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Breast Augmentation

Breast augmentation is one of the most common plastic surgery procedures today. Breast implants are used during augmentation to increase the size and shape of the breast. Breast augmentation surgery uses implant devices to increase the patient's breast size. In most cases, breast augmentation surgery is strictly a cosmetic increase, but many breast cancer survivors use breast augmentation surgery to repair damages done during their cancer treatments.

What do I need to know before breast augmentation surgery

The plastic surgeon performing breast augmentation surgery and his patient should have at least one pre-operative meeting to discuss the patient's and doctor's expectations, outline the risks and benefits, and plan the procedures. This meeting should cover the patient's medical history, and determine if she is a good breast augmentation surgery candidate (she is in good health and has no conditions that would prevent breast augmentation surgery).

Breast size and shape can be improved through breast augmentation. Yet, a breast lift may also be necessary if the goal is to improve sagging of the breasts.  In the case of mastectomy, the need for breast reconstruction is evaluated that may involve a series of procedures and special considerations relating to the timeliness of the procedure.

The goal of breast augmentation surgery is to achieve natural looking results, consistent with a patient's overall figure. Therefore choosing the appropriate implant size is essential. The idea that any woman can go any size is absolutely untrue. The smaller breast augmentation sizes have a lot of advantages that the larger breast augmentation sizes do not. Many women do not have a desire to stand out as a result of their breast augmentation sizes but have a more realistic appearance. Smaller breast augmentation sizes allow for a great ability to achieve a more natural, softer and more undetectable feeling.

The appropriate size of breast implants is determined by a number of factors including:

  • a patient's expectations
  • her anatomy
  • physical health
  • the patient’s weight
  • other considerations

A good plastic surgeon will discourage a patient from extreme breast enlargement if he believes that the possible risks outweigh the intended benefits of the procedure. Many women do not have enough breast tissue to cover or support extreme breast enlargement, that can lead to a variety of health problems.

How is the procedure performed?

Breast augmentation is performed under general anesthesia in a hospital whereby the plastic surgeon has privileges or in an outpatient surgical center. The procedure may require up to three hours or more when a breast lift is performed at the same time.

In a breast augmentation procedure, incision preference is ultimately left up to the woman undergoing the procedure. There are different benefits and drawbacks to each of the four incision options, which should be discussed in detail with your surgeon. Incision preference will also be related to the type of implant that you desire, as some incisions do not allow for the use of certain implants.

Subpectoral or submuscular

The implant is placed under the pectoralis muscle. This particular breast implant technique is best for women who have small breasts and is not recommended as often for athletic women.

Subglandular

The implants are placed above the pectoralis and below the breast tissue. This breast implant technique is better for athletic women and has a shorter recovery with less pain and swelling.

Periareolar incision

It is the most popular incision used by surgeons to insert implants during breast augmentation. The periareolar incision is made around the edge of the nipple where it meets the surrounding breast tissue. The scar from a periareolar incision is virtually invisible, as it blends well with the natural change in skin color.

In addition to being the most easily concealed incision, the periareolar option has several other benefits:

  • it allows the surgeon to place implants under the muscle or under the glandular tissue
  • if there are any subsequent complications after the initial breast augmentation surgery, an additional incision will not be required
  • the implant is rolled up into a protective sleeve before being inserted through the passage into the implant pocket, preventing the implant from coming into contact with bacteria that could later cause a local infection

On the downside, the periareolar incision is associated with the highest degree of difficulty breastfeeding after surgery. Loss of sensation in the nipple area is also another risk patients should consider.

Inframammary incision

The inframammary incision is a very popular surgical option for breast augmentation. It is made in the fold under the breast, making the scar relatively inconspicuous after surgery. It allows the placement of implants both under the muscle and the glandular tissue. If there are any postoperative complications, the surgeon will typically be able to re-use the incision without needing to make any additional incisions. The scar from the inframammary incision is not as conspicuous as the scar from nipple incision.

A major benefit of the inframammary option is that women typically experience less difficulty breastfeeding. The inframammary incision bypasses the milk ducts, posing less risk of damage to those areas. This surgical option also does not require the protective sleeve when placing the implants.

Transaxillary incision

The transaxillary incision is made under the arm, so that there are no scars in the breast area. It is possible to see the transaxillary scar when the arms are lifted, but the incisions are placed as inconspicuously as possible.

When the transaxillary incision is chosen, the surgeon may conduct the surgery with or without an endoscope. During the surgery, the doctor will make the transaxillary incision and cut a channel from the armpit to the breast area.

One potential drawback of the transaxillary incision is the risk of less than perfect placement of the implant. This is because the surgeon is working further away from the actual surgical destination, leaving more possibility for error. When a surgeon is trained and experienced with the transaxillary technique, the risk of error in implant placement is very low.

