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Breast Augmentation Surgery Overview

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Breast augmentation is surgery to enhance the size and shape of your breasts. Over the half-century plus that it has been performed, this procedure, also known as augmentation mammoplasty, has steadily improved in safety and effectiveness as new techniques and implants have been developed and adopted.

Breast augmentation surgery usually involves placing implants that simulate natural breast tissue into the body. Breast implants are pouches of either saline (a sterile salt water solution) or gel-like silicone. The pouch material is a rubbery material called silicone elastomer. In the United States, the Food and Drug Administration (FDA) regulates the types of breast implants that may be used. We have separate sections devoted to saline implants and silicone implants.

During augmentation surgery, the implants are added to the natural breast to create a larger breast size. Natural breast tissue may also be reshaped to create the desired look, and this may be a significant part of the surgery as it is in pectoral enhancement surgery for men, which usually involves reshaping the tissue rather than adding implants to increase the size of the chest.

Breast augmentation can have life-changing results. Some women have always wanted bigger breasts than what nature gave her. Some breast augmentation patients are seeking to regain their youthful breasts, which may have lost volume due to age, pregnancy, nursing or weight fluctuations. Other women undergo breast augmentation to rebuild breasts lost to disease or accident. Either way, most women who have breast augmentation feel better about themselves because they feel that they look better. Improved appearance can aid self-esteem and self confidence for almost anyone.

It must be stressed that any cosmetic surgery breast enhancement, face lift, rhinoplasty or liposuction, to name a few can improve a persons physical appearance, but that is all it can do. It cannot change your mental or emotional state. If you are suffering from depression or other psychiatric or psychological problems, breast augmentation is not going to help you. You need to deal with mental or emotional problems before you consider any cosmetic procedure.

You may have already seen lots of breast augmentation photos showing before-and-after shots of breast augmentation patients, and you may know women who have had breast implants or breast enhancement surgery. Remember that your results may not match the photos and that your experience may not be the same as that of your friends. Your experience will be as individual as you are, and results may be different due to age, your bodys ability to heal, your overall health, your current breast size and structure, and other factors. No two people ever have the same experience or the same results because no two people are exactly the same. 

You also must understand that breast augmentation surgery can permanently change your breasts. If you decide to have your implants removed in the future, your breasts will not look exactly the same as they did before you had surgery. 

Common Reasons for Wanting Breast Augmentation

Breast augmentation is a very popular and commonly performed cosmetic surgery. According to the American Society of Plastic Surgeons, breast augmentation was the most popular surgical cosmetic procedure performed in 2007, when more than 347,000 women underwent the procedure. Liposuction and rhinoplasty (nose reshaping) came in second and third as most popular cosmetic procedures.

The most common reason for breast augmentation surgery, to state the obvious, is to increase the size of the breasts. But the procedure is also done to balance unevenly sized breasts and to reconstruct the breast after mastectomy or injury.

Women who have undergone childbirth are often candidates for breast enhancement surgery. Pregnancy, breastfeeding, and general aging can result in a loss of breast tissue, and women who experience this may see breast augmentation surgery and sometimes a breast lift as a way to regain a more youthful appearance.

Other women opt for breast enhancement surgery simply because they are not happy with the size and shape of their breasts. And women who have undergone a mastectomy because of breast cancer often choose to have breast surgery to replace their lost breast. This type of surgery is referred to as reconstructive breast surgery.

Choosing to undergo breast augmentation surgery requires serious thought. It is not a decision to be made lightly. There are inherent risks to breast augmentation, just as there are with any other types of surgery. There is the possibility that you could experience complications that can have lifelong consequences. For this reason, you should consider your options carefully, choose a qualified breast augmentation surgeon and, most importantly, understand the risks and benefit's of the procedure.

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Points to Consider Before Having a Breast Augmentation

The U.S. Food and Drug Administration (FDA) offers the key points below for you to consider before undergoing breast augmentation, reconstruction, or revision:

  • Breast implants do not last a lifetime. Either because of rupture or other complications, you will likely need to have the implants removed and/or replaced. (Many surgeons and most implant manufacturers recommend that breast implants be replaced after 7 to 12 years).
  • You are likely to need additional doctor visits and revision operations because of one or more complications over the course of your life.
  • You are likely to have the implants removed, with or without replacement, because of one or more complications over the course of your life.
  • Many of the changes to your breasts following implantation may be cosmetically undesirable, as well as irreversible.
  • If you later choose to have your implants removed, you may experience unacceptable dimpling, puckering, wrinkling, loss of breast tissue, or other undesirable cosmetic changes of the breast.

