Cosmetic Breast Augmentation Information
Background on Breast Enlargement
One of the most popular forms of plastic surgery - the third most popular procedure performed in the United States for American women today - is breast augmentation. Technically known as augmentation mammoplasty, breast augmentation is designed to enhance or alter a woman's breasts through the use of artificial implants. There are many reasons that women are interested in changing the size or shape of their breasts, ranging from reconstructive necessity following a mastectomy to enhancing or balancing the natural contours of the body.Best Candidates for Cosmetic Breast Augmentation
Breast augmentation is a popular choice for women who are in good physical health, psychologically stable, and want to improve their appearance. A healthy, informed choice about breast augmentation could lead to an increase in confidence and self-esteem.Uncertainty and Risk of Breast Enlargement
Like any other surgical procedure, breast augmentation carries certain risks. Your Board certified plastic surgeon will review this in detail during your consultation.Planning for Breast Augmentation Surgery
During the initial consultation, your surgeon will determine which procedure is appropriate for you based on the type of implant, tone and condition of your skin and breasts, and your aesthetic desires. Be open with your surgeon; the look you desire is based on frank communication between you and your doctor. Your surgeon should be equally honest with you, and describe the potential risks and benefits of different types of implants. It is also wise to ask for a copy of the manufacturer"s insert that comes with the implant, so that you may be fully informed about it.Preparing for Breast Enlargement Surgery
Prior to surgery, your doctor will give you specific guidelines regarding eating, drinking, and smoking. The surgeon will also advise you on what vitamins and medications to take before and after your procedure. It is also generally a good idea to arrange transportation to and from surgery and arrange for any extra help that you many need during the initial recovery period.Where the Breast Augmentation Surgery is performed
Most surgeons elect to perform breast augmentation in either their office, a surgical center, or a hospital outpatient facility.Types of Anesthesia for Breast Enlargement Surgery
Most surgeons elect to perform breast augmentation with a general anesthetic, although some choose to use an IV sedation. The choice of anesthetic depends on many variables, so discuss them with your surgeon.How the Breast Augmentation Surgery is performed
The nature of the surgery greatly depends on the type of implant, position in the breast, and the method of insertion. Common insertion points for the implant are in the crease under the breast, through the areola, or under the armpit. The surgeon takes great care to minimize the amount of visible scarring caused by the insertion point in order to provide the most aesthetically pleasing figure.Regardless of the insertion point, the surgeon will create a precise pocket under the breast tissue to insert the implant, either directly behind the tissue or underneath the chest muscle. There are advantages to both approaches, so be sure to discuss them with your surgeon beforehand.
Most surgeries take one or two hours. Sutures seal any incisions together tightly and are often reinforce with special antiseptic tape. A firm bandage helps the breasts conform to their new shape and also accelerates healing.
Post-op/Recovery after Breast Enlargement Surgery
Most women feel a bit sore and tired the first day or two after surgery, but are up and around on the third day. Most pain can be managed by prescribed medication.A few days later any gauze bandages come off which will necessitate the wearing of a special support bra. Wear it as long as your doctor recommends, as it helps your breasts conform to their new shape. Any stitches are removed after about 7 days, although swelling often takes three to five weeks to fully disappear.
Most people return to work within a few days. Most surgeons limit physical activity and exercise for three to four weeks because of increased sensitivity. Scars will begin to fade after about six weeks, becoming almost imperceptable by 6 months.
After a few weeks, most women find their new shape more than satisfying; it is thrilling. Regular checkups protect against complications, and the benefits of a breast augmentation far outweigh any initial discomfort.
Approach: Breast Augmentation Incision
Inframammary Breast AugmentationSurgeons often choose the inframmary approach to optimize visualization. Of the thousands of breast enhancement surgeries preformed each year, 70-80% of them are inframamary; that is directly inserted into the fold beneath the breast. By placing the implant directly into the breast tissue, a surgeon can maintain greater control over the location and shape of the implant, and can also make minute corrections that will enhance overall aesthetics.
Furthermore, as inframammary implants rarely disturb milk production, women may still nurse with few side effects. Should any complications arise the surgeon may use the initial incision to correct any problems. Inframammary implants are commonly used for women who are older or have had children, for the natural shape and contours of these breasts can often conceal the scars in the lower breast area. Younger women, thinner women, or women who have not yet had children may have a noticeable scar on the lower portion of their breasts.
