATION
The diagnosis for breast reconstruction is almost always visual. The underlying medical reasons include equalizing otherwise normal breasts that are markedly different in size, replacing all or part of breast tissue that has been removed during the course of cancer treatment, or replacing breast mass that has been lost due to injury. Underlying cosmetic reasons include personal preference for larger breasts among genetic females or the creation of breasts in male-to-female transsexuals.
Before any surgery is performed, the woman should have a clear understanding of what her new breasts will look like. She and her physician should agree about the desired final result. Many surgeons find it helpful to have the patient review before and after pictures of other patients, to clarify expectations. Computer modeling is often used to assess expected results.
A person in poor health or having a severe or chronic disease is not a good candidate for this procedure.
Breast augmentation is normally performed by a surgeon with advanced training in plastic and reconstructive procedures. It is typically performed as an outpatient procedure.
QUESTIONS TO ASK THE SURGEON PRIOR TO SURGERY
- What will be the resulting appearance?
- Is the surgeon board certified in plastic and reconstructive surgery?
- How many procedures has the surgeon performed?
- What is the surgeon's complication rate?
Breast Implants
Assorted Sizes & Colors
Breast Implants
Silicone Filled
Breast Implants
Adjustable Saline Filled
BREAST IMPLANTS - COMMON QUESTIONS
Are breast implants safe? The question of breast implant safety has been extensively investigated over the past several years, following the controversy over the possibility of various diseases attributed to silicone. At this point in time, however, there is probably no product which has undergone more thorough scrutiny than breast implants. The safety question has been reviewed in detail by the Institute of Medicine, which considered all available scientific data in addition to testimony from breast implant patients; the full text of their report can be found at www.nap.edu. It is interesting to note that silicone has been approved for injection directly into the eye for treatment of retinal detachment. Doesn't it seem reasonable to infer that it would be appropriate for use in breast implants also? The saline and silicone implants made by mentor and Allergan are FDA-approved.
How about breast enlargement creams and products as a alternative to breast implants? Creams and herbal-based products used for breast enlargement are generally found to be ineffective, possibly dangerous for some individuals with estrogen-related health issues. Several products have appeared in recent years claiming to enlarge breasts using "safe, all natural" herbal supplements. Yet despite the marketing claims, no clinical studies have ever been published to verify either the safety or effectiveness of these supplements. An article published in the June 2003 edition of the medical journal Obstetrics & Gynecology raised serious questions about both aspects. Of primary importance is the question of safety. Since these products act by stimulation of the breast tissue in a manner similar to estrogen, there is a real possibility that the risk of breast cancer could be increased. Only large scale, long-term studies could answer this question.
Are the "anatomical" implants better? For most women, the smooth round implant will look and feel the most natural. They are softer and move in a more natural way. So-called "anatomical" or "teardrop" implants are firmer and do not move like a normal breast; their primary use is in reconstruction after mastectomy where a more mature breast shape is needed. Additionally, it has been proven that smooth round implants form a teardrop profile in the upright position, identical to the "anatomical" implants. For these reasons, the shaped implants have faded from popularity for augmentation.
Should implants be placed under or over the muscle? There are several compelling reasons to place the implants under the pectoral muscle which is behind the breast tissue: lower risk of capsular contracture, more thorough and easier mammograms, a more natural look for many patients, less visible rippling of the implants, and less sagging of the breast over time. The downside is that more effort and experience is required by the surgeon to ensure that the implants are not too high, too far apart, or create an unnatural contour on the bottom of the breast in patients who have some sagging pre-operatively.
Subfascial breast augmentation is a third option instead of over or under the muscle is called "subfascial" has recently been reported (pronounced like "fashion" without the "n"), which is a sort of compromise between the two. Although it is thin, it is usually substantial enough to provide a layer behind the breast and in front of the implant. Many surgeons are offering the subfascial option in selected cases. If you would like to know more, contact your surgeon and he/she would be happy to discuss it in consultation.
