Breast augmentation is a surgical
procedure to increase the size of the breasts. It is usually
performed to enlarge small, underdeveloped breasts that
have decreased in size after pregnancy. It can also be
performed in cases of breast deformity, or where one breast
has not developed in proper symmetry with the other. When
a breast is lost due to breast cancer, breast reconstruction
may also be possible.
There are several types of incision
techniques that can be considered for breast augmentation.
The incision type used generally depends on the surgeon's
technique. Once the incision is made, the surgeon will
lift breast tissue up and down to create a pocket. This
pocket will either be under the tissue or underneath the
chest wall muscle. Once the pocket is created, the surgeon
will place a breast inplant inside. Traditionally, this
procedure has been accomplished by using a flexible pastic
envelope containing a silicone gel. However, there have
recently been concerns raised about the safety of silicone
implants. While further research is being done, new patients
desiring breast augmentation are restricted to saline-filled
implants.
Breast augmentation surgery can usually
be done in one-day surgery as an outpatient procedure.
Most women are able to return to work in four days.
Risks:
As in any surgical procedure, there is a chance of infection
or bleeding. Loss of nipple sensitivity is also a risk,
but fortunately quite rare. A small percentage of patients
experience scarring around the breast implant, producing
a tightening of the implant. (encapsulation). This makes
the breasts too firm. This condition can be remedied,
but will probably require an additional procedure.
Costs:
Breast Augmentation surgery ranges between $3500-$5000,
depending on the size of the implant, and the type of
surgery (such as subglandular or submuscular)
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About Breast Reconstruction
Each year, thousands of women lose
their breasts to cancer. To compensate for the loss, some
choose to have their breasts reconstructed. Breast reconstruction
can be done during, or following a mastectomy. Breast
reconstruction can be performed on even those women whose
skin has been damaged by radiation, or those who have
had a radial mastectomy. (Where the pectoral muscles have
also been removed.)
Breast Reconstruction Procedure If
done during a mastectomy, after the breast has been removed,
an implant is inserted, the incision is then closed and
drainage tubes inserted. This type of reconstruction has
several advantages: It avoids a second operation, an additional
scar, and increased expense. Many people who undergo reconstruction
during mastectomy surgery, rather than after, do not experience
the same sense of loss.
If breast reconstruction surgery
is done following mastectomy, there are a couple of options.
The most typical method of reconstruction involves gradually
stretching the skin and muscle so that an implant can
be inserted. During the initial surgery, a balloon-type
expander is placed under the tissue of the chest wall.
Over the course of several weeks, the balloon is filled
with increasing amounts of salt water solution. When the
skin and muscle are stretched enough, the expander is
removed, and replaced with a permanent implant.
On occasion, there is enough loose
skin to allow for the placement of an implant without
going through the step of expansion. This method uses
the patient's own tissue from either the abdomen or back.
The skin, fat and muscle are repositioned on the chest
wall creating a natural breast contour with, or without
the use of an implant. Most women who undergo breast reconstruction
also have nipple reconstruction surgery. The final step
utilizes tattooing pigment, to help the reconstructed
breast look as natural as possible.
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Incisions in Breast Enlargements
Saline implants for breast enlargement
can be placed through several types of incisions. Usually
the type of incision used depends on the surgeon's technique.
There are several types of incisions
that are used for breast enlargement. One of the most
commonly used incision techniques is an inframammary (in-fra-mam'-a-ree)
incision. This incision is made slightly above where the
lower part of the breast touches the chest. Another common
technique is the periareolar (pear-e-are-ee-o-lar) incision.
This incision is made around the lower border of the areola
(are-ee-o-la) which is the dark pink skin that surrounds
the nipple. Another technique, which is used less frequently,
is an incision in the armpit. Incisions are generally
very small, one-inch incisions which are then filled with
a saline-filled implant.
Once the implant is complete, the
incisions are then closed by a few sutures. The sutures
will be removed within a week of the surgery and every
effort is made to keep scars as inconspicuous as possible.
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Technical Information Regarding Breast
Augmentation
Breast augmentation requires incisions
to insert an implant. This incision is usually no longer
than an inch. It can be placed (following the surgeon's
preference or the patient's specific needs) in the fold
below the breast, below the areola or in the armpit region.
Rarely, the umbilical road will be chosen.
Implants can be placed under the
gland (subglandular) or under the pectoral muscle and
gland (submuscular). Submuscular placement is the most
common for saline-filled implants since it reduces the
risk of ripple, implant visibility, and hardening of the
breast.
Sometimes scarring can occur around
the breast implant, producing a tightening of the implant
(encapsulation). This process occurs in a few cases, producing
breasts that are two firm. This condition can be remedied,
but will probably require an additional procedure.
A breast lift is the placement of
an implant to correct the sagging of the breast. After
an evaluation, the surgeon should tell you if placement
of the implant is sufficient to correct breast or nipple
sagging or if an additional procedure is needed. This
second surgery can be done simultaneously with breast
augmentation, but will require more incisions than a simple
enlargement.
As in any surgical procedure, there
is a chance of infection or bleeding. Loss of nipple sensitivity
is also a risk, but fortunately is quite rare. And remember
the long-term effect of a breast implant should be discussed
with an experienced plastic surgeon at the time of the
original evaluation.
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Placement in breast enlargement
A woman can choose to enlarge her
breasts through a process called augmentation (awg-men-tay-shun).
This surgical procedure involves the placement of an implant
under the breast in order to increase its size. There
are two types of placement options for implants.
A breast implant can be placed either
over or under the pectoralis chest muscle. There are advantages
to each approach depending on a patient's age, degree
of breast sagging, and requirements for mammography. In
general, the sagging breast requires an implant to be
placed above the muscle in order to provide the most aesthetically
contoured breast. However, an implant placed below the
muscle makes mammography a little easier.
These factors as well as others should
be carefully considered to determine which placement option
is most appropriate for you. Consultation with an experienced
board certified plastic surgeon familiar with both approaches
is advisable.
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Saline Implants
In nineteen ninety-two (1992), the
Food and Drug Administration outlawed the silicone gel
breast implant for most breast surgery. Saline implants
have since replaced the silicone gel implant for breast
augmentation and reconstruction. These implants contain
a natural salt water solution surrounded by a textured
silicone rubber shell.
Implants may be placed between the
breast and the muscle behind it, or between the muscle
and the ribs. Your surgeon will discuss with you the pros
and the cons of each placement option.
The Food and Drug Administration
is also currently scrutinizing the use of saline implants
in breast augmentation. A detailed review of the safety
data and the FDA position on saline implants can be provided
by an experienced, board certified plastic surgeon.
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