ABOUT BREAST AUGMENTATION
The following information is regarding breast augmentation, which is important to review, understand and discuss with family and/or friends before choosing to proceed with surgery.
Goals of Breast Augmentation: The purpose of augmentation mammoplasty is to create more normal proportions in women with underdeveloped breasts or to recreate fullness in women who have lost volume due to pregnancy or weight loss. The operation is designed to preserve breast function, specifically sensitivity, and the ability to breastfeed and to satisfy psychological needs. In any given patient these goals may be only partially met.
Limitations to the Procedure: This procedure cannot stimulate normal breast tissue to increase in size, nor can it create younger skin or eliminate “stretch marks”. In addition, if sagging is severe, this cannot be eliminated with implantation alone. Asymmetries such as differences in breast shape or position, rib cage irregularities, or differences in nipple-areolar size may not be correct by this procedure. Although the procedure may improve body image and a sense of well-being, the procedure cannot solve personal, marital, or work-related issues.
Alternatives to the Procedure: Loss of breast volume and breast sagging are normal features of aging and in themselves not a disease that requires surgery. Upper body exercise will tone the pectoralis muscles giving the upper chest a fuller appearance. However, as there are no direct muscle communications to the breast tissue itself, exercise will produce little, if any, change in breast shape. Other surgical procedures are available, primarily involving transferring of skin and or fat grafts have produced only temporary improvement in most women. More complicated procedures such as transferring skin and muscle flaps, as used in breast reconstruction, could be performed, but these are extensive surgical procedures, which leave significant scars in the area from which the tissue has been transferred. Most commonly, synthetic implants are used for breast augmentation. Saline implants, either smooth or textured, are the primary implants available for implantation today.
Breast Cancer and Augmentation Mammoplasty: There is no evidence that the incidence of breast cancer is increased or decreased by the presence of breast implants. As the implants are placed behind the breast tissue, not in the breast tissue, physical examination is not affected. Mammograms can be performed on patients with breast implants, but it is important to realize that mammograms may be more difficult to perform and special views may be required. In addition, a radiologist experienced in viewing mammograms of patients with breast implants is required. For these reasons, mammograms on patients with implants may be more expensive than routine mammograms. It is also known that a small amount of breast tissue may be obscured by the presence of the implants and very early cancers may be missed in patients with implants. Silicone has been found to produce a very rare cancer in laboratory rats called fibrosarcoma. This is not breast cancer and has not been found to occur in humans.
Surgical Techniques/ Anesthesia/Recovery: The breast implants can be placed in two positions: underneath the breast tissue either in front or behind the chest muscle. With implants placed above the chest muscle directly under the chest tissue, there is a higher incidence of noticeable scar formation that may lead to hardness or other deformities of the breast. In addition, with implants in this position, mammography is somewhat more difficult to perform. When the implant is placed behind the chest muscle against the rib cage, scar tissue is less prominent and the breasts tend to remain softer. In addition, mammography is easier. The procedure is generally performed under general anesthesia as an outpatient. For the first 24-48 hours there is discomfort in the chest area, which may limit upper body and arm motion. Showers can be resumed 48 hours following surgery. Most patients are able to return to work within one week of surgery. Depending on the individual, supportive dressings may be sued or the patient may be instructed to braless for a certain period of time. It is necessary to refrain from heavy upper body exercise for 4-6 weeks following surgery. Lower body exercises can be resumed 2-3 weeks after surgery. In some patients, instructions are given to massage the breast for a certain period of time postoperatively. The most common incisions used for the placement of implants are either in the crease beneath the breasts or in the margin of the nipple. Implants can be placed through incisions high in the armpit, but these are technically more difficult and have a higher incidence of complications. With the nipple incision, there may be limitations as to the size of the implant or the position in which it might be placed. The incision directly underneath the breast in the breast crease allows the most direct access for implant placement. Over time the incision will fade, although it will not disappear completely. In some patients, the incision may remain red or slightly firm for several years following surgery. The sutures in the surgical incisions are clipped or removed 10-14 days following the surgery.
Risks/Complications: The most common complication following this surgery is a collection of blood or tissue fluid around the implant. If this causes swelling or deformity of the breast, it may require a second operative procedure to remove the collected fluid. Infection is uncommon and usually responds to antibiotic therapy. However, in rare instances, the implants must be removed before the infection can be eradicated. The implants cannot be replaced for a minimum of 3-6 months following such an event. There may be temporarily increased or decreased nipple sensation. In a small percentage of patients, this change in sensation is permanent. It is impossible to guarantee absolute symmetry in terms of shape, size, or nipple position. There may be problems due to the composition of the implant itself. Specifically, there may be palpable wrinkling or irregularity of the covering. There can be thinning of the tissue overlying the implant or severe tightening of scar tissue around the implant producing firmness and/or discomfort. Stretch marks may be produced or accentuated by the placement of implants. Breastfeeding may be impossible. There may be calcification in the normal scar tissue or enlargement of lymph glands in response to the presence of the implant. Implant failure can occur, which is generally due to leakage of the saline from the implant. While this produces no negative evidence linking saline implants with an immune reaction although long-term effects are not known.
Even though the risks and complications cited above occur infrequently, they are; the ones that are peculiar to the operation and/or of greatest concern. Any and all of the risks can result in additional surgery, time off work, hospitalization, and expense to you.
The practice of medicine and surgery is not an exact science. Although good results are expected, there can be NO guarantee nor warranty expressed or implied by anyone as to the results that may be obtained. Many factors beyond the control of the surgeon affect short and long-term outcomes, scarring, and other health factors. On occasion, secondary surgeries may be indicated or desired to obtain the optimal result. If such procedures are performed, there may be additional charges incurred by you.
Comments: If you are a smoker, you must be off cigarettes for three weeks before surgery and for three weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss, and skin loss in smokers.
If there is any item that you do not understand, please call the office. An explanation or additional information will be provided.