|
Information, costs, and side effects
Anesthesia: General or Sedation
Location: Hospital, surgical center or office
Surgery time: 2-4 hours
At the initial visit,
your doctor will likely ask you to describe in detail what you would
like improved. Be specific about what you would like done. If your
surgeon fully understands your expectations, they'll be able to
determine whether your goals are realistic. Your surgeon will examine
your breasts and talk to you about the size you want your breasts
to be.
Breast augmentation is performed to balance a
difference in breast size, improve body contour, or as a post-surgery
reconstructive technique. Silicone shells filled with saline solution
are implanted either directly under the breast tissue or beneath
the chest wall muscle, giving breasts a fuller and more natural
contour.
Breast augmentation will enlarge your breasts. It will not improve
nipple asymmetry, move breasts closer together, or lift droopy breasts.
If you have droopy breasts, consider a breast lift (mastopexy).
During pre-operative exams you and your surgeon will determine:
- Breast Implant shape: round or teardrop
- Breast Implant surface: smooth or textured
- Breast Implant size and volume: cup size/210 ml-500 ml
- Breast Implant placement: above or below the muscle
- Breast Surgery Incision site: armpit, areola, breast or belly
button
- Breast Implant shape
The average cost
of breast implants
Breast Implant Costs: $5,000-$7,000
Surgeons fee: $3,050
Anesthesiologist: $700
Facility fee: $950
Implant fee: $1,300
Breast Implant shape: Round breast implants are not affected
by rotation and cost less than teardrop implants. They do not require
a textured surface. There are no disadvantages to round breast implants.
This is the most common implant employed.
Teardrop breast implants were developed to provide a more natural
look. They cost more than round breast implants and require a textured
surface to prevent rotation. In the event that the implants rotate,
it creates a distorted breast shape.
A recent study determined that a round breast implant takes on the
same shape as the teardrop implant when standing. The study also
concluded that when lying down, the round breast implant is more
natural in appearance than the teardrop implant because it retains
the teardrop shape and the round breast implant does not.
Breast Implant surface: Textured breast implants
have an increased risk of rippling but a decreased risk of displacement.
They also cost more (about $100). A recent study showed that textured
breast implants have a higher deflation rate and are firmer than smooth
implants.
Smooth breast implants have a lower risk of rippling, are less firm
than textured breast implants. Any rotation of the implant will not
affect the appearance. Smooth breast implants are used in 90% of operations.
Saline Implants Approved by the
FDA
On May 10, 2000, the FDA granted approval of saline-filled breast
implants manufactured by Mentor Corporation and McGhan Medical. To
date, all other manufacturers' saline-filled breast implants are considered
investigational.
The majority of implants being used today are saline-filled implants.
These have a silicone rubber shell and are filled with sterile salt
water.
See www.fda.gov
for more information.
Breast Implant size and volume: Breast Implants that
are less than 350 ml have a lower risk of displacement, but may not
provide the desired size.
Breast Implants that are more than 400 ml have a higher risk of
displacement, but may provide the desired size.
Choosing your desired size can be a difficult decision. You'll want
to decide your cup size and that will determine how large your implant
will be. A 400 ml implant placed on a woman with an A cup will produce
a C cup. The same implant placed on a woman with a B cup will produce
a D cup. Bring pictures of your desired size (take a look at a lingerie
catalog or swimsuit pictures) to your consultation. Take the time
to decide what you'll be happy with so you don't feel the need to
undergo a second surgery. You can also ask your surgeon for implant
sizers to try on different breast implant sizes.
Be sure your surgeon plans to overfill the implants. This technique
decreases the risk of deflation, rippling, and sloshing. There are
no disadvantages to overfilling. Implants are meant to be overfilled,
and the implant manufacturers recommend surgeons to overfill them.
Breast Implant placement: Breast Implant position
refers to whether the breast implant is placed above or below the
pectoralis muscle. See Illustration below.
Subpectoral or submuscular breast implants: Placement under the
pectoralis muscle is the approach most commonly used. It has a lower
risk of capsular contracture, interferes less with a mammogram,
and a better cosmetic result in women with small breasts and a worse
cosmetic result in athletic women. It is associated with a lengthier
recovery and more pain and swelling than placement above the muscle.
This approach requires general anesthetic.
Subglandular breast implants: Breast Implants that are placed above
the pectoralis muscle and below the breast tissue. This has a greater
risk of capsular contraction, interferes more with a mammogram,
and a worse cosmetic result in women with small breasts. It has
a better cosmetic result in athletic women (body builders may want
to consider a male pectoral implant as it can look more natural).
It is associated with a shorter recovery and less pain and swelling
than placement below the muscle. This approach can be performed
with intravenous sedation and local anesthetic.
Incision site: Inframammary incision: The incision
is made on the lower portion of the breast, in the crease where the
breast meets the chest, so that any scar will still be hidden. This
incision allows your surgeon the best visibility during surgery. Most
commonly done.