Breast Augmentation Anatomy
Subglandular Breast Augmentation
Subfascial Breast Augmentation
Subpectoral Breast Augmentation
Can deformity of the breast with muscle flexion be corrected? The traditional technique for submuscular placement of implants often results in a problem characterized by distortion of the breast when the muscle is flexed. Typically, the breast moves up and indents along the bottom portion. This is due to the fact that a portion of the muscle has to be detached, so it pulls on the implant capsule. The subfascial (or subglandular) technique generally eliminates this, but sometimes at the expense of inadequate coverage of the upper portion of the implant. A variation of the subfascial technique called the split subpectoral/subfascial method is often a good solution. This uses the upper portion of the muscle for implant coverage but the lower portion which is usually detached is left behind the implant instead. Many of my primary augmentations are now done this way, and I have published and reported the technique.
Can fungus or bacteria grow inside the implant? Reports of bacterial or fungal infections developing inside of an implant are rare. Implants are now inflated with a "closed fill" system, eliminating the possibility of contamination of the fluid. There has never been a confirmed report of bacterial or fungal growth in a saline implant filled using a closed fill system.
What are the chances that the implants will leak and need to be replaced? The primary reason for replacing a saline implant is deflation, which is a harmless event and not usually related to any specific activity. While it is unlikely that every implant will last a lifetime, there is no reason to replace an implant arbitrarily after a certain period of time.
What are the advantages of high profile saline implants? High profile round implants have a smaller diameter but more projection compared to the standard implants. My experience is that when the implant diameter matches the natural base diameter of the breast, the result is more natural appearing and there is less rippling. With the availability of the new HP implants (introduced in 2002) surgeons are now able to match the diameter with a choice of different sizes.
PROCEDURE
Because of the current concern about adverse reactions to breast implants, the only implant type presently available for cosmetic augmentation is saline-filled; breast reconstruction patients may still get the silicone-filled if desired.
A local or general anesthesia is used.
Incisions may be made under the breast, through the nipple or in the armpit.
The breast tissue is brought forward by raising muscles from below the breast or the muscles next to the chest wall.
A pocket is created, and the implant (a mammary prosthetic usually filled with saline) is inserted. The procedures are usually repeated on the other breast.
The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery. A light bandage is applied.
A bra or elastic bandage is fitted to give support and to reduce possible bleeding.
EXPECTED OUTCOME
Expect complete healing without complications. Allow about 2 weeks for recovery from surgery.
Breasts of expected size and appearance are the normal results of this surgery. Normal scar formation should be expected. With any silicone prosthesis, a capsule usually forms around it. However, in some instances a mild form of capsular contraction ensues. Mild ridges that can be felt under the skin categorize this condition. The capsule contracts, which occurs occasionally, and can result in a hardening of the breast. There is no way to predict who will excessively scar.
POSSIBLE COMPLICATIONS
Over the past few years, there have been many reports of adverse reactions to breast implants. There are known risks including those associated with the surgical procedure; implant risks (leaking, scar formation, calcium deposits, etc.); and concerns about interference with mammography.
In addition, there are the possible risks of autoimmune (such as rheumatoid arthritis) and connective tissue disorders (such as lupus). Be sure you are aware of all the risks and benefits for this procedure.
A consent form will need to be signed before the surgery is scheduled.
MORBIDITY & MORTALITY RATES
In addition to scarring, other risks include infection, excessive bleeding, problems associated with anesthesia, rupturing of the implant, and leakage. There have been a total of 120,000 reports of ruptured silicone implants. Approximately 50,000 reports of breakage have been received for saline implants.
Deaths associated with breast augmentation are extremely rare. Most post surgical mortality has been attributed to anesthesia errors or overdoses of pain medications.
ALTERNATIVES TO BREAST IMPLANTATION
Alternatives to breast implant surgery include using external breast forms that fit into brassiere cups or are attached to the skin of the chest. Creams that allege to increase breast size usually produce no noticeable results. The use of creams containing hormones can lead to long-term hormonal imbalance. Reputable experts do not generally recommend these preparations for breast enlargement.
POST PROCEDURE CARE
GENERAL MEASURES
Sutures are usually removed in seven to 10 days.
Typically, a woman can resume all routines, including vigorous exercise, in about three weeks.
The scars will be red for approximately one month, but will fade to their final appearance within one to two years.
Hard ridges may form along the incision. The ridges will heal and recede gradually without treatment.
Bathe and shower as usual. You may wash the incision gently with mild unscented soap.
