Monday, 07 June 2010 23:07

Breast Augmentation

Breast Augmentation

Breast augmentation is most popular surgical procedure currently being undertaken according to figures released by the American Society for Aesthetic Plastic Surgery in March 2010. Women choose to have breast augmentation for a variety of reasons. This could be due to breasts being too small, because the breast’s natural volume needs to be restored following weight loss or breast feeding, or to restore a breast following mastectomy. Statistics reveal that, in the US, 311,957 breast augmentation procedures were completed during 2009.

What is Breast Augmentation?

This surgical procedure is also known as augmentation mammaplasty. It involves the use of silicone or saline implants, if the breasts are to be made larger or fuller. Not all patients are able to tolerate silicone implants so it will come as some relief to know that saline-filled implants can be used instead of those made of silicone. There are various pros and cons for each, largely summed up in terms of consistency, size of incision, rippling, and cost. Although it is possible to use the rectus abdominus muscle to fashion a muscle flap to be used in place of an implant (and requiring a more aggressive technique), this approach is most appropriate for patients who have undergone more radical tissue removal, as in some cases of breast cancer requiring mastectomy.

Saline implants are less expensive than silicone and require a smaller incision than their silicon counterparts. However, saline implants do tend to be firmer than natural breast tissue while silicone implants are very similar in consistency to the feel of breast tissue. Furthermore, rippling is more likely to occur with saline implants than with silicon implants. Minimum age also needs to be taken into account if you are particularly young and considering breast augmentation. For saline implants you need to be at least 18 years old. To be considered for breast augmentation with silicone implants, you must be 22 years of age.

Breast Anatomy and Terminology

Breast tissue is made up of lobules that produce milk, each one surrounded by fatty tissue interspersed with connective tissue. During the time breast milk is being produced, milk is secreted in the lobules and flows through the ducts that link each lobule with the nipple where it becomes available when the infant sucks, as a result of the let-down reflex. Around each nipple is the areola, circumventing each nipple in a deeper pigmented circle. The actual breast tissue itself is supported by a layer of muscle, the pectoralis major, as well as the serratus anterior, the external oblique, and the rectus abdominus fascia, all of which are important structures that feature prominently during breast augmentation surgery. This is because the blood supply that flows through these muscles also continue through the breast tissue, ensuring each breast is richly supplied with blood and preventing the possibility of rejection of tissue and reducing the chances of complications arising from surgery. Furthermore, the pectoralis major is the muscle used to cover the implant, especially important in the case of mastectomy when the layer of skin and subcutaneous tissues may be rather scant. Aside from that, proper positioning beneath the pectoralis major results in a far more pleasing aesthetic appearance.

When would an Individual Consider Breast Augmentation?

Quite often women lose breast volume after pregnancy or weight reduction and this can have a negative impact on their daily lives and self esteem. The most frequent reason given for considering a breast implant is dissatisfaction, for one reason or another, over the size, feel and aesthetic appearance of your breasts. Obviously another major reason would be to reconstruct a breast following mastectomy as a result of cancer intervention. Invariably, however, augmentation mammaplasty or breast augmentation, whichever name you wish to give to it, is usually carried out to improve the balance of your body by increasing the fullness as well as the projection of your breasts while, at the same time, enhancing, or augmenting, your self-confidence as a result of an improved self-image.

Although there are some things that breast augmentation can do, there are some things that breast augmentation cannot do, for example correct overly droopy breasts. For this defect to be corrected you might need to consider breast lift surgery, which is a completely different technique. Although breast lift and breast augmentation can be performed in the same surgery setting, if both procedures are desired and necessary. Lifting up drooping breasts, or mastopexy as it is medically known, involves completely different surgical techniques that are best discussed separately.

Is Breast Augmentation What I am Looking For?

