The breast enlargement operation is also known as Breast Augmentation. Due to its very high satisfaction rate, this is one of the most common cosmetic procedures performed in the United States today. Enlargement is accomplished by surgically creating a pocket either under the breast tissue (sub-glandular) or under the pectoralis muscle (sub-muscular) which itself lies directly behind the breast tissue. Women with ample breast tissue are sometimes candidates for sub-glandular placement, while women with less breast tissue must have the implants placed sub-muscularly. Most commonly, the implants are placed under the muscle as the shape of the breast is maintained for a longer period of time with this placement.
Some common reasons for seeking breast enlargement include minimal breast development, loss of breast tissue after breast feeding, or the desire for a more beautiful and fuller figure no matter the amount of breast tissue already present. In some instances an improvement in breast shape is sought.
This procedure involves using a "prosthetic implant" to accomplish the enlargement. Because of this, there are some particularities of this procedure which are an inherent part of the operation, and the result should be well understood by the woman who wishes to undergo this procedure.
The operation is performed under local anesthesia with light sleep sedation and may be performed using one of four different sites of entry to the breast. The four sites of entry are: (1) An incision is placed in the creases and folds of the nipple (areola). (2) An incision is placed in the inframammary fold (at the junction of the breast and the chest wall in the underside of the breast). (3) An incision is placed in the axilla (armpit). (4) An incision is placed in the belly button using the latest endoscopic techniques. The Cosmetic and Reconstructive Surgery Center is one of only a few in the Bay Area offering the belly button approach, making it our most commonly used approach for patients with saline filled implants. For more information about breast augmentation through the belly button, click here.
The First Three Weeks After Surgery
At the end of the operation, two bras and an Ace bandage will be placed on the patient. Two days after surgery, one of the bras may be removed. The third day after surgery, the Ace bandage may be removed. Only dissolving sutures will be used, thus no sutures will be removed.
The bra should be worn for three weeks, both day and night. After three weeks, the patient may then wear the bra during the day only. After six weeks, the patient does not have to wear a bra if she so desires; however, we do not recommend this except on special occasions, as it tends to promote stretching. The patient will have been placed on antibiotics prior to the surgery, and these will be continued for two weeks after surgery.
Regarding activity, the patient should rest and relax for the first few days after surgery. There should be no bending, lifting, or straining for 21 days after surgery. Avoid overheating, excitement of any kind, and significant arm movements. Relaxed walking, up to a half-mile, may be started six days after surgery. Very light housework, such as dishwashing, may be started two weeks post-operatively. You may begin normal exercising three to four weeks after your surgery.
There Is More To It
Breast enlargement continues to be a procedure that confers a very high degree of satisfaction to both the patient and her surgeon. This satisfaction is in part due to a complete understanding of the different types of implants, different incisions available, and the risks and possible complications of the procedure. A thorough understanding of these factors is essential before deciding to proceed with this surgery.
Types of Impants
Smooth Implants: Softer and much less frequently the cause of ripples compared to textured saline implants. We use these implants the majority of the time. Product life: 10-15 years.
Textured Implants: Created originally for silicone gel. When used with saline they have a higher rate of rippling, therefore they must be placed under the muscle. That said, even submuscular placement does not decrease rippling on the sides of the breast.
Smooth (Silicone) Implants: Very soft; however, they can produce more scar tissue and hardening toward the end of their product life (10-15 years) or if there is an early rupture. These implants cannot be placed without an incision on the breast. They create less rippling than saline implants.
Possible Risks and Complications
Infection: Infection is a risk with any surgical procedure. Because we are placing a foreign object into the body, infections require implant removal in all cases. The risk of infection is less than one percent using the umbilical approach, and one to two percent with the other approaches. You may be subject to an infection months or years after the operation, because foreign bodies in your body may become "seeded" by a serious infection or even minor dental work. This is quite uncommon but can occur. After placement of implants, you should always take antibiotics prior to any dental work, even cleaning, and prior to and after any surgical procedure.
