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Bid for Surgery: Breast Enlargement
Breast Enlargement
(Augmentation Mammaplasty)
| Procedure: |
Enhance the size of breasts using
inflatable implants filled with saline. |
| Risk Factor: |
Lack of implant permanence
-- surgical removal or replacement of the implants may be required to treat problems, including: deflation; the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard; bleeding or infection.
Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent.
Mammography requires a special technique. (Some women have reported symptoms similar to those of immune disorders. Ask your doctor about these and other FDA concerns.) |
| Side Effects: |
Temporary soreness, swelling, change in
nipple sensation, bruising. Breast sensitive to stimulation for a few weeks. |
| Length: |
Several hours. |
| Anesthesia: |
Local with sedation, or general. |
| In/Out: |
Usually outpatient. Some patients may
require short inpatient stay. |
| Recovery: |
Back to work: a few days. Physical contact
with breasts:
3 to 4 weeks. Fading of scars: several months to a year or more. |
| Duration: |
Variable. Implants may require removal or
replacement. |
| The Procedure |
Many surgeons perform augmentation mammaplasty
in their office-based surgical suite or in an outpatient surgical center.
Depending on the extent of the surgery, the procedure may be done in a hospital, in which
case you can plan on staying for a day or two.
Breast augmentation can be performed under general anesthesia, so you'll sleep through the
operation. Some surgeons may use a local anesthetic combined with a sedative to make you
drowsy. In this case, you would be awake but relaxed. You would not feel pain, but might
feel some tugging or pushing during the procedure.
The method of inserting and positioning the implant will depend on your anatomy and your
surgeon's recommendation. The incision can be made either in the crease where the breast
meets the chest,
around the areola (the dark skin surrounding the nipple), or in the armpit. The goal is to
place the incision so resulting scars will be as inconspicuous as possible.
Working through the incision, the surgeon will lift the breast tissue and skin to create a
pocket, either directly behind the breast tissue or underneath your chest wall muscle.
This placement may interfere less with breast examination by mammogram than if the implant
is placed directly behind the breast tissue. Placement behind the
muscle may be more painful for a few days after surgery than placement directly under the
breast tissue. Discuss these alternatives with your surgeon.
The surgery usually takes one to two hours to complete. Stitches are used to close the
incisions, which may also be taped for greater support. A firm gauze bandage is applied
over your breasts to help with healing. A temporary drainage tube may be inserted to
prevent fluid from collecting in the surgical site during healing. |
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| The best candidates for a |
Breast augmentation can enhance your appearance
and your self-confidence, but it won't necessarily change your looks to match your ideal,
or cause other people to treat you differently.
Before you decide to have surgery, think carefully about your expectations and discuss
them with your surgeon.
The best candidates for breast augmentation are women who are looking for improvement, not
perfection, in the way they look. If you're physically healthy and realistic in your
expectations, you may be a good candidate. |
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| Types of implants? |
A breast implant is a silicone shell filled with
either silicone gel or a salt-water solution known as
saline.
Because of concerns that there is insufficient information demonstrating the safety of
silicone gel-filled breast implants, the Food & Drug Administration (FDA) has
determined that new gel-filled implants, at the present time, should be available only to
women participating in approved studies. Some women requiring replacement of the implants
may also be eligible to participate in the study.
Saline-filled implants continue to be available to breast augmentation patients on an
unrestricted basis, pending further FDA review. You should ask your doctor more about the
specifics of the FDA decisions. (Above guidelines are current as of July 1992.) |
| Risk factors, complications, side effects?
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Breast augmentation is relatively
straightforward. But as with any operation, there are risks associated with surgery and
specific complications associated with this procedure.
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 your doctor.
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.
A few women with breast implants have reported symptoms similar to diseases of the immune
system, such as scleroderma and other arthritis-like conditions. These symptoms may
include joint pain or swelling, fever, fatigue, or breast pain. Research has found no
clear link between silicone breast implants and the symptoms of what doctors refer to as
"connective-tissue disorders," but the FDA has requested further study.
While there is no evidence that breast implants cause breast cancer, they may change the
way
mammography is done to detect cancer. 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. Additional views will be required.
Ultrasound examinations may be of benefit in some women with implants to detect breast
lumps or to evaluate the implant.
While the majority of women do not experience these complications, you should discuss each
of them with your physician to make sure you understand the risks and consequences of
breast augmentation. |
| Types of anesthesia |
Breast augmentation can be performed with a
general anesthesia, so you'll sleep through the entire operation. Some surgeons may use a
local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but
awake, and may feel some discomfort. |
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| How long would recovery take? |
You're likely to feel tired and sore for a few
days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your
discomfort can be controlled by medication prescribed by your doctor.
Within several days, the gauze dressings, if you have them, will be removed, and you may
be given a surgical bra. You should wear it as directed by your surgeon. You may also
experience a burning sensation in your nipples for about two weeks, but this will subside
as bruising fades.
Your stitches will come out in a week to 10 days, but the swelling in your breasts may
take three to five weeks to disappear. You should be able to return to work within a
few days, depending on the level of activity required for your job.
Follow your surgeon's advice on 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. |
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| Would I have a new look? |
For many women, the result of breast
augmentation can be satisfying, even exhilarating, as they learn to appreciate their
fuller appearance.
Regular examination by your cosmetic surgeon and routine mammograms for those in the
appropriate age groups at prescribed intervals will help assure that any complications, if
they occur, can be detected early and treated.
Your decision to have breast augmentation is a highly personal one that not everyone will
understand. The important thing is how you feel about it. If you've met your goals, then
your surgery is a success. |
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| Cost of this procedure varies with region from a low of
$3,500 to a high of $6,000. This cost includes surgeon's fee, anesthesia, and facility
costs. |
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