First and foremost, as with any surgical procedure, you need to make the decision based on what is best for you rather than deciding to undergo the surgery to please somebody else. Even if you have decided to undergo this procedure for yourself, you still need to have a realistic expectation as to the outcome. Basically, if you are in good physical health and your breasts are fully developed, then you would be considered as a suitable candidate for breast augmentation. However, that said, you do need to be completely frank during your initial consultation. This is important for your safety during surgery as well as to ensure its ultimate success.

There are various questions your surgeon will ask you during your initial consultation. These questions might involve your motivation--the reasons why you may want the breast augmentation procedure carried out, what you expect from the outcome and your overall expectations as a result of surgery. Your surgeon will need to know if you have any allergies to any drugs at all, whether you have any medical conditions and if you are undergoing any medical treatments at the present time. You will also be asked whether you habitually use herbal supplements or vitamins, what current medication you take, if any, and if you smoke or drink.

Another question your doctor will ask you is whether you have a drug dependency issue. You will also be asked if you have undergone any surgery in the past and, if so, what procedure. Finally, another very important question is whether you have any family history of breast cancer, have had any biopsies done in the past and what the results of any previously done mammograms are. It is important for you and your surgeon that you answer these questions honestly.

What are the Different Kinds of Implants Used?

The most common kind of breast implant used is round in shape. Round implants are used in as many as 90% of operations. There are three reasons for this:

  1. If they rotate in situ there is no obvious aesthetic disadvantage
  2. They cost less than teardrop implants
  3. They do not require a textured surface

So, put another way, round implants are both better and less expensive than teardrop implants. Consequently, round implants are used far more commonly than teardrop implants. Despite the fact that teardrop implants were developed to provide breasts with a more natural appearance, they do need a textured surface prepared to prevent rotation which, if it does occur, results in the shape of the breast looking distorted. Teardrop implants are also prone to increased risk of rippling which doesn’t occur as often with the round implant.

Furthermore, the results of a recent clinical study revealed that, when a woman is lying down, the round implant looks just as natural as the teardrop one does. Round implants also have a lower incidence deflation than teardrop implants and tend to have a consistency more in keeping with that of natural breast tissue.

Other Considerations Regarding Breast Implants

Saline implants consist of a silicone outer shell and are filled with sterile salt water. Making a decision about the size of the implants is quite important and not as easy as you might think. One of the most important considerations is the risk of displacement. If an implant is filled with less than 350ml of water it will have less chance of becoming displaced while implants will with more than 400mls stand a higher risk of displacement. There are various sized implants, designed to provide you with an A, B, C, or D cup size. You will, no doubt, have an image in your mind of the appearance you want to achieve. Basically, however, if your natural breasts are an A cup and the surgeon introduces a 400ml implant, you will end up with a C cup whereas if you are normally a B cup, 400mls will provide you with a D cup.

Placement of the Implants

Implants are usually placed below the pectoralis muscle as this reduces the risk of capsular contracture and provides a more natural appearance. Furthermore, an implant placed below the muscle is less likely to be a problem when you need to have a mammogram. This sub-muscular approach is always performed under general anesthetic. There is also more pain associated with this method due to swelling of the tissues, resulting in a slightly longer recovery period. However, for women who are involved in athletics, the cosmetic result is not as becoming as the subglandular breast implant placement.

Subglandular implants are placed above the pectoralis muscle but beneath the breast tissue. While this is not really a suitable option for women whose breasts are normally small, this method does reduce the recovery time. Furthermore, there is less pain due to a reduced chance of swelling and can be performed with local anesthetic together with intravenous sedation.

The actual surgery time is approximately 2 hours and, as discussed above, depending on the procedure, can be done under a general anesthetic or local anesthetic with sedation. Your surgeon will discuss with you the best place for the incision to be made, although the choice will always be in a place where scarring is less visible. Incisions can be made around the areola, known as a peri-areolar incision. This is the most commonly made incision. You can also have your incision placed underneath the breast, known as an infra-mammary incision, or it can be placed in the armpit, known as a transaxillary incision. Rarely, an umbilical incision is done, in the region of your belly button.