Hematoma: The collection of blood in the pocket occurs in less than one percent with the umbilical approach and one to three percent with other approaches. This makes surgery necessary to remove the blood. Generally the implant may be placed back into the pocket at the time of hematoma removal. As noted, hematoma is much less common with the belly button approach in our experience.
Noticeable Scars: All four approaches to the placement of implants have their advantages and disadvantages. The scars generally heal extremely well, making it very difficult to see them; however, not everyone heals in the same fashion. An undesirable scar will occur in about five percent of patients. Scar revision may often improve the situation. In some instances, one must accept a less than perfect scar, along with an improved shape. The scar via the belly-button approach is inside the belly button and is therefore practically invisible.
Asymmetry: All people have asymmetries from one side of their bodies to the other. Breasts are no different, and one may be sized or shaped differently than the other. Although we attempt to correct asymmetries to some degree, there are limitations. One must accept the fact that though both breasts may be beautiful, they will probably not be exactly the same, and preexisting asymmetries will be the same post-operatively. An exception to this is size variation which can be improved by the surgery.
Numbness: The nipples may have reduced sensation temporarily, and in one to three percent of cases, can be permanent after surgery. This can vary from some loss to complete loss (rarely) post-operatively. Most of the time, sensation returns to the nipple within one year, and generally much sooner. The skin on the underside of the breast can become numb, but this generally disappears slowly over six to eight months. The umbilical approach has a one half percent (.5%) rate of permanent numbness.
Deflation or Leak of the Implant: Implant deflation with saline and silicone implants can and does occur. We see about a three to five percent rate of rupture over the first 10 years. In the event a rupture does occur, the replacement procedure is much less strenuous than the original procedure if performed within a couple of weeks of the rupture. Silicone implants last about the same amount of time; however, when a rupture occurs the silicone is not absorbed so the breast does not deflate. That said, the contact of gel with the body often causes scar tissue formation so that the breast begins to feel hard.
Excessive Firmness, Capsule Contracture and Wrinkles: The body's response to the placement of the implant is to form a membrane of scar tissue around the implant. This is known as a "capsule.” This is a normal occurrence and is present 100 percent of the time. In some instances, the capsule causes excessive firmness of the breast. This occurs in two to four percent of patients. Some patients do not mind the firmness, because the improved shape is what is important to them. In a smaller group of patients, the capsule will contract and cause the breast to change shape and, in fact, may be painful. When the firmness is unacceptable or with capsular contracture, another operation may be necessary to remove the capsule. Ripples and wrinkling occur in 10 percent of patients. This is where noticeable wrinkling in the skin happens because the weight of the implant pulls the implant and skin slightly, creating a visible ripple. Textured implants have a higher rate of rippling than smooth implants. Ripples, when present, are generally on the outside of the breast under the axilla (armpit). Silicone implants have the lowest rate of rippling and the highest rate of eventual hardening.
Breast Feeding: Most women can successfully breast feed after the placement of implants. The belly button approach does not affect breast feeding at all because no breast tissue or ducts to the nipple are injured in any way. Once the pocket is created, the implant is placed from below and then is slid up under the breast tissue and under the pectoralis muscle in submuscular placement.
Breast Cancer: There is no evidence that implants increase the rate of breast cancer. In some studies, patients with implants, in fact, had a lower rate of breast cancer. This may be due to the fact that patients having implants generally have less breast tissue to begin with. What is clear, however, is that the placement of the implant does make the breast more difficult to completely visualize with mammography. This may make detection of a cancer and early detection more difficult. Therefore, I recommend breast augmentation patients over the age of 30, who have a history of breast cancer in the family, to have a pre-operative mammogram as well as a mammogram one or two years post-operatively. As the vast majority of breast cancers are found through self-examination, the patient should examine herself monthly. The American Cancer Society has guidelines for mammography. We recommend that these be followed. They are not detailed here as they change from time to time, so please refer to their website,www.cancer.org.
Autoimmune Disease: In the 1990’s there was much discussion in the news concerning these diseases, yet the scientific literature demonstrated no connection between implants and autoimmune disease. The population studies undertaken have shown the same percentage of women getting these diseases with implants as not having implants, meaning there is no correlation between the two.
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