Breast Augmentation and Reduction
Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include:
- To correct reduction in breast volume after pregnancy.
- To balance a difference in breast size.
- As a reconstructive technique following breast surgery.
Augmentation mammoplasty is done on an outpatient basis in our surgical center, usually under general anesthesia. An implant (prosthesis) is placed through an incision, under the breast tissue or under the muscle. The incision can be made under the breast, around the nipple or under the arm. A breast implant is composed of an outer silicone shell filled with saline (the FDA has restricted the use of silicone gel implants). The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman’s needs.
When the implant is placed sub muscularly under the breast, there is a lower chance of contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable. There is also less risk of visible or palpable implant edges. However, some believe the implant has a more natural appearance when placed above the muscle, under the breast tissue. Your plastic surgeon can help you decide which placement and type of implant will work best.
Determining Implant Size
The shape of your augmented breasts depends on the implant. Implants may be round or teardrop-shaped (anatomical). The choice depends on the look you want to achieve: Anatomical implants produce a gentle slope, resulting in a fuller upper area, whereas round implants create a round curve in the upper part of the breast. Another factor to consider prior to surgery is breast width, which determines the amount of “cleavage” between your breasts and the outer curves, which you may want to balance with your hips.
Realistic expectations of this procedure are important. Women often think of breast size in terms of bra cup size. If you are currently a size “A” and wish to be a size “C”, there must be adequate existing breast tissue coverage; otherwise you will be warned of visible or palpable implant edges and other possible risks.
Post Operative Care
You must have someone drive you home and stay with you for 24 hours after surgery. You will experience some pain the first day or two that is easily controlled with pain pills. Some tightness in the breast area is also normal as your body adjusts to the implants.
You can move about freely after surgery. Wear a bra at all times (except when showering) during the first 2 weeks following surgery. Avoid heavy lifting for 2-3 weeks. Moderate exercise such as walking or stationary biking is allowed after the first week. Vigorous exercise such as jogging or aerobics may be resumed at 3-4 weeks. You will most likely be able to return to work within a few days, but you will need to avoid any strenuous activity for at least a couple of weeks.
During recovery, the breasts will be somewhat swollen. Within a few weeks, the actual shape and size will be evident. You may notice some asymmetry; however most breasts are naturally somewhat asymmetrical.
Delayed wound healing may occur in persons with diabetes, history of radiation, autoimmune disease or smokers. Other complications include capsular contracture, bleeding, infection, or irregularity of the skin. It is important to have a thorough medical evaluation beforehand to address these potential risks. You also need to know that even a small hole in an implant can cause the saline to leak out, resulting in a "flat” implant and necessitating surgical replacement. This is completely avoidable, however, by taking proper precautions.
About silicone gel implants:The FDA placed a hold on silicone implants in 1992 to further investigate their safety and effectiveness. They have since been replaced by saline (salt water) implants. There has been much discussion about the possibility of silicone and in particular silicone gel, being related to autoimmune disease. However, a large study of women with and without breast implants conducted at the Mayo Clinic showed that autoimmune disease occurred with the same frequency in both groups. It is not known what causes autoimmune diseases, seen in middle-age women.
Augmentation mammoplasty is a safe procedure that has produced pleasing and satisfying results for many women. Those who are psychologically stable and have realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you.