This involves the use of an endoscope and is a much more complicated procedure. The choice for the location of these incisions is governed by the type of implant, your personal anatomy, the personal preference of doctor and patient, and how much the incision needs to be enlarged to get the implant in place. Finally, once the implant is in place and the surgeon is satisfied everything is as it should be, the incision is closed using layered sutures through the breast tissue and finished off with either skin adhesive, sutures or surgical tape to close the skin incision.

The Results of Breast Augmentation

As you recover from surgery your scars will slowly fade. Meanwhile, your breast augmentation will, hopefully, be what you expected, enabling you to wear the lingerie and swimwear you dreamed of. The outcome should be an enormous boost to your self-confidence. It is important for you to understand, however, that as you age your breasts will also change shape. Furthermore, if your weight fluctuates, your breasts will change as well. Although your new breast implants are intended to be long-lasting, it is always wise to stay in contact with your surgeon in case your implants do need to be replaced or if revision is required.

Recovery Time from Breast Augmentation Surgery

Post surgery recovering time is usually between 24 – 48 hours. This should be followed by limited activity for a few days following surgery although the swelling and soreness could last for a few weeks. Your surgeon will give you an indication as to how soon you can resume your normal activities, as well as instructions on how to look after your breasts following surgery. This includes how to reduce the risk of infection and medication to reduce pain or promote healing. Take your time returning to normal activities and if you should experience any symptoms such as chest pains, shortness of breath or an awareness of different heart beats, contact your doctor straight away.

Levels of Discomfort or Pain Experienced following Surgery

This really does depend on whether the implants were placed above or below the muscle. If placed beneath the muscle you can expect moderate to severe discomfort for up to 2 weeks during which suitable medication will be provided for you. Many patients experience bruises or numbness for up to 2 weeks following surgery. You are usually advised to avoid lifting anything substantial for around a month to give tissue a chance to heal properly. Similarly, wait for a few weeks before resuming exercises. If your implant was placed above your muscle it is probably fine for you to return to work after a week although for those ladies whose implant was beneath the muscle it is best not to return to work until the pain and bruising have subsided.

Risks Associated with Breast Augmentation

Occasionally a problem can occur with silicone breast implants, associated with inflammatory changes to the tissue surrounding the implant. This can lead to a fibrous cyst. In cases where silicone leaks from the implant the tissues surrounding the implant will form a fibrous cyst, thereby preventing further leakage. This has been known to calcify many years later, often causing some discomfort. Other from that, there are a few risks associated with any kind of surgery, such as poor healing and infection. Mainly, however, risks associated with breast augmentation can be summarized as:

  • Unsightly scarring
  • Hematoma [bleeding]
  • Temporary or permanent reduction in breast sensation
  • Capsular contracture as a result of too solid scar tissue forming around the implant
  • Skin wrinkling across the implant
  • Rupture or leakage of the implant
  • Accumulation of fluid
  • Persistent pain caused by over-sensitivity of nerve-endings being disrupted
  • Deep vein thrombosis or blood clots
  • Anesthetic risk
  • Pulmonary embolism or cardiac involvement
  • Revisional surgery may be required.


Additional Information

The average cost of breast augmentation tends to be around $5,000 - $7,000. These costs can be broken down into $3,050 for the Surgeon; $700 for the Anesthesiologist; Implant costs around $1,300 and the outstanding amount of $950 relates to the cost of the surgical room needed for the procedure to be carried out.

There has actually been a satisfaction survey carried out by the FDA, involving 450 women who had previously had breast augmentation surgery. This survey was carried out over 10 years. The FDA report that, of these 450 women, 96% with saline-filled breast implants confirmed total satisfaction with the results of their implant. Furthermore, of those 450 women, whose comments were taken over a 10 year period, 71% admitted that they considered their breast implants to be soft, both looking and feeling like natural breast tissue.


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