| Breast
Augmentation
One of the most popular cosmetic operations in the western world
is augmentation mammoplasty (breast enlargement) with breast implants. Throughout the
world there is a growing demand for this operation, and it runs a close second to
rhinoplasty (nose alteration surgery) in frequency worldwide. It is also one of the most
satisfying of all cosmetic operations in terms of patient happiness, ranking on a par with
cosmetic surgery of the nose and liposuction to remove fat.
Every woman wants to look as good as possible in clothing and every woman wants to have a
well-proportioned, pleasing silhouette. Classic beauties of the world have had firm,
lifted breasts with balance and symmetry to the waist and hips. There is no question that
aesthetic surgery of the breasts can result in a more pleasing appearance and a rebirth of
self-confidence.
There is a new flair for life and deeper sense of pride in appearance for women who have
grown up with small breasts and suddenly have a full figure. They feel more fulfilled and
less cheated by nature's meager endowment. It is no wonder that women who observe fashion
models and movie stars with full breasts have a desire to be what the world considers more
attractive. Part of life's challenge is to feel a rich sense of acceptance. Breast
augmentation surgery alone will not accomplish this, any more than a nose change or
liposuction, but it does contribute to the overall satisfaction of feeling more feminine
and lovely, and that is why so many women seek the procedure in today's world.
Two groups of women generally seek breast augmentation. The first is made up of women in
their late teens or early twenties who have never enjoyed a well-proportioned bosom. The
second includes women in their late twenties, all the way to their fifties. They may have
lost breast size and shape after childbearing and/or breast feeding. Or they may be women
who have come to terms with their dissatisfaction of so many years without full breasts.
They can afford the surgery and want the results that this procedure can bring. Both
groups of women desire a more pleasing shape that is usually associated with a more
youthful body and a better appearance in all types of clothing.
Breast augmentation is usually associated with cosmetic surgery. There is an important
difference between cosmetic surgery patients and others. Those who submit to surgery for
eradication of disease have fewer choices. Surgery eliminates a serious problem. Cosmetic
surgery is elective. This means the patient and doctor may choose what type of procedure,
within some guidelines, to achieve the best possible results.
What Breast Surgery Will Do
Basically, breast implants will make small breasts larger. To help you understand what
this will do for you, the surgeon must visually examine your breasts. At the time of
examination, you will be asked what it is you wish to achieve in breast enlargement in
terms of size and shape. He may have some questions for you and point out what is possible
and what is not. Listen carefully to what he tells you. Make mental notes of what is
discussed, so that you can determine in your own mind the probable results of the surgery.
The surgeon will indicate where the incisions will be placed and what type of implant will
be used. He may show you samples of implants. If he doesn't, you may want to ask him to
show you one. At the examination time the surgeon will undoubtedly explain the best
approach with the least amount of scarring.
Sites of Incision
As a rule, the surgeon selects the site of incision. There are at least three entry areas
of the breast to insert the implant. The doctor will discuss the site of implant entry and
may even offer a choice, but it is best to follow the recommendation for best results.
Most patients accept the surgeon's evaluation as to the best incision site. For the
patient with drooping breasts, in which the skin of the breast touches the skin of the
chest wall when the patient is standing erect, the inframammary incision is placed
slightly up on the breast, perhaps one-fourth to one-half inch above the inframammary
fold. The incision will be almost completely hidden and may be the preferable and the most
recommended site of entry. In the patient with tiny areolae, the areola incision may be
nearly impossible to perform. Most surgeons prefer that the incision be at least 2
centimeters long. If the size of the areola calls for an incision of less than 1.5
centimeters, and the patient insists on not having the underarm incision, then permission
must be given to extend the areola incision laterally as much as 1/2 to 2 centimeters in
each direction. Without this extension, the surgeon may not be able to insert an implant
of over 200 cubic centimeters in volume through the opening. The extended scar may be too
visible and/or the skin beneath the incision may be numb. Ordinarily, the areola incision,
made in the wrinkles of the brown skin of the areolae, heals with the least amount of
visible scarring, except in pendulous breasts. The axillary (arm pit) incision is
sensitive and doesn't heal well a lot of the time. Also, another incision may be necessary
if there is too much bleeding. The areola approach is the only one of the three most-used
incision sites that invades the breast tissue itself The thousands of surgeries performed
have demonstrated that there is almost no danger of breast nodules or cysts developing in
the lower portion of the breast when this approach is used. Many patients who have had
this approach have subsequently become pregnant and have breast fed their babies. This is
true of all approaches. Breast self- examination and mammography can also be done without
difficulty.
