Q. What is breast augmentation?

A. Breast augmentation involves the insertion of a sterile silicone or saline implant within the breast to enhance its appearance by enlargement and/or elevation.

Q. Why do most women get breast augmentation?

A. Breast augmentation is done to enhance self-esteem, reduce anxiety in certain social situations, and to permit a woman to obtain a better fit in clothes and swimsuits. Women who seek this operation often have had small breasts since puberty or developed smaller, flatter breasts after pregnancy and/or breast feeding.

Q. What should I expect after surgery?

A. At first, the enlarged breasts are swollen and stiff but within a few weeks, the swelling disappears, and the breasts become soft and feel more natural. It is important to understand that it is impossible to create the “perfect breast,” but I strive for a result that is natural in appearance, cosmetically pleasing, and symmetrically in balance with the rest of your body.

Q. What facts do I need to know?

  • Breast implants do NOT cause breast cancer. They may, however, interfere with mammograms. Your radiologist must be informed about their presence before a mammogram is taken.
  • The lifespan of breast implants is not known. There are no guarantees they will last for your lifetime. However, if there are no problems with the implants, they can be maintained indefinitely. They do NOT have to be replaced after ten years.
  • I use only top-of-the-line breast implants, which come with a warranty against failure from a manufacturer’s defect. You will be given a copy of the warranty, and the terms and conditions will be explained to you.
  • I use both saline and silicone implants. Since the FDA approved the use of silicone implants in November 2006, they have surpassed saline implants in popularity because they are softer, more natural in shape, and ripple less often.
  • If you become pregnant after this surgery, your breasts will enlarge and become engorged as is normal in pregnancy. This does not interfere with the implants. Typically breast augmentation does not impair your ability to breast feed, but no guarantees can be given that it will be possible to breastfeed after this surgery.

Q. What is my approach to breast augmentation surgery?

  • I always strive to obtain symmetry of the breasts by a process called differential augmentation. However, if the breasts were uneven before surgery, they may remain so after surgery. Also, malpositioning of the implants, although rare, can occur and may need a second surgery for correction. I never leave the operating room unless the implants are positioned as evenly as possible.
  • I use a small 3 cm incision in the armpit for a saline implant OR a 4 cm incision along the inframammary fold to insert a silicone implant.
  • I place breast implants above the pectoralis major muscle but under the fascia. In this position, the implants look more natural and do not become deformed when the muscle contracts during activities, such as upper body exercises or aerobics. This approach causes significantly less pain and recovery time than implants placed under the muscle. Finally implants placed under the muscle, over time, may “bottom out” and look unnatural. (Of course, if a patient truly wants implants placed under the muscle, I will fulfill that request.)

Q. What are possible complications of surgery?

  • Capsular contracture is the most common problem after breast enlargement. This occurs when the body makes excess scar tissue around the implant, causing it to feel hard. This happens in about 1 in 100 patients. There are various degrees of capsular contracture. One breast may feel “firmer” than the other. Capsules are not medically dangerous, however, in rare cases re-operation may be needed to replace the implant and remove the scar tissue due to breast malformation related to the capsular contracture. Newer textured implants have less incidence of capsular contracture and this will be discussed.
  • Although uncommon, sensation in the breast and nipple areola complex may be temporarily or permanently altered.
  • Although uncommon, there is also a risk of infection and/or bleeding. To prevent infection, I always administer antibiotics before and intravenously during surgery. Furthermore, I use the “no-touch” technique of implant insertion for every case. To prevent bleeding, I advise you to avoid alcohol, aspirin, garlic or garlic pills, vitamin E, or any NSAID, such as Advil or Motrin, for four weeks prior to surgery. (See the “Drugs to Avoid” pamphlet for the complete list of medications to avoid.)
  • Occasionally, the edge of the implant can be felt especially in women with very little breast tissue or body fat.  This is called edge palpation. There is no correction necessary for this situation and most patients get use to the feeling.
  • In fewer instances, the implant can “ripple” and be seen under the skin. This occurs in both saline and silicone implants and also in both implants placed over and under the muscle. I make every attempt to avoid this, but all implants tend to ripple to some degree once they are inside the body. The type of incision, technique of surgery, suture, implant, or placing the implant above or below the muscle are not the cause of rippling. In general, the worst rippling occurs in tiny women with very little fat on their bodies or very small breasts. Saline implants tend to ripple more often than silicone over time.
  • Finally, as with any breast surgery, there is a small but definite risk of infection, bleeding, hematoma, swelling, bruising, poor healing, keloid, postoperative nausea/vomiting and/or headache, altered breast lactation, rejection of the implant, movement of the implant, visible rippling of the implant through the skin, functional impairment and permanent scarring and disfigurement.
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