Discuss these issues with your plastic surgeon during your initial breast augmentation consultation.

When visiting your plastic surgeon for the pre-surgical consultation, ask to view before and after breast implants pictures for his or her patients. The surgeon or surgical coordinator should take time to sit with you while reviewing pictures from previous patients so that you can ask questions about specific previous patients. Also, you may want to ask if you can contact previous patients to learn more about their experiences.

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    Health Insurance Issues Associated with Breast Augmentation

    Another factor to consider when you are thinking about having breast enhancement surgery for cosmetic or reconstructive reasons is the cost, not just immediately, but in the future. Health insurance rarely covers breast implant surgery, unless it is done to reconstruct a diseased or injured breast, such as after mastectomy. In fact, your health insurance premiums may increase, your coverage may be dropped, and future coverage may be denied. Treatment of complications or the costs of future tests recommended by your surgeon (MRIs, ultrasound) may not be covered either. You should check with your insurance company regarding these coverage issues.

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    How Breast Augmentation Surgery Is Performed

    Women who are considering breast augmentation surgery should have a complete understanding of how the procedure is performed. Your surgery may differ from what we describe here, but this description is very typical of the experience.

    Breast enhancement can be performed in a free-standing surgical clinic,a surgical suite in your surgeon's office, or in a hospital. It is often done on an outpatient basis, where you arrive in the morning and go home that afternoon or evening.

    Generally, breast augmentation surgery takes up to 4 hours to perform, depending on the technique used, the skill of the surgeon, how much reshaping of the natural breast tissue is needed, and other factors. More extensive surgery takes longer; less complicated surgeries can be done more quickly. If you are having other cosmetic procedures at the same time such as liposuction, tummy tuck, or a breast lift this will extend the length of the surgery.

    A breast implant can be inserted in several ways to give the appearance of a well-shaped, natural-looking breast. Unless there is no breast tissue, such as after a mastectomy, the implant is almost always placed underneath glandular and fatty tissue that is the natural breast. That placement between the breast and ribcage can vary slightly, but significantly:

    • In a subglandular placement, the implant is placed under the breast tissue and above the muscles of the chest wall. This most closely resembles the placement of normal breast tissue.
    • In a partial submuscular placement, the implant is placed under the breast tissue and partially under the pectoral and other chest muscles. The surgeon will cut the pectoralis major muscle and slip the upper part of the implant under that, while the lower part of the implant is placed above the muscles and beneath the breast.
    • In a complete submuscular placement, the implant is placed completely under the muscles and connective tissue called fascia. The upper portion of the implant is behind the pectoralis and serratus muscles, while the lower part is under connective fascia connecting those muscles.

    Implants that are placed under muscle are sometimes called unders and those placed over the muscle are referred to as overs. There are advantages and disadvantages to each of these placements that you should discuss with your surgeon.

    In addition to the placement of the breast implant, there are several locations for the incisions through which the implants are inserted. Incisions can be made in the navel (known as transumbilical breast augmentation, or TUBA), in the armpit (transaxillary), around the nipple (periareolar), in the crease under the breast (the inframammary fold). Another procedure called transabdominoplasty (TABA) is similar to TUBA in that the implants are tunneled up from the abdomen into the chest. This technique is used when the patient is simultaneously undergoing a tummy tuck (abdominoplasty) and avoids creating extra incisions in the chest area.

    The choice of incision used depends on how much scarring you are willing to put up with,whether this is a first implant or a revision surgery, what type and size of implant is being used, and other factors. Incisions are almost always made where the scarring will be least noticeable. Again, there are advantages and disadvantages to each type of insertion that you have to discuss with your surgeon.

    There are several phases of breast augmentation surgery:

    Preparation: This is the phase when you are prepped for surgery. At this time, your surgeon will mark you with a semi-permanent marker to indicate where incisions will be made. The location, length, and direction of these incision lines will be dictated by the technique being used. During preparation, you will be scrubbed with an antimicrobial agent to minimize the possibility of infection. You may be given injections of lidocaine and epinephrine. Lidocaine is a pain reliever, and epinephrine is a vasoconstrictor, which constricts blood vessels and decreases the risk of excessive bleeding during the surgery. You will also be hooked up to several monitors so that the surgical team can monitor your vital signs.

