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 Breast Augmentation Surgery
What is breast augmentation surgery? Breast augmentation is a surgical procedure to enhance the size and shape of women's breasts. Usually, this is done by creating a pocket under the breast tissue or the muscle underlying the breasts and inserting soft implants filled with a saline solution. Breast augmentation usually can increase a woman's breasts by one or more brassiere cup sizes. This procedure is also often referred to as breast enlargement and by the technical name augmentation mammaplasty. Breast augmentation is performed for any of a number of reasons, including a straightforward desire to improve body contour in women who may feel their breasts are too small in relationship to the rest of their body, to restore breasts that have decreased in size following pregnancy or weight loss, or to correct differences between breasts that are different sizes. Sometimes breast augmentation is done on the normal breast in connection with reconstruction of a breast following mastectomy or other surgery. Except in unusual circumstances, breast augmentation surgery is not covered by most health insurance plans. Depending on your situation, your surgeon may recommend that you also consider another cosmetic procedure called breast lift, or mastoplexy. This surgery removes and tightens extra skin to eliminate sagging or drooping and improve breast shape. (return to top) How frequently is breast augmentation surgery performed? Some 220,000 patients underwent breast augmentation surgery in the United States in 2001, according to the American Society of Plastic Surgery. This represented about 14 percent of all cosmetic surgery procedures performed on women. Breast augmentation usually is not done until the patient's breasts are fully developed and their permanent, natural size and shape are clear and only when they are psychologically ready, so it is unlikely to be appropriate for patients under the age of 18. Beyond that, it is successfully performed on women ranging in age from the late teens on. (return to top) Are breast implants safe? The implants used for breast augmentation surgery are bag-like capsules made of silicone and filled with a soft, pliable material to give them form. While silicone gel was a popular filling for several decades, the filling of choice today is a saline (or salt water) solution. A reality of breast augmentation is that breast implants are not guaranteed to last forever. Some may leak or burst, due either to trauma or — more likely — to the natural pressures of body movements over time. Because of concerns among patients with silicone-gel-filled implants that leakage of the gel was causing health problems such as immune-related diseases, the use of silicone-gel implants today is restricted by the U.S. Food and Drug Administration to patients participating in clinical studies. The safety of saline solution implants has never been in question. If saline solution were to leak from the implant, the implant might deflate over a period of hours or days, but the solution would be harmlessly absorbed by your body — which is mostly water anyway. A second operation would be required to replace the implant. In addition, implants may make mammograms more difficult to read accurately, but this is a problem that is manageable and should be discussed with your surgeon. There is no evidence whatsoever associating saline solution breast implants with breast cancer. (return to top) What should I think about in considering breast augmentation? If you have a realistic expectation of improving your body contour, regaining former size and shape or correcting asymmetrical size or positioning of your breasts, you are likely to be a good candidate for breast augmentation. However, you should keep in mind that cosmetic surgery can improve your appearance but it cannot solve all your problems or make you perfect. If your goals are reasonable, the results can be fulfilling and gratifying. If your breasts are sagging or drooping, you may want to consider receiving a breast lift at the same time, removing excess skin and tightening remaining skin to create firmer shapes. In this process, the nipples and areolas will be raised to more natural positions. You should also keep in mind that any surgical procedure leaves scars. In the case of breast augmentation surgery, any scars are likely to be minimal, with small incisions placed as inconspicuously as possible in the crease where the breasts hang against the chest, around the areolas surrounding the nipples or in the armpits, but you should be aware that there will be some scarring. Although it's not guaranteed, most breast augmentation surgery scars fade to thin white lines over time. In some cases, women who undergo breast augmentation surgery experience changes in the sensitivity of their nipples, becoming overly sensitive, undersensitive or even numb. These symptoms are usually temporary but can be permanent. You should also keep in mind that breast augmentation is a surgical procedure, and any surgery carries with it very small-but-possible risks of complications such as reaction to anesthesia, bleeding and infection. (return to top) What should I do to schedule breast augmentation surgery? Since every case is different — both in physical concerns and in conceptions of what is desirable in breast size and shape — you also want a physician with whom you can talk frankly about your expectations and likely outcomes for your surgery. Don't be afraid to ask questions. You and your surgeon should talk about issues that may affect your procedure, such as the current size and shape of your breasts, your desired result in terms of size and shape, the kind of implants being considered, the condition of your skin, the type of anesthesia to be used, the options for location of your incisions and the prospect of scars and other possible side effects. (return to top) What are the options for my incisions and the positioning of my implants? Breast augmentation surgery begins with small incisions either in the crease where the breasts hang against the chest, around the lower halves of the areolas surrounding the nipples, or in the armpits. Whatever the location, the incisions will be made as minimal as possible so as to leave scars that are as inconspicuous as possible. You and your surgeon should discuss carefully what your anatomy allows and what your preferences are. You should also discuss possibilities and preferences regarding positioning of the implants. The implants can be placed directly underneath the breast tissue, or beneath the pectoral muscles located between the breast tissue and the chest wall. This option reflects a belief by some surgeons that placement of the implants behind the muscle wall reduces the possibility of scar contraction around the implants. It is also thought to result in fewer problems with reading future mammograms than placement directly beneath the breast tissue. However, it may also be more painful for the first several days than placement beneath the breast tissue. (return to top) What are the preparations for breast augmentation surgery? During your initial consultation, your doctor will measure your breasts and may take photographs of them. He or she may order a mammogram to screen for breast cancer. You