Trans-Axillary Breast Augmentation
Women who seek to have less visible indications of breast implants often elect to receive what is called Trans-Axillary breast enhancement. Rather than directly operate on delicate breast tissue, surgeons make a small incision directly into the armpit, or the axilla, and insert the implant.
This type of procedure allows for both submuscular and subglandular placement of the implant, giving both a more natural appearance and causing fewer complications with nursing. Surgeons sometimes use an endoscope, a small, fiberoptic camera that allows more direct placement of a submuscular implant. Furthermore, younger and thinner women with little breast sag often choose this procedure because it produces a much less noticeable scar than inframammary breast implant procedures.
Trans-Umbilical Breast Augmentation/Endoscopic Breast Augmentation
Trans-Umbilical Breast Augmentation (TUBA) is a relatively new approach for breast augmentation that combines a virtually unnoticeable scar with similar complication rates. A cosmetic surgeon makes a small incision around the belly button or navel, and inserts a small, fiber optic camera called an endoscope into the breast.
Using this camera, the surgeon makes a small tunnel up to the breast, and inserts an empty implant in to the hollow space beneath the breast. After reaching the desired location, saline solution is pumped into the implant to fill it to capacity. The advantage of this technique is that there is no incision on or near the breast.
Peri-Areolar Breast Augmentation
Women who desire breast implants but are concerned with the appearance of unsightly post-operative scars often elect to have Peri-Areolar augmentation. By making an incision that imitates the natural shape of the areola, doctors can disguise the scar within the natural shape and colors of the breast.
Many women have found that this type of surgery gives them augmentation they desire but without telltale scaring commonly caused by inframammary approaches. Implants can be placed above or below the muscle. If revisions are required, the same incision can be used.
Breast Implant Placement
Subglandular Breast Augmentation
The patients who choose subglandular breast augmentation usually do so for a number of common reasons. By inserting an implant directly under the breast tissue itself, there are fewer disturbances of muscle fibers which reduces much of the soreness associated with breast augmentation.
Furthermore, many women who have mild sagging often find that they do not need an additional lift to achieve the look they desire. Unfortunately, because the implant is close to the skin, it is less concealed.
Submuscular Breast Augmentation
Submusclar implants offer an aesthetically pleasing shape by concealing the implants under more tissue. The implant is gently inserted beneath both the pectoral muscle and breast tissue, which not only gives a more natural shape but also reduces the risk of augmentation interfering with normal mammography procedures.
Unlike in subglandular placement, should the woman lose weight due to diet or pregnancy the muscle will support the implant which reduces the possibility of sag. This procedure is a bit more uncomfortable, but it is the procedure of choice for most patients and surgeons.
Breast Implant Overview
Doctors have been augmenting breasts since 1865, when surgeons in Germany implanted fat from a benign tumor into the breast of a woman. Since then, breast enhancement has become a bit more sophisticated.
The first true man-made implants were developed at Dow-Corning Laboratories in 1961. These implants were made from a thick viscous silicone gel that greatly reproduced the look and feel of natural tissue, and the first augmentation surgery took place in 1962. Unfortunately silicone gel was linked to a number of negative side effects including auto immune deficiencies, and early implants were prone to leakage and breakage. After thousands of costly lawsuits, these types of devices were restricted to a certain procedure in the 1990"s.
After silicone was withdrawn from the market, sterile saline implants were developed to answer the demand for a safer alternative. While not as realistic feeling or natural looking, many women felt more confident in asking for these type of implants rather than risk potentially fatal side effects of silicone implants. In fact, saline implants make up nearly all augmentation surgeries in the United States.
Newer and safer forms of breast implants are constantly researched, and one of the most promising developments is the genesis of the so-called Tissue Engineered implant. This technique combines the latest in cell engineering to create new breast tissue from a patient"s own cells. The advantages of this technique allow for a more natural and longer lasting augmentation without the risk of rejection or eventual aesthetic degradation.
Saline Breast Implants
Saline implants were initially developed as an alternative to silicone gel implants. While still using a silicone outer shell, saline implants are instead filled with sterile salt water that is safely absorbed by the human body should the implant rupture.
Saline implants offer a variety of advantages over silicone ones. The primary advantage is that saline implants are adjustable; doctors can differentially fill implants to obtain near perfect symmetry. Saline implants are also ostensibly safer that silicone implants, although medical data does not support that claim.
