Breast enlargement, or augmentation mammaplasty, enhances the body contour of a woman who is unhappy with her breast size.
It may also be used to correct volume loss after pregnancy, or to help balance breast size asymmetries, as well as a reconstructive technique following other breast surgeries.
The operation is carried out on an outpatient basis.
An implant is placed through an incision, under the breast tissue or under the muscle.
The incision can be made under the breast, around the nipple or in the armpit.
It generally takes two to three hours to complete the entire procedure.
A breast implant is composed of an outer shell filled with saline (salt water) or silicon gel.
The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman's needs.
The US FDA has approved both saline and silicon gel implants for breast augmentation.
Studies have shown that implants do not increase the risk for breast diseases.
Detection rate of breast cancer is unaffected if mammography and physical breast examination are combined.
Based on current experience, the implants should last for many years.
However, since no breast implants have been implanted for a full life span, it is impossible to give an unequivocal statement in this regard.
As is the case in all surgery, there are certain risks that are inherent in this operation.
Irregularity or thickening of scars can occur which might require revision.
Rarely, hemorrhage may require removal of prosthesis to control the bleeding.
Infection is probably the most serious risk of breast augmentation.
If an infection occurs, antibiotics alone will rarely clear up the infection unless the implant is removed.
It is necessary to leave the implant out for a period of about three months before it is safe to attempt replacement.
The risk of infection is less than 0.
5%.
Infection is usually confined to the early post op period, however infection can show up much later, fortunately the prosthesis can usually be successfully replaced at a later time after the infection has completely resolved.
Sensory changes can occur resulting in numbness or discomfort, and while these symptoms are usually not long-standing or severe, they can be in some cases.
Temporary sensory changes are common and usually last 2 to 6 months.
No studies have indicated that implants interfere with nursing.
Capsular Contracture The natural tissue capsule that forms around the implant within the body can sometimes thicken or contract causing unnatural firmness or shape to the breast.
This condition is called "capsular contracture".
This is a very uncommon complication which can be reduced by exercises.
If it occurs open or closed capsulotomy may be required.
Rippling Rippling, or surface irregularities over the implant that can be seen or felt, is a potential problem with any type of breast implant.
The added risk of rippling is the trade-off for the increased safety of the saline filled device.
Because of the potential problem, placement of the saline filled implant under the muscle may be indicated to help decrease the risk of rippling.
This may be particularly true for patients who have very little mammary tissue.
In selecting the size of the implant, the general choice should be jointly made by the patient and the surgeon prior to surgery.
While ultimately, the choice of size is made by the patient, she should recognize that there are advantages to a conservative selection.
Capsular contracture and rippling are more common with larger implants.
Postoperative numbness and long term sagging are also more common the large size selected.
The shape of your augmented breasts depends on the implant size and shape along with how your breast appear prior to surgery.
The same size and shaped implant on one patient can look completely different on someone else.
Therefore, one should avoid picking a size or shape solely on what 'looks good' on someone else.
The breast normally covers a muscle on the chest wall called the pectoralis muscle.
Breast implants can be placed above or below this muscle.
When implants are placed below the muscle, it is called a sub muscular placement or a sub pectoral placement.
When the implant is placed above the muscle, it is called a sub glandular or sub mammary placement, meaning that it's below the mammary gland.
A possible advantage of sub muscular placement is that it may allow better mammography.
It is generally felt that there is less chance of missing a lesion on mammography when the implant is below the muscle.
The pectoralis muscle tends to hold the implant against the chest wall during mammography.
Another advantage of sub muscular placement is that the implant is entirely beneath the breast tissue, decreasing the possibility of interference with breast function.
It is also felt that sub muscular implants are less likely to develop firmness (capsular contracture).
This may be the result of pressure or internal massage of the muscle around the implant and its associated scar tissue (capsule).
While this has not been definitively proven, it is our feeling that patients have less capsular contracture when implants are placed in the sub muscular position.
Disadvantages of sub muscular implant placement include a more painful recovery than the sub glandular approach and longer healing times.
Although soreness is typically somewhat more that for sub mammary implants, the increase in discomfort is not long term and most patients feel back to near normal in 2 weeks.
The most severe pain last for one week on average.
Over use of the arms and pectoralis muscles can cause the sub muscular implant to 'ride up' initially.
And, sub muscular implant position does require more time to settle than sub mammary implants.
Slight flattening beneath the breast should be expected initially.
This requires one to two months on average for the breast tissue to stretch and soften in order for the breast to 'round out' in the lower half.
Incisions There are several ways in which the breast implant can be inserted.
An incision can be made under the breast (inframammary), in the armpit (transaxillary), or around the bottom of the areola (periareolar).
The incision under the breast (inframammary) is the most common, and is a favorite due to a number of reasons.
First, it is the area that is hidden in a crease and hemostasis is easy.
Finally, inframammary scars usually heal well and the incision has been used for decades and remains a viable option that usually has no major problems.
The use of endoscopic surgery has allowed us to carry out breast augmentation with more precision and less bleeding.
Special instruments designed for this purpose allow us to work through very small incisions, monitoring the operation on a video screen.
The dissection is performed under close observation using an endoscopic telescope with a built in video camera to project the inside of the pocket on a large operating room screen.
