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.

hat are the risk of surgery?

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.