Breast Augmentation
How is a breast augmentation done and who is a candidate?
Candidates include women with small breasts and women who are not satisfied with their current breast size. During the consultation, women are evaluated and then counseled regarding their options. We determine how large they would like their breasts to be, what implants are available, where the implants will be positioned, and how they will be placed. The incisions are located either underneath the breast or around the nipple. The implants are positioned above or below the pectoral muscle.
What is the implant like?
The implants come in different shapes, sizes, and textures. These include: smooth-surface, textured-surface, anatomic shape, or round shape. There have been many improvements in the implants. The shell is still made of silicone and the filler material is saline. The risk of rupture is related to the length of time that the implant has been in the body. Currently, the only option for primary breast augmentation is saline. Silicone gel implants were more popular until 1991, when the FDA restricted their use. However, every study done since then has shown that the gel was not harmful in the way it was reported to be. So they may be available again within the next few years.
But after all that bad press, why would someone want them?
With silicone implants, the feel of the implant is much more natural because of the viscosity of the silicone gel. It causes less wrinkling or rippling, which is slightly more common with saline implants.
Can you see that rippling effect?
The rippling is noticeable in about 10% of breasts and depends on the size of the implant and the degree to which it is filled. In general, implants that are filled less than capacity and implants that exceed the breast tissue to breast implant volume ratio by 50% have a greater tendency to ripple.
There was some press recently about teenagers getting breast augmentations.
Our philosophy is to avoid breast augmentation in minors (less than 18 years of age). Once a woman is able to consent for herself, breast augmentation is an option.
Why is that?
Breast development may not yet be completed and for maturity reasons.
What is the operation like?
The operation itself is technically simple. It takes about 45 to 60 minutes. It can be performed under sedation or general anesthesia. It is a relatively safe operation and the down time is about 1 week. No strenuous activity is recommended for 5 to 6 weeks.
Does having an implant increase a woman’s risk for breast cancer?
No. Nor does an implant decrease the ability to detect breast cancer. With current mammographic techniques, one can detect cancer even with an implant, as long as the mammographer knows that you have an implant.
Do patients expect too much of this operation: that larger breasts will fix all their problems?
For all patients inquiring about cosmetic surgery, understanding their motivation is important. If it is to enhance their own self-esteem or their self-image, that’s fine. But it won’t change your life.
Is it just movie stars and dancers who do this?
No. Actually it is women from all walks of life: professional, educated, young, old, blue collar, white collar.
How much does it cost?
The fee for breast augmentation ranges from $2,000 to $3,000. The anesthesia and facility fees are usually separate. Thus, the total cost is usually between $5,000 and $6,000.
How long do the implants last?
Some patients have had implants for 25 years. In general, for breast augmentation, there is a 25% chance that the implant will have to be removed or replaced by 5 years. It is recommended that all women wear a bra routinely because supporting the breast will result in a better long-term appearance.
But even with implants, will breasts still sag?
Gravity will eventually catch up with all women. There are certain physical signs that tell us who will tend to sag more. If the skin is thin and there are stretch marks on the skin, that woman may be predisposed to ptosis or sagging. It is important to select the proper implant size and shape to minimize the chances of a long-term poor outcome. Sometimes a mastopexy or breast lift will be concurrently performed or performed at a later date
How should a patient with implants be monitored?
After the final postoperative visit with the plastic surgeon, the patient should continue to have annual examinations that include a breast exam. When it is time for mammography be sure to explain to the mammographer that an implant is in place. Over time, the implant may become hard or rupture. Be sure to maintain contact with a plastic surgeon should any changes start to occur.
|