The pocket is then tailored under direct vision rather than the traditional blind dissection.
It may also be used to correct volume loss after pregnancy, or to help balance breast size asymmetries, as well as a reconstructive technique following other breast surgeries.
The operation is carried out on an outpatient basis.
An implant is placed through an incision, under the breast tissue or under the muscle.
The incision can be made under the breast, around the nipple or in the armpit.
It generally takes two to three hours to complete the entire procedure.
A breast implant is composed of an outer shell filled with saline (salt water) or silicon gel.
The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman's needs.
The US FDA has approved both saline and silicon gel implants for breast augmentation.
Studies have shown that implants do not increase the risk for breast diseases.
Detection rate of breast cancer is unaffected if mammography and physical breast examination are combined.
Based on current experience, the implants should last for many years.
However, since no breast implants have been implanted for a full life span, it is impossible to give an unequivocal statement in this regard.
As is the case in all surgery, there are certain risks that are inherent in this operation.
Irregularity or thickening of scars can occur which might require revision.
Rarely, hemorrhage may require removal of prosthesis to control the bleeding.
Infection is probably the most serious risk of breast augmentation.
If an infection occurs, antibiotics alone will rarely clear up the infection unless the implant is removed.
It is necessary to leave the implant out for a period of about three months before it is safe to attempt replacement.
The risk of infection is less than 0.
5%.
Infection is usually confined to the early post op period, however infection can show up much later, fortunately the prosthesis can usually be successfully replaced at a later time after the infection has completely resolved.
Sensory changes can occur resulting in numbness or discomfort, and while these symptoms are usually not long-standing or severe, they can be in some cases.
Temporary sensory changes are common and usually last 2 to 6 months.
No studies have indicated that implants interfere with nursing.
Capsular Contracture The natural tissue capsule that forms around the implant within the body can sometimes thicken or contract causing unnatural firmness or shape to the breast.
This condition is called "capsular contracture".
This is a very uncommon complication which can be reduced by exercises.
If it occurs open or closed capsulotomy may be required.
Rippling Rippling, or surface irregularities over the implant that can be seen or felt, is a potential problem with any type of breast implant.
The added risk of rippling is the trade-off for the increased safety of the saline filled device.
Because of the potential problem, placement of the saline filled implant under the muscle may be indicated to help decrease the risk of rippling.
This may be particularly true for patients who have very little mammary tissue.
In selecting the size of the implant, the general choice should be jointly made by the patient and the surgeon prior to surgery.
While ultimately, the choice of size is made by the patient, she should recognize that there are advantages to a conservative selection.
Capsular contracture and rippling are more common with larger implants.
Postoperative numbness and long term sagging are also more common the large size selected.
The shape of your augmented breasts depends on the implant size and shape along with how your breast appear prior to surgery.
The same size and shaped implant on one patient can look completely different on someone else.
Therefore, one should avoid picking a size or shape solely on what 'looks good' on someone else.
The breast normally covers a muscle on the chest wall called the pectoralis muscle.
Breast implants can be placed above or below this muscle.
When implants are placed below the muscle, it is called a sub muscular placement or a sub pectoral placement.
When the implant is placed above the muscle, it is called a sub glandular or sub mammary placement, meaning that it's below the mammary gland.
A possible advantage of sub muscular placement is that it may allow better mammography.
It is generally felt that there is less chance of missing a lesion on mammography when the implant is below the muscle.
The pectoralis muscle tends to hold the implant against the chest wall during mammography.
Another advantage of sub muscular placement is that the implant is entirely beneath the breast tissue, decreasing the possibility of interference with breast function.
It is also felt that sub muscular implants are less likely to develop firmness (capsular contracture).
This may be the result of pressure or internal massage of the muscle around the implant and its associated scar tissue (capsule).
While this has not been definitively proven, it is our feeling that patients have less capsular contracture when implants are placed in the sub muscular position.
Disadvantages of sub muscular implant placement include a more painful recovery than the sub glandular approach and longer healing times.
Although soreness is typically somewhat more that for sub mammary implants, the increase in discomfort is not long term and most patients feel back to near normal in 2 weeks.
The most severe pain last for one week on average.
Over use of the arms and pectoralis muscles can cause the sub muscular implant to 'ride up' initially.
And, sub muscular implant position does require more time to settle than sub mammary implants.
Slight flattening beneath the breast should be expected initially.
This requires one to two months on average for the breast tissue to stretch and soften in order for the breast to 'round out' in the lower half.
Incisions There are several ways in which the breast implant can be inserted.
An incision can be made under the breast (inframammary), in the armpit (transaxillary), or around the bottom of the areola (periareolar).
The incision under the breast (inframammary) is the most common, and is a favorite due to a number of reasons.
First, it is the area that is hidden in a crease and hemostasis is easy.
Finally, inframammary scars usually heal well and the incision has been used for decades and remains a viable option that usually has no major problems.
The use of endoscopic surgery has allowed us to carry out breast augmentation with more precision and less bleeding.
Special instruments designed for this purpose allow us to work through very small incisions, monitoring the operation on a video screen.
The dissection is performed under close observation using an endoscopic telescope with a built in video camera to project the inside of the pocket on a large operating room screen.
The pocket is then tailored under direct vision rather than the traditional blind dissection.
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