Breast augmentation is surgery to enhance the size and shape of your breasts. This surgical procedure has been performed for more than 50 years, and has continued to improve in safety and effectiveness.
Cosmetic breast surgery procedures like breast augmentation are more popular than they have ever been. They are now within the financial reach of almost everyone and many women are taking advantage of it.
Breast augmentation usually involves placing implants that simulate natural breast tissue into the body. Breast implants are usually pouches of either saline (a saltwater solution) or gel-like silicone. The pouch material is a rubber-like material called silicone elastomer. In the United States, the Food and Drug Administration (FDA) regulates the types of breast implants that may be used.
During augmentation surgery, the implants are added to the natural breast to create a larger breast size. Your own natural breast tissue may also be reshaped to create the desired look. This reshaping of your breast tissue may be a significant part of the surgery. In fact, breast enhancement surgery for men usually involves reshaping the tissue rather than adding implants to increase the size.
Breast augmentation can have life-changing results. Most breast augmentation patients are seeking to regain their youthful figures, which have been altered by age, pregnancy, nursing or weight fluctuations. Breast augmentation surgery can significantly increase their confidence by giving them a more appealing appearance.
The impact that breast enhancement surgery can have on how you feel about yourself can be amazing. 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 cosmetic surgeries such as a breast enhancement, face lift, rhinoplasty or liposuction can improve a person’s physical appearance, but that is all they can do. They cannot correct mental conditions. 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.
A cosmetic surgery can only change your appearance, it cannot change your mental or emotional state. Still, a cosmetic procedure can help you feel better about your appearance, which can give you self confidence and boost your self esteem.
You will probably see before-and-after photos of breast augmentation and you may know other 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 match that of your friends. Your experience and results may be different due to age, your body’s 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 the same.
Breast implants do not last forever. You will probably need surgery at some time in the future to remove and replace your implants, and they may need adjustment or permanent removal. You should discuss this with your plastic surgeon during your initial breast augmentation consultation. Many surgeons and most implant manufacturers recommend that breast implants be replaced after 7 to 12 years.
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 2006. About 329,000 people had breast augmentation in 2006. Nose reshaping and liposuction came in second and third as 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.
Women who have undergone childbirth are often candidates for breast enhancement surgery. Pregnancy, breast feeding, and aging can result in a loss of breast tissue and women who experience this may see breast enhancement surgery 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 of course, women who have undergone a mastectomy because of breast cancer often choose to have breast surgery to replace their 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 pros and cons of the procedure.
Breast Augmentation and Breast Implant Myths
There are many myths about breast augmentation and breast implants in general. These myths cover the spectrum from health concerns to physical appearance. Some information about breast enhancement is out of date or only relates to procedures or types of implants that are no longer used. Having all the facts at hand about breast augmentation will help you better understand the procedure.
Myth: Breast implants rupture all of the time.
Fact: In reality, breast implants are quite durable, and while occurrences of ruptures do exist, they are not common. For one brand of breast implant, the incidence of rupture after breast augmentation was 2.7% over 4 years. A study conducted with 106 women who had breast implants an average of 11 years showed an incidence of rupture of 15%. (Please note that this study was done in Europe and may have included older types of implants.) A study of saline implants found that leakage or deflation occurred in about 3% of cases after 3 years.
A rupture occurs when the shell of the implant develops a tear or hole. Rupture in a silicone implant may be what is called “silent.” This means that you have no signs that your implants are leaking. With saline implants, rupture will cause the breast to deflate, either slowly or quickly.
Myth: As soon as an implant is placed in the body, the implant is changed forever.
Fact: The chemical make-up of the implant is not changed as soon as it enters the body, but this does not mean the implants will last forever. Implants are not designed to last forever, and a replacement surgery will likely be required at some point.
Myth: Capsular contracture (CC) happens quite frequently.
Fact: CC is the formation of too much scar tissue around the implant. Scar tissue normally forms around the implant, but it is considered CC only if it becomes tight or squeezes on the implant. It can range in severity from normal feeling to causing the breasts to be hard, painful or look abnormal. For one brand of silicone implants, the incidence of severe CC was 13% over 4 years. For saline implants, one study showed an incidence of CC in 9% of patients over 3 years. CC occurs when a patient does not react well to the implants. The incidence of CC increases over time and it is more common in revision breast augmentation. CC may be associated with infection.