If there are postoperative complications that require a subsequent surgery, it is generally not possible to reuse the same transaxillary incision. During a corrective surgery, the surgeon will typically have to use the periareolar or inframammary technique, adding another scar from breast augmentation.

Transumbilical incision

The transumbilical breast augmentation technique, also known as the TUBA method, is a less common incision option during this type of cosmetic surgery. During the transumbilical technique the surgeon will make an incision in the patient's belly button or navel in order to insert the implants.

One of the greatest benefits of the transumbilical incision is that there are no scars in the breast area and all other scars are hidden within the belly button area. While it may seem like an extreme surgical option, the transumbilical technique is actually the least invasive. Recovery time is also not as great with other methods.

There are also limitations and drawbacks to the technique. A patient who chooses this procedure must receive inflatable implants, since it is not possible to have a pre-filled implant guided through such a small incision into the breast area. If there is a complication with the results and additional surgery is required, the surgeon will not be able to re-use the incision and will have to make a periareolar or inframammary incision. The transumbilical technique also has the greatest risk of error because the incision is so far from the actual implant destination.

Procedure

Regardless of incision preference, breast augmentation surgery will begin with the surgeon making one incision for each implant. These incisions will be made as small and inconspicuous as possible in order to reduce the appearance of scarring after the procedure. Once the incisions are created, the surgeon will have to cut a path to the surgical site. Necessary tissues will then be cut and/or separated in order to create a pocket for the implant.

When the patient and her surgeon have chosen inflatable implants, all four incision techniques are possible and the incision is typically smaller. During surgery, the inflatable implant will be rolled up and pushed through the channel into the appropriate place. The incision will be closed once proper position has been attained and the surgeon will fill the implant through a syringe to a predetermined size. If the chosen implant is a pre-filled implant, the incision will be larger and incision preference will be more limited.

Breast Augmentation Recovery

Plastic surgeons provide a complete list of pre- and post-operative instructions in order to reduce the risk of complications and allow for a smooth recovery. Breast augmentation surgery is major surgery, but most patients should be able to return home within hours of their procedure. There is usually considerable soreness and limitation of movement, but pain varies with each person. Breast augmentation surgery, like all surgery, involves some risk of infection, so patients should be careful to keep the incision clean and call their doctor at the first sign of infection.

Recovering from any plastic surgery procedure takes time, greatly depending on individual factors and how invasive the technique was. To help speed up recovery, a top that snugly secures a cold/hot gel pack against the chest has been created. This is just one recovery system developed to help with breast augmentation recovery.

Breast implant risks

Although breast augmentations have been suspected of causing numerous systemic illnesses, the majority of these unfounded claims have been proven wrong. As a result, breast augmentation surgeries are on the rise. Women should be aware, however, that there are potential risks associated with breast augmentations, as are present with any other surgery.

Some women with breast implants can experience some kind of trouble after the procedure. Before you decide to go forward with breast implant surgery, you should consider the risks of breast augmentation. These risks include:

  • breast implant rupture
  • breast pain
  • capsular contracture
  • germ or bacterial contamination of the implant shell
  • infection
  • seroma
  • hematoma
  • other local complications

If you are considering having children, another of the risks of breast augmentation is that breast implants may affect your ability to produce milk for breastfeeding. It is also possible to lose sensation in your breasts or nipples.

While no direct cause and effect link has been identified between breast cancer and risks of breast augmentation, the placement of a breast implant may cause increased difficulty with taking and reading a mammogram. This should also be considered with other risks of breast augmentation when making the decision to have surgery.

When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. It is also advisable to have a baseline mammogram taken prior to breast augmentation surgery.

Nipple and Breast Sensation Changes

There have been a number of implant manufacturer studies conducted to determine the frequency of nipple and breast sensation changes experienced by women who have had breast augmentation surgery.  According to the largest implant manufacturer, Inamed and Mentor, studies suggest that between five and nine percent of patients experience intense changes in nipple sensation at three years and ten percent do at five years.  An additional ten percent of patients will experience a permanent loss of nipple sensation.  Seven to eight percent of patients experience intense skin sensation between three and five years after breast augmentation surgery. This means that over thirty percent of all women will experience nipple and breast sensation changes after breast augmentation surgery. 

Factors

There are some factors that can increase the risk of nipple and breast sensation changes following surgery.  Periareolar incision techniques pose a greater likelihood that the patient will experience nipple and breast sensation changes.  A few studies have also shown an increase in this risk for patients who undergo the transaxillary incision technique.  Nipple and breast sensation changes are possible with any type of incision when nerve damage is caused. 

Nipple and breast sensation changes also seem to be more common in patients who choose subglandular, rather than submuscular, placement of the breast implants.  This complication is more likely with subglandular placement because there is a greater chance that the surgical procedure will interfere and damage the outer layers of the skin that are responsible for sensation.

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