    Anesthesia: The choice of anesthesia should be discussed with your surgeon well before surgery. There are several options for anesthesia during breast enhancement surgery. These include general anesthesia, conscious sedation, or local anesthesia. With general anesthesia, you are completely unconscious and unaware. With conscious sedation, you are asleep, but not completely unconscious. Local anesthesia numbs the chest area where the surgeon will be working, and you usually also receive a sedative to keep you calm and relaxed. In all cases, you will most likely have an intravenous (IV) line started. This is used to maintain your hydration levels or to administer medications during the procedure. After administering the anesthetizing medications, your surgeon will test to ensure you are sufficiently anesthetized before beginning the procedure.

    Surgical Procedure: After anesthesia is begun, your surgeon will carefully follow the premarked incision lines drawn during the preparation phase. After making the first incision, he or she will create a pocket behind the breast tissue or under the pectoral muscle tissue; this process is called dissection. The surgeon then inserts the implant into the pocket. A silicone implant is put in place already filled, and saline implants are inflated with saline at this point. The incisions are then closed and a dressing is applied to protect the wounds, to keep the tissue and implant securely in place, and to reduce swelling.

    Recovery: Right after the surgery, the patient is awakened and moved to a recovery room where nurses monitor vital statistics for about 2 hours. You may feel a number of sensations during this time, including pain, nausea, or uncontrollable shivering. Some patients experience emotional anguish as they come out of surgery. The staff can provide you with pain relievers, antinausea medications, and warm blankets if you need them.

    After your surgery, your surgeon will give you a card containing information about the implants that were placed in you. This is called the device card. Keep it in a safe place because you may need it in the future. The card gives information about the brand, type and lot numbers of your implants.

    Usually, you go home a few hours after your surgery. You must arrange for someone to drive you home because you may still  be a bit groggy and possibly sore.

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    Breastfeeding After Breast Augmentation

    With increasing numbers of younger women undergoing breast augmentation, one question often arises: Can I breastfeed after breast augmentation?

    Breastfeeding with breast implants is not impossible, but the implants may make the process more difficult. You really wont know until you try. Whether or not you are successful depends on many variables, but one of the most important is whether milk ducts and major nerves were cut or damaged during the breast augmentation procedure. Other factors include the length of time since the surgery, past lactation experiences, and the mothers support system.

    If you are having breast augmentation surgery and plan to breastfeed any future children you may have, its best to explain this to your plastic surgeon. He or she can take your plans into consideration when deciding which breast augmentation technique to use. For example, both the type of incision and implant placement can affect a womans ability to breastfeed at a later date. The most risky incision is the periareolar (around the areola) because it may damage nerves that trigger the release of prolactin and oxytocin, two hormones responsible for milk production. The other incisions outlined above are a better bet, but none guarantee the ability to breastfeed. As for implants, those placed under the muscle are less likely to place pressure on the milk ducts than those placed over the muscle.

    If you have already undergone breast augmentation and would like to breastfeed, there are a few points to consider. If you have experienced a loss of sensation in the breast or nipple, it could indicate that nerves were cut or damaged. They can regenerate on their own during a process known as reinnvervation, but it takes time. Similarly, any milk ducts that were cut or damaged can reconnect and create new pathways (recanalization), but the amount of milk available to your infant will depend on how many ducts were affected and whether they grow back. Damaged nipples or areolae can also impact on the milk flow from the breast. Your OB/GYN, local lactation specialist, or a representative of La Leche League International can provide you with information and with help when you breastfeed..

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    Other Factors to Consider Before Getting Breast Implants

    • Breast implants dont last forever. The day will come (on average, about 10 years after your initial surgery) when your implants will need to be removed for either cosmetic or functional reasons. Many surgeons and implant manufacturers recommend removing or replacing breast implants after 7 to 12 years. Swapping out old implants for new is a fairly straightforward procedure, and it usually requires less recovery time than the original surgery.
    • Breast implants can alter the shape and feel of your breasts, which may require additional surgery to correct. If you decide to have you implants removed at some point, your breasts will not return to their pre-implant appearance. Its also important to know that breast implants will not keep your breasts from sagging after pregnancy.
    • Breast implants can interfere with mammograms to screen for cancer. Additional images of various angles of your breast will be necessary, and those images may be harder to interpret because the implant may obscure the cancer. Your doctor may recommend more advanced imaging tests, such as ultrasound or magnetic resonance imaging (MRI) to be safe, and your insurance may not cover these tests. The American Cancer Society strongly encourages all women, including those with breast implants, to  have regular mammograms and an annual examination of your breasts by a health professional. Many groups involved in cancer screening also recommend that you regularly examine your breasts.

    Website References:

    American Society of Plastic Surgeons
    American Society for Aesthetic Plastic Surgery
    Humberto Palladino, MD

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