Tuesday, January 6, 2009

Breast Augmentation from a Surgeon's Perspective

By Franklin D. Richards, MD Bethesda, MD

Breast augmentation is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons. Most often a woman seeks breast augmentation to enhance the body contour, who, for personal reasons, feels her breast size is too small or to correct a reduction in breast volume after pregnancy. Some desire to improve an imbalance in breast size. By inserting an implant behind each breast, surgeons are able to increase a woman's bustline by one or more bra cup sizes.

Breast augmentation can enhance your appearance and your self-confidence. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Possible Complications
A breast implant is a silastic shell filled with a saltwater solution known as saline. Breast augmentation is relatively straightforward. But, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. If this occurs it can make the breast feel firm or even hard. Capsular contracture can be treated by removal or scoring of the scar tissue.

Complications with this procedure are possible, but fortunately, unusual. They include bleeding, infection, nipple numbness and implant leaking. Sporadically, breast implants may break or leak. Rupture can occur as a result of injury or even from normal compression and movement of your breast and implant, causing the shell to leak. If a saline implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. However, the ruptured or leaking implant must be replaced. This involves opening the original incision and inserting a new implant.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to notify the center that you have breast implants. Often this will mean that additional oblique mammographic views are performed. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience the above complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

The Surgical Procedure
Breast augmentation is most commonly performed in an outpatient facility using general anesthesia, so you'll sleep through the entire operation. Some surgeons may use local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake, and may feel some discomfort.

The method of inserting and positioning your implant will depend on your anatomy and your surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola or in the armpit. Usually the incision around the areola is less conspicuous, however, the incision under the breast is frequently hidden by the breast itself. The armpit incision often heals well, but it may be noticeable with a raised arm, and it is difficult to create an accurately placed pocket with this incision.

The implant may be placed in a pocket under the pectoralis muscle or directly on top of it. Generally, saline implants are placed behind the muscle as there is often better breast form, less chance of capsular contracture (hardening) and it helps to prevent any waviness‚ of the implant from being noticed. If you have any significant breast droopiness (ptosis), the implant pocket may need to be placed on top of the muscle. This allows the implant to fill out the breast skin and results in a better correction of the droopy breast.

Shape of the Implant
Several considerations are made in choosing a breast implant. There are round implants and also tapered sometimes called contoured or anatomical implants. Generally, for a very thin individual, a tapered implant will result in a more natural, less rounded appearance to the upper portion of the breast. However, if the implant is placed behind the muscle, the appearance is very similar.

Additionally, implants may have a smooth or textured surface. The textured implant was developed to help reduce the incidence of capsular contracture (hardening). Again, if the implant is placed behind the muscle, there does not appear to be significant differences between the implant surfaces.

You’ll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure. The surgery usually takes one to two hours to complete. There is often a wrapped gauze dressing around the breasts for one or two days.

After the Surgery
You should be able to return to work within a few days, depending on the level of activity required for your job. Follow your surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to exercise and direct stimulation for two to three weeks.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear widened. After several months, the scars will begin to fade, although they will never disappear completely.

It's Your Own Decision
For may women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it.

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