Breast Augmentation (Mammoplasty)
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Breast augmentation (or enlargement) is generally performed on women with underdeveloped breasts or on women who have experienced a decrease in breast size or shape due to pregnancy or weight loss. The surgery consists of lifting the breast tissue and placing an envelope containing a soft, natural-feeling implant material underneath.
Dr. Vincent will evaluate your health and perform a breast exam most appropriate for you, based on the condition of your breasts and skin tone.
Although several implants are available at the present time, the implant which is used most often for augmentation purposes, is made of a silicone shell, and filled with a saline solution. Under certain conditions, silicone gel implants can be used, but these are mostly used for revision surgery. There are a variety of implant designs, all of which have advantages and disadvantages.
Implants may be placed beneath the muscle or above the muscle. Dr. Vincent will explain the advantages and disadvantages with you and will make a recommendation based on the shape and size of your breasts, your skin tone, and chest wall shape. If your breasts are sagging, he may also recommend a breast lift.
Dr. Vincent will discuss the choice of implant, reasons for the selection, and will review with you the size changes that are possible with the procedure.
Breast augmentation is usually done under a general anesthesia on an out-patient basis at a surgery center or a hospital. Several different methods are used for placement of the implants. An incision can be made in the crease of the lower part of the breast, along the lower half of the dark skin around the nipple or in the armpit, or through the belly button known as a TUBA (transumbilical breast augmentation). All of these methods are designed to result in minimal scarring so that the incisions are not easily detected. Working through the incision, Dr. Vincent will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples. The implants are then adjusted to ideal size and symmetry before the incision is sutured closed. The method of inserting and positioning your implant will depend on your anatomy and Dr. Vincent's recommendation. Placement behind the muscle, however, may be more painful for a few days after surgery than placement directly under the breast tissue. The surgery takes approximately one hour to perform.
A surgical dressing is usually placed to protect the incisions. Some swelling, bruising and minor discomfort may be experienced for several days after the surgery. Discomfort can be easily controlled with pain medication.
Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. Your stitches will come out in a week to ten days, but the swelling in your breasts may take three to five weeks to disappear. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.
You should be able to return to work within a few days, depending on the level of activity required for your job.
Dr. Vincent will advise you when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.
Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.
Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.
As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.
A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.
Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.
There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by Dr. Vincent.
Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body.
If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.
Complications (as with any other surgical procedure) can happen in breast augmentation surgery. We recommend you read the specific complications outlined in the Food and Drug Administration pamphlet. To obtain this free pamphlet, contact the FDA Consumer Information Line at 1.888.INFO.FDA (1 888.463.6332.) The Food and Drug Administration Web site can be found at www.fda.gov. A copy of this form will also be provided during your consultation.
More information on the safety of silicone breast implants can be found at www.nap.edu/catalog/9618.html
These surgical procedures will be performed on an out-patient basis, in the hospital, or in an ambulatory surgery center under general anesthesia.