should prepare for your surgery by making sure you don't take certain vitamins or aspirin, ibuprofen or other blood-thinning analgesics for at least two weeks before your procedure. Any herbal remedies you are using may need to be discontinued. If you smoke, you should also stop for at least three weeks before and after your surgery, as nicotine interferes with blood supply and can adversely affect the healing of your incisions (and the final appearance of your scars). You will probably be asked not to eat or drink after midnight of the night before your surgery. This surgery is usually performed under general anesthesia (in which case you will be asleep throughout the procedure). You should have a family member or friend available to drive you home after you are discharged, as you are not allowed to drive yourself home. Breast augmentation surgery is usually performed on a day-surgery basis, but it is conceivable the doctor may have you held overnight in the hospital following your procedure. (return to top) How is the surgery performed? While specific techniques may vary depending on your anatomy, breast augmentation generally begins with small incisions either in the crease where the breasts hang against the chest, around the lower halves of the areolas surrounding the nipples, or in the armpits. The incisions will be kept as small as possible — possibly one to one-half inches in length — so as to minimize scarring. Once the incisions are made, the surgeon will create pockets for the implants under the breast or underlying muscle tissue and slip the implants into place, adjusting them to ensure that they are positioned correctly under the nipples and areolas and are symmetrical. If a breast lift is to be performed in conjunction with this surgery, it will be done at this time. Following the surgery, your breasts will be covered with gauze dressings. You may be wrapped in a compressive bandage or may be given a special brassiere to wear while you heal. (return to top) What can I expect following surgery? Your breasts will be bruised and swollen for several days and you will experience some pain. Your dressings will be removed in one to three days, but you'll be asked to continue to wear the special surgical brassiere. You may feel a burning sensation in your breasts, but that will subside. Your stitches will be removed in seven days or so. You should be able to return to work in several days, but your breasts will be sensitive and you should try to avoid physical contact or exertion for three to four weeks. You should avoid sexual activity for at least two weeks — sexual arousal tends to cause the breasts to swell, which interferes with healing. Scars left from the incisions will remain swollen and red for several months, but will fade, usually to thin white lines, over time. A problem that can occur following breast augmentation surgery is capsular contraction, when the scars (or capsules) around the implants begin to tighten and squeeze the implants. As a result, the breast can feel harder or firmer than normal. If this becomes severe, follow-up surgery may be necessary to reduce or remove the scar tissue, to remove and replace the implants, or possibly just to remove them. (return to top) What should I know about getting mammograms after breast augmentation surgery? When you schedule your breast augmentation surgery, depending on your age and family and personal breast history, your physician may ask you to have a mammogram taken to screen for breast cancer. Some time after your implant surgery, you should plan on having another mammogram performed to establish a baseline with regard to scar tissue for reading of future mammograms. When scheduling future mammograms, you should be certain to ask for a technician skilled in mammography for breasts with implants, as special techniques and additional images will be required. (return to top) Is breast augmentation a successful procedure? More than two million women have had breast augmentation surgery, with a very high rate of satisfaction. As suggested earlier, you should keep in mind that cosmetic surgery can improve your appearance but it cannot solve all your problems or make you perfect. If your goals related to body contour are realistic, the results of breast augmentation can be very fulfilling and gratifying. (return to top) Frequently asked questions How does breast augmentation differ from breast lift? Breast lift is a procedure to eliminate sagging and drooping and establish a firmer shape. In brief, the surgeon removes excess skin from the breasts (usually from the lower sides) and pulls the skin remaining at the sides together to shift the breasts upward and create new shapes for them. For many patients seeking breast augmentation, a breast lift performed in conjunction with the augmentation is recommended to achieve the appropriate positioning. How does breast augmentation surgery affect pregnancy and childbirth? Having breast implants should not affect your pregnancy but could alter your ability to breast-feed. However, breasts tend to change shape and reduce in size after pregnancy, and if you are considering becoming pregnant you might want to delay your breast augmentation until afterwards. The same would hold true for any anticipated significant weight loss. Should I expect to have future surgeries related to my breast augmentation? If you should experience any problems related to bleeding or infection (which would be evident soon after the surgery) or deflation of an implant due to leakage, it would be necessary for follow-up surgery to correct the problem. In general, your implants should last for a long time but it is conceivable that someday you may need additional procedures to have them replaced or removed. In addition, the forces of aging and gravity will continue to affect the size and shape of your breasts over a period of years, and at some point you may want to consider breast lift surgery. What will happen if an implant leaks or bursts? Quite frankly, you'll experience a change in the size of a breast in a matter of hours or days. Other than that, the saline solution itself will be absorbed without any effect by your body. Does health insurance cover breast augmentation surgery? Except in special circumstances, breast augmentation surgery is usually considered a strictly cosmetic procedure and is not covered by health insurance. Your physician will advise you if there is any medical therapeutic basis for your surgery. If my breast reduction surgery is not covered by insurance, how much does it cost? In the Hartford region, the average cost for breast augmentation surgery for a woman is $5,000 to $5,500. (return to top) For additional information You can find additional information about breast augmentation surgery at web sites sponsored by government agencies, societies and healthcare institutions. It should perhaps be noted that the World Wide Web is open to many sources posting questionable information and promises, and you are encouraged to seek information from established, reputable organizations. Likely sources include: The American Society of Plastic Surgeons www.plasticsurgery.org The U.S. Food and Drug Administration Center for Devices and Radiological Health www.fda.gov/cdrh/breastimplants/bisurgery.html |
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