Myth: You can get a fungus infection from a saline-filled implant.
Fact: There are two kinds of saline implants, the kind that are permanently filled and a type whose size can be adjusted after surgery by adding more saline. All implants are designed to be impermeable to all known fungi, including those that can cause an infection. Although the elastomer of an implant is porous, these pores are too small for any type of fungi to pass through. Even salt molecules in saline implants cannot escape through these pores because their molecular structure is too big, and they are far smaller than any fungus. At one time, the adjustable saline implants were filled in such a way that the saline being added could have been contaminated. Now, saline implants are filled from a sterile bag of saline, allowing no possibility of infection during the filling process. Additionally, the FDA prohibits the injection of any substance, including Betadine, into the implant.
Myth: The silicone elastomer shell can make you sick.
Fact: No published studies have found that the silicone elastomer shells used in both saline and silicone-filed implants cause disease or illness. In 2006, the FDA approved the use of silicone gel-filled breast implants. The agency concluded that silicone-shell breast implants are safe for both cosmetic and reconstructive purposes. But, silicone implants can rupture, and while studies regarding the long-term effects of exposure to the silicone gel in the body are underway, none have reached conclusions as yet. As part of FDA approval, companies that produce breast implants are required to monitor breast implant patients for connective tissue disease and cancer in studies that are on-going.
Myth: Breast implants will make your breasts sag earlier.
Fact: Sagging of the breasts is a result of gravity, weight and the collagen structure of your skin. This means two breasts of the same size and weight will likely sag at approximately the same time, even if one breast is natural and the other is enhanced with implants.
Myth: Breast implants make it very difficult to detect breast cancer.
Fact: Breast implants can interfere with cancer screening, but both benign and precancerous lumps can still be visible during a mammogram. These lumps can also be detected during manual self-examinations of the breasts. Ask your surgeon to show you how to examine your breasts after you have implants. Women who have had augmentation must tell the radiology technician conducting the mammogram about their implants. Because the breast is compressed during mammography, there is the possibility of an implant rupturing. Usually, extra care will be taken and more x-rays of the breasts will be done. When you schedule your mammogram, tell the receptionist or scheduler that you have implants so that more time will be allotted for you. Mammograms are recommended for all women over the age of 35, whether they have implants or not.
Myth: Silicone breast implants cause breast cancer.
Fact: Before re-approving the use of silicone gel-filled breast implants in 2006, the FDA’s rigorous scientific review concluded that there is no convincing evidence that breast implants are associated with breast cancer. However, companies that manufacture implants are monitoring breast cancer rates during the post-approval studies mandated by the FDA.
Myth: If you need to replace a breast implant, the recovery is as long and involves the same amount of pain as the original surgery.
Fact: The original surgery requires a significantly longer recovery period than replacement surgery (also called revision surgery). This is because the original surgery involves creating a pocket for the implant as well as the expansion of the skin and surrounding tissue, while replacement surgery only involves replacing the original implant. In replacement surgery, the majority of the discomfort is in the area of the sutures and is minimal in comparison to the discomfort associated with the original procedure.
Silicone vs. Saline Breast Implants
If you decide to have breast augmentation, the next big decision is which type of implant to use. There are two basic types of implant: saline filled and silicone gel filled. Both types use an outer shell or sack made of silicone elastomer. There are advantages and disadvantages to each type, and certain situations may warrant the use of one rather than the other. Patients should discuss the options with their surgeon and carefully weigh all of the facts before making a decision.
Both types of implants come in several varieties. Some have a single shell and some have two shells, one within the other (called a double lumen). Some shells are smooth and others are textured. Both are also available in a variety of shapes and sizes. Breast implants can be shaped or round. Even similarly sized implants allow you to choose a higher or lower profile. The size of some saline breast implants can be adjusted after they are inserted by adding more saline. Shape and size are personal choices; discuss this decision with your surgeon, who is experienced in recommending what will look best.