Silicone Breast Implants
Silicone implants were first used in the 1960"s to provide what millions of women have sought throughout history; a fuller, shapelier chest. Previous attempts to augment the size of the breasts included fat transplants, paraffin implants, and even direct injection of silicone. These attempts had rather predictable results, but the new surgical silicone implant offered both (relative) safety and acceptable results.
Silicone is a man-made substance that has many uses, ranging from lubricants, adhesives, sealants, gaskets to dishware and Silly Putty. In a breast implant, it closely resembles the look and feel of natural breast tissue, so it was a obvious choice when the first implants were created.
Unfortunately, problems began to arise with the perceived safety of the implants. Even though study after study failed to demonstrate a link between silicone implants and any negative health condition, the U.S. Food and Drug Administration banned the use of silicone implants.
In the United States today, silicone implants are only available as part of a breast reconstruction or replacement procedure. The FDA is currently testing the new wave of silicone implants. It is important to note, however, that 90% of breast augmentation surgeries performed outside the U.S. use silicone implants and safety has not been questioned.
Cohesive Gel Breast Implants
Cohesive gel implants refer to a new type of implant still in developmental and testing stages that was formulated to mimic the benefits of an implant that was popular in the 1980s, but without the severe disadvantages that limited its value.
This earlier model, known as the Replicon, was an anatomically shaped, polyurethane coated, silicone gel filled implant that has highly positive initial results, but soon lost its shape when the body eventually degraded the polyurethane and left the remaining thin and pliable shell unable to hold the silicone gel in place.
Cohesive gel implants, known as "gummy bear implants" because they are more solid than other silicon models, were originally invented to create a longer-lasting implant, and one that would retain an attractive and predictable shape. At present, these implants are available today only as part of an "adjunct study," which is open to patients that have specific congenital defects or need a revision for particular reasons.
Breast Augmentation Questions and Answers
Who is a good candidate for breast augmentation?
Women who are dissatisfied with the way her breasts appear, are good physical and mental shape, and have realistic expectations about the outcome of the procedure are generally the best candidates.
How does my plastic surgeon evaluate me?
Evaluation usually begins with a complete medical history followed by a physical examination. Women who plan to lose weight or become pregnant should advise the surgeon beforehand in order to reduce the number of potential complications.
What should I do to prepare for breast augmentation surgery?
Before the surgery you should alert your doctor to any medications you are taking. Certain drugs such as aspirin and other anti-inflammatories interfere with blood clotting. Also, you should refrain from smoking and make arrangements for someone to assist you for the first few days following the procedure.
What will happen on the day of the breast augmentation surgery?
Most augmentations are performed on an outpatient basis in a hospital, office surgical suite, or in an independent surgical center. The use of general or local anesthesia depends greatly on the doctor and the needs of the patient, so be sure to discuss the pros and cons beforehand. After the surgery you will recover in a special area where your progress is closely monitored, and absent any complications you will be sent home in a few hours.
What are the initial results of the breast augmentation surgery?
You will most likely be a bit sore after the surgery; this is perfectly normal however, and you should be almost back to your normal self after a few days. Your doctor may insist you wear a special support bra after your wrappings come off and any stitches will be removed between seven and ten days.
When can I get back to normal?
Most women return to work after a few days or even a week, although this depends greatly on the nature of your job. Vigorous activity, including sexual intercourse should be avoided or limited for the next few weeks.
What types of implants to surgeons frequently use?
Depending on your situation, you and your surgeon will reach an agreement on the type of implant. Saline implants are the most common, although the Food and Drug Administration recently relaxed certain restrictions on silicon breast implants. Talk to your doctor to see which implant is right for you.
How does the surgeon place the incisions?
Your surgeon will endeavor to make the most discrete incision possible when inserting your implant. Insertion points for saline implants usually include under the breast, the armpit, or around the areola.
What are the risks of breast augmentation surgery?
Although thousands of breast augmentation surgeries are performed each year a small percentage of women experience a few complications. Rarely are these complications life threatening, but can reduce the aesthetics of the implant. Your doctor is fully apprised of the risks this surgery entails, so be sure to speak with him or her before you decide on your surgery.
How long do the results last?
Aside from implant deflation, your new breasts should remain well proportioned and attractive for many years to come. Aging, gravity, and weight change can alter the way they fit in your body, so many women find that minor "maintenance" such as a breast lift is necessary to achieve the look they desire. Routine examinations with your plastic surgeon also guard against potential long range complications.
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