Breast Augmentation

Breast Augmentation

     One of the most popular cosmetic operations in the western world is augmentation mammoplasty (breast enlargement) with breast implants. Throughout the world there is a growing demand for this operation, and it runs a close second to rhinoplasty (nose alteration surgery) in frequency worldwide. It is also one of the most satisfying of all cosmetic operations in terms of patient happiness, ranking on a par with cosmetic surgery of the nose and liposuction to remove fat.

     Every woman wants to look as good as possible in clothing and every woman wants to have a well-proportioned, pleasing silhouette. Classic beauties of the world have had firm, lifted breasts with balance and symmetry to the waist and hips. There is no question that aesthetic surgery of the breasts can result in a more pleasing appearance and a rebirth of self-confidence.

     There is a new flair for life and deeper sense of pride in appearance for women who have grown up with small breasts and suddenly have a full figure. They feel more fulfilled and less cheated by nature's meager endowment. It is no wonder that women who observe fashion models and movie stars with full breasts have a desire to be what the world considers more attractive. Part of life's challenge is to feel a rich sense of acceptance. Breast augmentation surgery alone will not accomplish this, any more than a nose change or liposuction, but it does contribute to the overall satisfaction of feeling more feminine and lovely, and that is why so many women seek the procedure in today's world.

     Two groups of women generally seek breast augmentation. The first is made up of women in their late teens or early twenties who have never enjoyed a well-proportioned bosom. The second includes women in their late twenties, all the way to their fifties. They may have lost breast size and shape after childbearing and/or breast feeding. Or they may be women who have come to terms with their dissatisfaction of so many years without full breasts. They can afford the surgery and want the results that this procedure can bring. Both groups of women desire a more pleasing shape that is usually associated with a more youthful body and a better appearance in all types of clothing.

     Breast augmentation is usually associated with cosmetic surgery. There is an important difference between cosmetic surgery patients and others. Those who submit to surgery for eradication of disease have fewer choices. Surgery eliminates a serious problem. Cosmetic surgery is elective. This means the patient and doctor may choose what type of procedure, within some guidelines, to achieve the best possible results.

What Breast Surgery Will Do

     Basically, breast implants will make small breasts larger. To help you understand what this will do for you, the surgeon must visually examine your breasts. At the time of examination, you will be asked what it is you wish to achieve in breast enlargement in terms of size and shape. He may have some questions for you and point out what is possible and what is not. Listen carefully to what he tells you. Make mental notes of what is discussed, so that you can determine in your own mind the probable results of the surgery. The surgeon will indicate where the incisions will be placed and what type of implant will be used. He may show you samples of implants. If he doesn't, you may want to ask him to show you one. At the examination time the surgeon will undoubtedly explain the best approach with the least amount of scarring.

Sites of Incision

     As a rule, the surgeon selects the site of incision. There are at least three entry areas of the breast to insert the implant. The doctor will discuss the site of implant entry and may even offer a choice, but it is best to follow the recommendation for best results. Most patients accept the surgeon's evaluation as to the best incision site.
     For the patient with drooping breasts, in which the skin of the breast touches the skin of the chest wall when the patient is standing erect, the inframammary incision is placed slightly up on the breast, perhaps one-fourth to one-half inch above the inframammary fold. The incision will be almost completely hidden and may be the preferable and the most recommended site of entry.
     In the patient with tiny areolae, the areola incision may be nearly impossible to perform. Most surgeons prefer that the incision be at least 2 centimeters long. If the size of the areola calls for an incision of less than 1.5 centimeters, and the patient insists on not having the underarm incision, then permission must be given to extend the areola incision laterally as much as 1/2 to 2 centimeters in each direction. Without this extension, the surgeon may not be able to insert an implant of over 200 cubic centimeters in volume through the opening. The extended scar may be too visible and/or the skin beneath the incision may be numb.
     Ordinarily, the areola incision, made in the wrinkles of the brown skin of the areolae, heals with the least amount of visible scarring, except in pendulous breasts. The axillary (arm pit) incision is sensitive and doesn't heal well a lot of the time. Also, another incision may be necessary if there is too much bleeding.
     The areola approach is the only one of the three most-used incision sites that invades the breast tissue itself The thousands of surgeries performed have demonstrated that there is almost no danger of breast nodules or cysts developing in the lower portion of the breast when this approach is used. Many patients who have had this approach have subsequently become pregnant and have breast fed their babies. This is true of all approaches. Breast self- examination and mammography can also be done without difficulty.

