What are the benefits of
breast augmentation with implants? This operation is performed
to enhance or restore the size and shape of a of lack of development
or changes following pregnancy, weight loss or congenital abnormalities.
Sometimes a woman's breasts are very asymmetric. This
operation can improve a woman's self esteem and quality of life.
Studies have shown over 90% of women are satisfied
with their results. Currently, saline implants (silastic bags filled
with salt water) are placed either behind the pectoral muscle and breast
tissue or in front of the muscle. This is done through an incision 1-1/2"
- 2" long placed either under the breast, around the areola, or in the
armpit.
What
do breasts look like after augmentation mammaplasty?
Saline-filled prostheses are the best means now available to enlarge
the breast by surgery However, the prospective patient should know
that the final appearance, shape and texture are not exactly the
same as normal breasts. They tend to be more firm. The contours
are usually somewhat different than in normal breasts. In some patients
these discrepancies may be rather noticeable. Although every effort
is made to place the implants symmetrically, complete symmetry is
rarely achieved. Immediately after surgery the breasts may appear
swollen and firmer. The final shape and size is seen after several
weeks. Please note that silicone gel implants are no longer available
for elective new breast augmentations because of FDA restrictions.
Are the prostheses safe? Can they cause cancer?
To the best of our present knowledge, these prostheses are made of
nonreactive, safe material. No one has had them in place for more than
about 25 years at this time. Thus, there is no way to say positively that
they won't cause trouble 20 years from now, but it is unlikely. The incidence
of cancer in augmented breasts is the same as that in normal breasts.
What kind of anesthetic is used? A general anesthetic is most
common when the implant is placed under the pectoral muscle. A local
anesthetic with sedation can be used if the implant goes in front of
the muscle.
What are my limitations in activity postoperatively? You should
plan to avoid activities which require much raising of the arms above
the level of the head for 10 days after surgery. With great care,
you can drive a day or two after surgery. Patients can usually return
to work in a few days unless their occupation requires particularly
strenuous movements and lifting. In such a case, 2-3 weeks should be
allowed.
General Risks of surgery include infection, pain, delayed
wound healing, hematoma (a collection of blood at the surgical site),
bleeding, reactions to anesthetic.
Cosmetic Complications: You may not be satisfied with appearance
of your implants(s). Incorrect implant size, inappropriate scar location
or appearance and misplacement of implants may interfere with a satisfactory
appearance. Asymmetry (unequal breast size or shape) may occur. The
implanted breast may sag or droop (ptosis) over time, much like a
natural breast. Very rarely the implant may change position or break
through the skin, particularly if you have very thin breast tissue
covering it. This is more common with saline implant(s).
Bleeding: When blood collects beneath the skin it causes
excessive discoloration. Sometimes lumps which last many months may
occur. If blood collection id discovered, it is usually removed by
taking out a few stitches and squeezing the clot out, or inserting
a needle and aspirating it. If bleeding continues it is sometimes
necessary to return to the operating room to stitch the bleeding vessels.
The risk is increased in people who take aspirin or who bruise easily.
Let your doctor know if this is the case. Do not use aspirin or aspirin-containing
products for two weeks before and two weeks after surgery. (See list
of medications which may increase bleeding.)
Wrinkling and Rippling: Some wrinkling of the implant shell
is normal and expected. If your breast tissue is very thin, these
wrinkles can show up as visible ripples, especially when you lean
forward without wearing a brassiere. The wrinkling can also produce
little corners on the implants that can sometimes be felt with your
finger if the breast tissue is very thin.
Capsular Contracture: The scar tissue that forms around the
implant can tighten and squeeze the implant as a natural response
to foreign object implanted in the body. This firmness can range from
slight to very firm. The firmest ones can cause varying degrees of
discomfort or pain. Capsular contracture can occur on one breast or
both. Implants under the muscle may result in less contracture.
Rupture/Deflation: Breast implants may not last a lifetime.
The silastic shell can break due to normal wear over time, injury
valve malfunction, breast manipulation (Mammograms), or unknown reasons.
The usual sign is loss of breast size over days or weeks. The saline
(salt water) will be absorbed by the body without any harm. Surgical
replacement will be needed to restore the breast size. Replacement
will involve additional costs.
Numbness: Sensory changes are expected to some degree immediately
after surgery but loss of nipple and breast sensation my be permanent.
Increased sensitivity is less common but does occur. These changes
can interfere with comfort, sexuality and nursing (lactation).
Pain: Can be related to the surgery itself or a later response
to problems such as tight capsule formation.
Infection: When severe may require removal of the implant
if it is not controlled with antibiotics. Rarely this can occur any
time after surgery. Consideration should be given to taking prophylactic
antibiotics with dental work or other surgeries. If an implant is
removed, replacement may be delayed for three months.
Hematoma: May require surgery to remove the collection of
blood. Sudden swelling of the breast after surgery should be immediately
reported to the doctor.
Scars: Generally do well with all breast incisions. However,
healing is unpredictable and occasionally patients may form thickened
or red hypertrophic/keloid scars. Additional surgery may be required.
Interference with Mammography: An implant can interfere with
the detection of early breast cancer because it may "hide" suspicious
lesions in the breast during an X-ray exam. It is especially important
for women who at high risk of developing breast cancer to consider
this before having implants. Additional views are required for routine
mammography in patients with implants. Mammographyis more effective
with implants under the muscle.
Calcium Deposits Can develop in the breast tissue at any
time after surgery. These are benign but may be confused on an X-ray
with breast cancer calcium deposits and require a biopsy.
Alteration in Breast Feeding: For women who have not had
children, this may alter your ability to nurture children. Spontaneous
lactation may occur after this surgery but is usually self-limited.
Lifetime of Implant: Implants will not last forever. The
FDA currently estimates implants will last about 10 years. This is
an estimate. The FDA has not reviewed all data about saline implants.
(1994)
Unknown Risks: In addition to these know risks, there are
unanswered questions about saline-filled breast implants. For example,
questions have been raised about whether these devices might cause
autoimmune diseases such as lupus, scleroderma and rheumatoid arthritis
in some women, or whether they might increase the risk of cancer.
There is not scientific evidence at present that women with either
silicone gel-filled or saline-filled breast implants have increased
risk of these disease, but the possibility cannot be ruled out.
Photography: Photographing, filming or videotaping of the
treatment or procedure for educational or diagnostic use is a standard
and required part of patient care.
No Guarantee: The practice of medicine and surgery is not
an exact science. Although good results are expected, there cannot
be any guarantee, nor warranty, expressed or implied, by anyone as
to the results that may be obtained.
Complications and Additional Surgery: Any of these problems
or disorders noted above may require additional surgery, hospitalization,
and time away from work. If this occurs. there will be additional
costs for surgical fees, supplies, anesthesia, etc. depending upon
the required operation. Complications of cosmetic surgery generally
will not be covered by medical insurance.
The better known complications are discussed above. Please ask
your surgeon if you want to know about remote complications, or
if you have any other questions.