Use ice packs to reduce swelling and to relieve incisional pain.
MEDICATION
Antibiotics may be prescribed, if needed, to fight infection.
Prescription pain medication should generally be required only for 2 to 7 days following the procedure.
You may use non-prescription drugs, such as acetaminophen, for minor pain.
ACTIVITY
Have someone drive you home from surgery. Resume normal activities slowly. You will be provided with specific instructions depending on individual requirements.
Avoid vigorous exercise for 6 weeks after surgery.
Resume driving 1 week after returning home.
DIET
No special diet. However, you should continue to follow a well-balanced, nutritious dietary plan for a strong immune system and fast recovery from surgery.
MoonDragon's Nutrition Information: Adult Regular Diet
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Pain, swelling, redness, drainage or bleeding increases in the surgical area.
You develop signs of infections: headache, muscle aches, dizziness, or a general ill feeling and Fever.
New, unexplained symptoms develop, such as nausea or vomiting.
BREAST LINKS
Alt.Support.Breast-Implant
Breast Implant Disease Skeptic's Page - essays and links to information skeptical of claims that silicone breast implants contribute to disease in women. Breast Implant Hot Spot - call to action for thousands of women who have been negatively affected by silicone breast implants.
Breast Implants - information on health effects of breast implants and information concerning litigation.
Breast Implants on Trial - PBS Frontline special from 1997.
Coalition of Silicone Survivors
Operation Commitment and Hope for Silicone Implant Survivors
Silicone Gel Breast Implants - report of the Independent Review Group.
Status Report on Breast Implant Safety - from the FDA.
Usenet - alt.support.breast-implant
The Real World DANGERS of Surgical Implants - This page deals with Breast Implant surgery and Breast Cancers. The possible pressure on some Plastic Surgeons to do what best for their pocket books
--http://www.newwomyn.com/nw008.html
Breast lift and reduction preface - View surgery sketches Preface | the surgery | post-op | possible complications | Mastopexy (breast lift) and reduction mammoplasty (breast reduction) are somewhat similar. These operations are both aimed at remodeling the breast. The reduction does
--http://www.plasticsurgery.ca/breast liftreduc.htm
Breast - Survivors Back Breast Implant Study (12/06/1998) Survivors Back Breast Implant Study By Kaja Perina Associated Press Writer Thursday, June 11, 1998 WASHINGTON (AP) -- Convinced that silicone breast implants cause years of illness and follow-up..
--http://www.health.fgov.be/WHI3/krant/krantarch98/kranttek...
No Title - 1993.01.05 : Saline Breast Implants Contact: Susan Cruzan - (301) 443-3285 (Home) -- (301) 926-7081 January 5, 1993 The Food and Drug Administration today announced a proposal that manufacturers of saline breast implants be required to submit..
--http://keepinformd.com/HHS/PR/1993/01/930105.txt
Healthline Magazine - The Breast Implant Debate - Please visit our Sponsor Magazines Healthline Skin Care Today Allergy & Asthma Information Subscriptions About Healthline Contact Us Disclaimer Sponsorship Health Links Home WOMEN'S HEALTH From: Healthline, January 1995 The Breast Implant Debate..
--http://www.healthline.org/articles/oldfiles/hl950105.html
Breast Implants - Breast Implants Title:Risk of connective-tissue diseases and other disorders after breast implantation Authors:Gabriel, S.E.; Fallon, O.; Michael, W.; Kurland, L.T.; Beard, C.M.; et al Journal:New England Journal of Medicine 330(24); June 16, 1994.
--http://www.life-research.edu/breasts.html
Breast Implant Safety - Breast Implant Safety Article by Dr. Zoltan P. Rona MD MSc Since 1962, between one and two million women have had silicone breast implants to enhance their physical appearance. Also since that time, thousands of women in North America have..
--http://www.srvitamins.com/Articles/BreastImplantSafety.htm
Important Information we would like you to read - We suggest you start with the Plaintiffs Science Submission it is long but has more facts and studies to help you and maybe your doctors understand how and why silicone can be harmful. Due to the lack of room we were unable to provide all of the..
--http://womnhlth.home.mindspring.com/Things%20You%20Need%2...
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