Periareolar incision: The second most common incision is made in
the areola. The incision is usually a small semi-circle. The scar
is camouflaged by the nipple. However, if there are any imperfections
in the scar, it will be highly visible. This type of incision has
an increased risk for diminished nipple sensation.
Axillary incision: The incision is made in the armpit, and may require
the use of an endoscope. The scar is well-hidden, but provides poor
visibility for the surgeon.
Umbilical incision: The incision is made in the belly button. It
usually requires the use of an endoscope, and it is very difficult
to place the implants below the muscle utilizing this method.
Recovery
Pain Level: Breast Implants above the muscle:
Mild to moderate discomfort. Breast Implants below the muscle: Moderate
to severe discomfort following placement under the muscle. 1-2 weeks
of pain medication
Swelling: Above the muscle: 4 days-2 weeks. Below muscle:
2-12 weeks.
Bruising: Up to 2 weeks. Some patients experience no bruising.
Numbness: 1-2 weeks.
Work: Above the muscle: 1 week. Below the muscle: 1-2 weeks.
If job is strenuous or requires lifting, wait a month.
Exercise: Wait 2-4 weeks
Final result: Breast Implants above the muscle: 1 month. Breast
Implants below the muscle: 4 months
On the day of surgery you will feel sleepy and may feel pain or
be nauseated. Your chest may feel tight and uncomfortable. Your
arms and back may also be sore. Pain medication will be prescribed
to minimize your discomfort.
After breast augmentation surgery, your breasts will be very firm,
high, and swollen. After about a month, the swelling will be gone
and they will be lower, smaller and softer. It may take up to a
year for the breast implants to settle into a permanent position.
For faster recovery:
- Keep ice packs applied to your chest on the day of your surgery.
- Sleep in an upright position.
- To avoid unnecessary swelling or bleeding, do not bend over,
strain, exercise, or do any other activities that could increase
pressure in your chest during the first week.
- If you have smooth implants, massage them daily to keep them
softer. Avoid capsular contracture and keep them in proper position.
Do not massage in the first 24 hours and do not massage textured
implants.
Your doctor knows your particular case best, these are only general
guidelines.
Source: www.plasticsurgery.org
Risks
and complications
Silicone Breast Implants: In the early 1990's it
was reported that silicone breast implants were responsible for connective
tissue diseases in some women. After a comprehensive evaluation of
the evidence for the Association of Silicone Breast Implants with
human health conditions, the Institute of Medicine concluded in June
that there is "no definitive evidence linking breast implants
to cancer, neurological diseases, neurological problems or other systemic
diseases." However, silicone implants are still not available
to the general public in the United States. They are still widely
used in Europe and may be available again in the US.
Silicone gel-filled breast implants are available for select cases:
women seeking breast reconstruction or revision of an existing breast
implant, women who have had breast cancer surgery, a severe injury
to the breast, a birth defect that affects the breast, or a medical
condition causing a severe breast abnormality.
Capsular Contracture: Capsular contracture is
one of the most common complications associated with breast augmentation.
It occurs when the scar tissue hardens around the implant. It may
be more common following infection, hematoma, and seroma. Capsular
Contracture is much less common and less severe with saline implants
than with silicone implants.
According to the FDA, in a clinical study of saline-filled breast
implants conducted by Mentor, 9% of 1264 women with implants experienced
Grades III and IV capsular contracture after 3 years of the study.
In a similar study by McGhan, the rate was also 9% (of 901 patients).
The rate of contracture in reconstructive patients is higher.
Another FDA study indicated that 17.5 % of 749 women had at least
one surgical procedure over an average of 7.8 years because of capsular
contracture. This study included women who had implants for cosmetic
and reconstruction purposes, most of whom had silicone gel-filled
breast implants.
Hematoma/Seroma: Hematoma is a collection of blood
inside a body cavity, and seroma is a collection of watery blood
around the implant or around the incision. Postoperatively, they
may contribute to infection and/or capsular contracture. If a hematoma
occurs, it is usually soon after surgery; it can also occur after
an injury to the breast. While the body absorbs small hematomas
and seromas, large ones will require the placement of surgical drains
for proper healing. A small scar can result from surgical draining.
Implant displacement: Implants can move out of
position at anytime after surgery. If they move only a little, it
may not be noticeable. If they move a lot, you may need surgery
to put them into position. This is very uncommon except in women
who have very large implants. The larger the implant, the greater
the chance that it will displace.
Infection: Infection is very uncommon; the risk
is about 1%. If it occurs, it is usually within six weeks of surgery
and the implants will have to be removed.
Necrosis: Necrosis is the dead tissue around the
implant. This may prevent wound healing and require surgical correction
and/or implant removal. Permanent scar and/or deformity may occur
following necrosis. Factors associated with increased necrosis include
infection, use of steroids in the surgical pocket, smoking, chemotherapy/radiation,
and excessive heat or cold therapy.
Galactorrhea: Sometimes after breast implant surgery,
you may begin producing breast milk. This is more likely if you
have previously lactated. The milk production often stops spontaneously
or medication may be given to suppress milk production. In other
cases, removal of the implant(s) may be needed.