Silicone Breast Implants
Silicone is a class of synthetic compounds derived from silicon, an element that is found in the crust of the earth. It should not be confused with either silica, the main ingredient in most beach sand, or the element silicon. Silicone is found in a wide variety of consumer and industrial products and was first used in breast implants in the early 1960s. It is also widely used in many different products made for implantation in the body. Silicone is available in both solid and gel forms. Although all types of breast implants have a flexible outer shell made of silicone elastomer, the term silicone implants usually refers to the type filled with silicone gel.
Silicone breast implants consist of a silicone elastomer shell filled with silicone gel. This type of implant was taken off the market in 1992 (except for use in women undergoing breast reconstruction) because of reports of women developing autoimmune diseases and other problems. In 1997, the federal government asked the Institute of Medicine of the National Academy of Science to examine the complications of silicone breast implant surgery. The institute concluded that "Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants."
Following a rigorous review process, the FDA approved the use of silicone gel-filled breast implants in 2006 for reconstructive breast surgery on women of any age, and for cosmetic augmentation surgery on women 22 years old and older. That age for cosmetic breast implants is based on the fact that a woman’s natural breast can continue to develop until a woman is in her early 20s, as well as concern that younger women may not be mature enough to make an informed decision about cosmetic breast augmentation.
One factor to consider with silicone implants is that the FDA and implant makers recommend patients have magnetic resonance imaging (MRI) performed regularly to detect any leakage of silicone gel. The cost of these MRIs may not be covered by your health insurance, and you may have to pay out of pocket for them.
Saline Breast Implants
Saline breast implants were available before the ban on silicone breast implants by the FDA, and became the most popular choice after that time and before silicone implants were reintroduced. Saline implants contain sterile salt water as the filler material, the same main ingredient in body fluids.
Although ruptures of implants are rare, they are possible. When saline implants rupture, the implant deflates and the saline is absorbed harmlessly by the body. The disadvantage is that when a saline implant deflates, it can deflate completely and the body is asymmetrical until the implant is replaced. Saline implants may not replicate the look and feel of a breast as well as silicone implants can, but many women choose them because of the safety concerns over the use of silicone. Some types of saline implant can be adjusted by adding more saline filler either during surgery or afterwards.
You must be at least 18 years old to undergo cosmetic breast augmentation with saline implants. This is a different minimum age than for silicone implants because the risks of the implants are different. There is no risk of silent rupture with saline implants and saline implants do not require having regular MRIs.
Health Insurance Issues
One factor to consider when you are thinking about having breast enhancement surgery is the costs, not just immediately, but in the future. Health insurance rarely covers breast implant surgery, and usually only when it is related to mastectomy. It may not cover the costs of removing breast implants, even if health problems have developed, and may not cover the costs of any future tests such as MRIs that your plastic surgeon may recommend. Some health insurers have raised the premiums for women who have breast implants.
How Breast Augmentation Surgery Is Performed
Anyone who is 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 the usual experience.
Generally, breast augmentation surgery takes up to 4 hours to perform, depending on the technique used, the skill of the surgeon and other factors, including how much reshaping of the natural breast tissue is needed. More extensive surgery takes longer; less complicated surgeries can be done more quickly. If you are having other cosmetic procedures—such as liposuction—done, this will extend the length of the surgery.
Breast enhancement can be done in a free-standing surgical clinic or in a hospital. It can also be done on an out-patient basis, where you arrive in the morning and go home that night.
How Is A Breast Implant Inserted Into the Body?
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. But even so, it can still be inserted into three slightly different locations between the breast and the ribcage:
There are advantages and disadvantages to each of these placements and you should discuss these with your surgeon.
Breast Implants Incision Techniques:
In addition to the final location for the breast implant, there are several locations for the incisions through which the implants are inserted. Incisions can be made around the navel (transumbilical), under the arm or in the armpit (transaxillary), around the nipple (aureola) and in the crease just under the natural breast (the inframammary fold). The choice of incision used depends on whether this is a first implant or a revision surgery, what type and size of implant is being used, how much scarring you are willing to put up with, 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.
Your surgeon will inform you of how long before surgery you need to fast. He or she will also tell you if you need to stop taking any medications you usually take (such as aspirin) a few days before surgery.
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 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 between you and your surgeon prior to the surgery. There are several choices 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 pre-marked 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 and then insert the implant shell into the pocket. With some types of saline implants, the implant is inflated with saline at this point.
The incisions are then closed and a dressing is then 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 usually 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, anti-nausea 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.