Breast Implants

     Implant manufacturers today are controlled by government regulators. It is their job to offer the safest, most natural appearing and functioning implant available. Many strides have been made in the past few years in this area. The manufacturers know that what the patient wants is the best possible appearance with the least amount of problems. Some implants are filled with a saline solution that, if it should leak (rare), will not cause infection. Others are filled with a silicone gel. There is also a combination saline and get implant that is used. Get filled implants and combinations are rarely used today because of the increased risk of rupture.
     In the 1970s, saline-filled implants came on the scene. The problem with these early saline implants was the leakage and deflation rate, which had crept up to nearly 25 percent of those receiving the implants. Saline implants used today rarely leak, due to improved technology. Both saline and silicone gel implants come in a smooth surface or in a textured surface. Capsular contracture (a tightening around the implant causing it to feel abnormally firm) was thought to be less frequent with the textured surface implants, but this has proved not to be the case. There are two possible locations for implants in the breast: beneath the pectoral muscles or between the muscle and the breast tissue. Let the surgeon decide which is best. You can ask why one or the other, but at this level of understanding about the procedure, where the implant is placed is the surgeon's preference in each individual case. It is a technical matter that the surgeon must decide.

Risks

     Infection is always a risk with any surgery. Breast surgery is no different. Should infection develop, the surgeon has a host of acceptable methods to deal with it. Bleeding is another factor to guard against.
     Scarring occurs due to the nature of placing an implant under the surface of the skin, where an opening has to be made. Most incisions are made in an area where they are hidden from view.
     In the extremely rare cases where the breast patient develops an infection, it is usually best to remove the implant and leave it out until all infection is gone. When the tissues are soft and pliable again (a minimum of three months in most cases), then the implants can be replaced in the breast.

Hematoma

     Hematoma is the pooling of blood and fluid and occurs more often in-patients who have taken aspirin or estrogens and patients with elevated blood pressure. Other causes are coagulopathies and excessive heat or exertion after surgery.
     This is often the result of a blood clot around the implant due to a broken blood vessel. If it happens, it occurs within the first week or so following surgery, and most often immediately after surgery. Be assured that this is not life threatening, either as a blood clot or from blood loss. It is what is termed a "closed space" hematoma.
     In the rare incidence that a hematoma develops, the patient will notice swelling of one of the breasts accompanied by pain and tenderness, or perhaps firmness and bruising or discoloration. Small clots can result without any of these usual signs.
     Any patient with these signs needs to see the doctor immediately. For one breast to have more bruising or discoloration and more swelling than the other is expected and normal. The rare patient who may need evacuation of a hematoma will usually be moderately to very uncomfortable, with a hard, swollen breast on one side. This condition can be cleared up with proper medical care.

Noticeable Scars

     Seldom does a patient need scar revision to correct a highly visible scar following breast surgery. Most incidences of scar revision include those patients with almost invisible scars but who feel they are noticeable. In reality, a hundred percent of all breast-implant patients have scarring, and whether or not they are noticeable is a matter of opinion. To most, the beneficial results outweigh the tiny scars.

Asymmetry

     As with scars, all breasts are to some extent different. It can be mentioned that nature made no two snowflakes, grains of sand, or anything else a human can see, exactly alike. Whether or not there is significant asymmetry is a matter of opinion.
     Many asymmetries exist before surgery. The surgeon will try to correct what is visible and make the two breasts as symmetrical as possible during surgery. The surgeon may also be able to improve abnormal shaping of the chest with implants.

Breast Volume

     The size of the breast can be controlled. The doctor can use implants of different volume to help correct asymmetries in size. Manufacturers of breast implants call them elastomer envelopes. There is a wide range of envelopes to fit the needs of individual patients, and an experienced surgeon knows which size to place in which breast.