Breast
Augmentation
Modern-day
breast augmentation began in 1963 with the introduction of a silicone
get- filled implant manufactured by the Dow Corning company and modified in
many ways over the ensuing years. Prior to 1963, breast augmentation was done
using ivalon, polyvinyl, polyurethane or silicone sponge materials or liquid
silicone injections into the breast tissue.
Today,
breast augmentation is accomplished by placing a silicone "bag"
filled with salt water either behind the existing breast tissue
or behind the muscle of the chest wall.
Women
with ptotic (drooping) breasts, as defined by the nipple being
lower than the crease or fold beneath the breast, will usually
require an additional operation to lift the nipple and remove
the excess loose skin. The augmentation and breast lift procedures
may be combined in one operation.
When
one breast is larger than the other, implants of different sizes
can be used to achieve better symmetry.
In
my practice, women desiring breast augmentation generally fall
into two categories - Young women in their early 20's who have
always had small breasts and desire to be one to two cup sizes
larger; and women in their 30's, often with two or three children,
who have noted a decrease in their breast size after childbirth
and nursing who desire a return to their pre-pregnancy breast
size and shape.
THE
BREAST AUGMENTATION PROCEDURE
After adequate sedation given by an anesthesiologist, a solution
containing a local anesthetic and a drug to minimize bleeding
is injected into the surgical site and an incision is made either
in the fold beneath the breast or at the junction of the pigmented
skin of the areola with the normal breast skin. Some surgeons
place the incisions in the axilla (armpit) or around the navel
(bellybutton). I do not utilize either the axilla or navel incisions.
A
space (pocket) is then developed by separating the breast tissue
from the underlying muscles or by elevating the pectoralis major
(chest muscle) from the ribs. Whenever the decision is made to
place the implant behind the muscle, I also elevate the serratus
anterior muscle (from the side of the chest) so that the saline-filled
implant will be totally
covered by muscle.
After all
bleeding is controlled, the appropriate size implant is then placed
in the pocket and filled with sterile saline solution. The incision
is then closed, a light dressing is applied over the incision
and a soft bra is placed.
THE
RECOVERY
Most
patients will need 5 to 7 days to recover from surgery before
returning to work. Strenuous activity is discouraged for at least
2 weeks. If the implant is placed behind the muscle, it may take
as long as three months for the muscle to relax and for the breast
to "settle" into its final shape.
RISKS
AND COMPLICATIONS
No surgical procedure is risk-free. The following risks/complications
have been associated with breast augmentation: infection, asymmetry
(one breast looks different than the other), numbness (loss of
feeling in breast skin and/or sensitivity in the nipple), hematoma
(excessive blood accumulation surrounding the implant), pulmonary
embolism (blood clot to lung), collapse of a lung (pneumothorax),
death. The most common complications are capsular contracture
(shrinkage of the scar tissue [which surrounds all implants] causing
a change in the shape of the breast, excessive firmness and sometimes
pain) and rupture of the implant or leakage of saline (from a
small hole in the implant or a malfunction of the valve used to
fill the implant) which cause the implant to deflate. Both of
these complications require surgery to correct the problem.
BREAST IMPLANT UPDATE
From
the Annual New Horizons in Cosmetic Surgery Meeting, January,
2002, sponsored by The Plastic Surgery Educational Foundation
and The American Society for Aesthetic Plastic Surgery, Inc.
This table describes the changes in breast implant procedures
done by plastic surgeons surveyed by major plastic surgery organizations
in the United States, between 1998 and 2001.