Breast Implants
Implant manufacturers today are controlled by government regulators. It is their job to
offer the safest, most natural appearing and functioning implant available. Many strides
have been made in the past few years in this area. The manufacturers know that what the
patient wants is the best possible appearance with the least amount of problems. Some
implants are filled with a saline solution that, if it should leak (rare), will not cause
infection. Others are filled with a silicone gel. There is also a combination saline and
get implant that is used. Get filled implants and combinations are rarely used today
because of the increased risk of rupture. In the 1970s, saline-filled implants came on the
scene. The problem with these early saline implants was the leakage and deflation rate,
which had crept up to nearly 25 percent of those receiving the implants. Saline implants
used today rarely leak, due to improved technology. Both saline and silicone gel implants
come in a smooth surface or in a textured surface. Capsular contracture (a tightening
around the implant causing it to feel abnormally firm) was thought to be less frequent
with the textured surface implants, but this has proved not to be the case. There are two
possible locations for implants in the breast: beneath the pectoral muscles or between the
muscle and the breast tissue. Let the surgeon decide which is best. You can ask why one or
the other, but at this level of understanding about the procedure, where the implant is
placed is the surgeon's preference in each individual case. It is a technical matter that
the surgeon must decide.
Risks
Infection is always a risk with any surgery. Breast surgery is no different. Should
infection develop, the surgeon has a host of acceptable methods to deal with it. Bleeding
is another factor to guard against. Scarring occurs due to the nature of placing an
implant under the surface of the skin, where an opening has to be made. Most incisions are
made in an area where they are hidden from view. In the extremely rare cases where the
breast patient develops an infection, it is usually best to remove the implant and leave
it out until all infection is gone. When the tissues are soft and pliable again (a minimum
of three months in most cases), then the implants can be replaced in the breast.
Hematoma
Hematoma is the pooling of blood and fluid and occurs more often in-patients who have
taken aspirin or estrogens and patients with elevated blood pressure. Other causes are
coagulopathies and excessive heat or exertion after surgery. This is often the result of a
blood clot around the implant due to a broken blood vessel. If it happens, it occurs
within the first week or so following surgery, and most often immediately after surgery.
Be assured that this is not life threatening, either as a blood clot or from blood loss.
It is what is termed a "closed space" hematoma. In the rare incidence that a
hematoma develops, the patient will notice swelling of one of the breasts accompanied by
pain and tenderness, or perhaps firmness and bruising or discoloration. Small clots can
result without any of these usual signs. Any patient with these signs needs to see the
doctor immediately. For one breast to have more bruising or discoloration and more
swelling than the other is expected and normal. The rare patient who may need evacuation
of a hematoma will usually be moderately to very uncomfortable, with a hard, swollen
breast on one side. This condition can be cleared up with proper medical care.
Noticeable Scars
Seldom does a patient need scar revision to correct a highly visible scar following breast
surgery. Most incidences of scar revision include those patients with almost invisible
scars but who feel they are noticeable. In reality, a hundred percent of all
breast-implant patients have scarring, and whether or not they are noticeable is a matter
of opinion. To most, the beneficial results outweigh the tiny scars.
Asymmetry
As with scars, all breasts are to some extent different. It can be mentioned that nature
made no two snowflakes, grains of sand, or anything else a human can see, exactly alike.
Whether or not there is significant asymmetry is a matter of opinion. Many asymmetries
exist before surgery. The surgeon will try to correct what is visible and make the two
breasts as symmetrical as possible during surgery. The surgeon may also be able to improve
abnormal shaping of the chest with implants.
Breast Volume
The size of the breast can be controlled. The doctor can use implants of different volume
to help correct asymmetries in size. Manufacturers of breast implants call them elastomer
envelopes. There is a wide range of envelopes to fit the needs of individual patients, and
an experienced surgeon knows which size to place in which breast. |