Mammography: Saline and silicone implants affect
a mammogram reading. Implants placed below the muscle permit a clearer
reading. When implants are below the muscle, 90% of breast tissue
is visible. When breast implants are above the muscle, 75% of breast
tissue is visible.
Regardless of where placed, breast implants do not interfere with
self-exams. They do not interfere with MRI scans or ultrasounds,
which are alternatives to a mammogram. No studies have shown a connection
between implants and breast cancer (See http://www.pla sticsurgery.org/mediactr/evidence.htm).
However, ineffective mammography could result in a higher risk of
undetected breast cancer from other causes. If you have a history
of breast cancer in your family, breast augmentation may not be
an option.
Rippling: Rippling looks like indentations or waviness
on the surface of the breast. It is the saline moving inside the
implants. In most cases it occurs during movement. According to
a 1994 survey (commissioned by implant manufacturers) 12% of women
who were dissatisfied with their implants were dissatisfied because
of rippling. Rippling is less likely to occur with implants that
have a smooth surface. It is more common in implants that are placed
above the muscle, especially in women with little or no breast tissue.
Rippling can be a result of underfilling the implant.
Sagging: Sagging is less likely in implants placed
above the muscle. Because the implant is likely to be higher on
the chest than the breast tissue, you may have separate tissue hanging
from the firmer implant. Your surgeon may recommend a mastopexy
(breast lift) in addition to the augmentation.
Sensation loss/change: After surgery, you may have
temporary or permanent numbness. There is also possibility of diminished
sensation or increased sensitivity. The risk of having permanently
numb nipples is roughly 15%.
Implants placed above the muscle may have a greater risk for this
as the surgery may interfere with breast tissue near the skin. You
can also expect sensation change if your incision is in the aerola.
If the surgeon injures the nerves which lead to the nipple area
it can lead to temporary or permanent numbness. All incisions have
a risk of diminished sensation.
Rupture or leak: If a saline implant breaks, it
will deflate and the salt water will be absorbed by the body. Alert
your physician right away as the implants will have to be replaced.
Some implants deflate or rupture in the first few months after being
implanted and some deflate after several years. You should also
be aware that the breast implant may wear out over time and deflate.
Additional surgery is needed to remove deflated implants.
In a study conducted by Mentor, 3% of 1264 patients had deflation
after 3 years. In a similar study by McGhan, the deflation rate
was 5%of 901 women after 3 years. Another study indicates that 10.1%
of women followed for an average of 6 years had at least one implant
deflated.(2)
Rupture of silicone-gel implants: When silicone
gel implants rupture, women may notice decreased breast size, hard
knots, uneven appearance of the breasts, pain or tenderness, tingling,
swelling, numbness, burning, or changes in sensation. According
to the FDA, 69% of 344 women had at least one ruptured breast implant.
Factors that were associated with rupture included increasing age
of the implant, the implant manufacturer, and submuscular rather
than subglandular location of the breast implant. A summary of the
findings of this study is also available at the FDA's website at
www.fda.gov/cdrh/breastimplants/studies/biinterview.pdf
For silicone gel and saline-filled breast implants, some causes
of rupture or deflation include:
- damage by surgical instruments during surgery
- underfilling of saline (only) breast implant
- capsular contracture
- trauma, injury, or intense physical manipulation
- excessive compression during mammographic imagingplacement through
the belly button
- Deflation is less likely to occur if the implants are over filled.
If the breast implants are not over filled they will fold when
you move and may eventually rupture and deflate.
Additional surgeries
Additional surgery may be needed to replace or remove the implants
due to problems such as deflation, capsular contracture, infection,
shifting, and calcium deposits. Women who do not have their breast
implants replaced may have cosmetically undesirable dimpling, puckering
of the breast following removal of the implant, or other unsatisfactory
cosmetic outcomes.
In a study of saline-filled breast implants conducted by Mentor,
13% of 1264 patients needed additional surgery after 3 years. In
a similar study by McGhan, 21% of 901 patients needed additional
surgery after 3 years.
A study by Gabriel of both saline and silicone-filled breast implants
concluded that 24% of women with breast implants experience adverse
events resulting in surgery during the first 5 years after surgery.(1)
According to this study, about 1 in 3 women getting breast implants
for reconstruction may need a second surgery within five years,
and about 1 in 8 women getting breast implants for augmentation
may need a second surgery within five years. These additional surgeries
may result in the loss of breast tissue.
Scars
Surgical scars are permanent. However, the incisions are placed
so that they are not normally noticeable except on very close observation.
Scar location will depend on the incision site (either in crease
below breast, armpit, belly button or areola).
Satisfaction rate
A recent study conducted at the University of Minnesota
in consultation with the Food and Drug Administration (FDA) did
a 10 year follow-up with 450 women who had undergone breast augmentation.
Almost 96% of women with saline-filled breast implants stated they
would make the same choice again. 93% were satisfied or very satisfied
with their breast implants and 71% rated their breast implants as
soft and natural.
For more information, view breast
implant before and after photos.
|
