The Basics of Breast Augmentation
Summer and beach weather are just around the corner! As spring begins, we are already seeing a surge of women getting ready for swimsuit season. Breast augmentation is, once again, topping the wish list for new patients in the plastic surgery office.
Despite the popularity and acceptance of breast augmentation in our country, many women still have questions about this procedure. The sheer volume of misinformation that circulates about breast implants is both astounding and confusing.
This article presents scientific data from published, peer-reviewed clinical studies in order to answer some of the most common questions about breast augmentation. Hopefully, this factual approach to a sometimes emotional topic can help women make the best choice for them. Happy sunbathing! (with sunscreen on.)
The Basics
Breast augmentation helps women by adding volume to the breasts. The majority of patients who decide to get breast augmentation usually fall into one of two categories: Category One: Women in their twenties who were never quite happy with their breast development, and Category Two: Mothers who hope to correct the "deflated" look of their breasts by achieving a more youthful fullness.
"Breast augmentation is an outpatient procedure lasting approximately one hour. Most patients can return to work after a long weekend of rest and recovery. Most women can even resume their full aerobic exercise routine as soon as four weeks following breast augmentation."
In contrast, sometimes the problem can be more than just a lack of breast fullness. Some women may have drooping of the breasts characterized by nipples which point down instead of forward. Such patients will benefit from a breast lift (mastopexy), which can be done by itself or in combination with breast implants for added volume and lift. Still, some women experience drooping of the breasts but actually prefer that their breasts were smaller, as opposed to larger, in which case, a breast reduction would be beneficial.
Breast augmentation is an outpatient procedure lasting approximately one hour. Most patients can return to work after a long weekend of rest and recovery. Most women can even resume their full aerobic exercise routine as soon as four weeks following breast augmentation.
Breast Implant Safety
Breast implants are among the most studied of all medical devices. During a 14 year moratorium on the cosmetic use of silicone gel implants, literally thousands of studies on breast implant safety and effectiveness were reviewed. No research was found to support claims that silicone breast implants had caused autoimmune diseases (Lupus, Rheumatoid Arthritis, etc.) or other systemic diseases. Therefore, in the fall of 2006, the FDA once again made silicone gel implants available for cosmetic breast augmentation. Now patients may choose either silicone or saline breast implants for their cosmetic augmentations.
However, this is not to say that patients should regard breast augmentation as a risk-free endeavor. All surgeries carry surgical and anesthetic risk. In addition, breast augmentation also poses the risk of implant-related complications. For example, breast implants (like all devices implanted in the body) form scar tissue capsules around them. These capsules can harden and hurt the appearance and softness of the breasts. Also, nipple sensation can be affected. Although most patients have temporary post-op numbness which returns to normal, some patients can have a permanent decrease or loss of nipple sensation, while others experience a permanent increase in sensation. Additionally, there is a risk of implant rupture that is about 1% per year for both saline and silicone-filled implants. A few studies suggest that breast augmentation may affect a woman's ability to breast feed in the future as well. Patients should also note that after breast augmentation, gravity will cause stretching of the breast over time (ptosis), and this stretching will be more severe when larger, heavier implants are placed.
Despite these risks, breast augmentation does not affect a woman's chance of developing breast cancer. The ability to detect a breast cancer by mammography is not decreased by breast augmentation as long as the implants are placed under the pectoralis major muscle, and an appropriate five-view mammogram is done.
Augmentation Choices
At this time, the vast majority of breast implants used are smooth, round implants, as opposed to textured or shaped devices which were more popular several years ago. Most implants are now placed underneath the pectoralis major muscle, giving the advantage of a hiding the implants better, making mammography easier, and in many cases, giving a more natural-looking result. More than 90% of breast implants are inserted through small incisions in the fold underneath the breast (inframammary fold), although implants can also be placed through incisions in the armpit, as well as incisions around the border of the areola (pigmented skin around the nipple). Placement of implants through a belly-button incision has not gained popularity with either surgeons or patients.
Another choice the patient must make is silicone-filled and saline-filled breast implants. Silicone implants have the benefit of being softer and more natural-feeling, but are more expensive and require a slightly longer incision to insert the implant. Also, the FDA requires that an MRI be done to evaluate for silicone implants rupture every two years which can be expensive. Plus, the chance of forming hard scar tissue (capsular contracture) around the implants is higher with silicone implants than with saline.
Finally, patients must choose the size of implant. Often patients can "shop" for their new breast size by trying on different "sizer" implants, which can be both fun and confusing, as it is difficult to make a final decision about size. Although one study showed that 90% of women wished they went bigger, it is important to keep in mind that larger implants increase the risk of certain complications. Additionally, not all sizes of implants will reasonably fit all patients. Therefore, the sizing process is best worked through with your Plastic Surgeon and his/her staff.
Frederick G. Weniger is a third generation physician. He is cosmetic surgeon with his own practice, Weniger Plastic Surgery, with locations in Bluffton, Hilton Head and Beaufort. He can be reached by calling (843) 757-0123 or by logging on to www.wenigerplasticsurgery.com.