Breast Augmentation (Augmentation Mammaplasty)
If you are considering breast augmentation, you probably already know that it is a procedure to enhance the size of your breasts using breast implants. While breast augmentation is not the answer for everyone, many women find that the procedure has helped improve their appearance, and even their self-confidence. The first step is deciding if it's right for you.
Taking this step means thoroughly understanding how breast augmentation surgery works and thinking carefully about your own expectations. The information here will introduce you to the basics of breast augmentation surgery, including how the procedure is performed and what options are available.
Please keep in mind that this information is only an introduction. You should still seek the personal evaluation and advice of Dr. Jensen.
Recently, we have begun offering e-Stetix©, the first worldwide, real-time based 3D breast augmentation simulation technology. To see more on how this technology can help with your augmentation decision, click here.
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What gives the breast its shape?
The breast consists of milk ducts and glands surrounded by fatty tissue, and covered by skin. The fatty tissue gives the breast its soft feel and shape. Skin elasticity also affects breast shape. Pregnancy (during which the milk glands are temporarily enlarged) and the inevitable effects of gravity over time stretch the skin envelope and change breast shape.
The pectoralis major muscle lies beneath the breast, and indirectly affects breast projection. The pectoralis major muscle helps with flexing and rotation of the arm at the shoulder joint. (See Illustration 1)
What is a breast implant?
A breast implant consists of a silicone elastomer (rubber) shell now most commonly filled with saline solution (salt water). In 1992, the Food & Drug Administration (FDA) decided that more safety and effectiveness information was needed on the type of breast implant filled with silicone gel, and greatly restricted the use of these implants in the United States.
(See Illustration 2)
Safety and effectiveness information on saline-filled breast implants is still being collected by manufacturers through extensive clinical trials. In the meantime, the FDA has allowed saline-filled breast implants to remain available.
In March 1996, the FDA published a booklet called Breast Implants. An Information Update that explains breast implant regulations and medical issues. You can obtain a copy of this booklet by calling the FDA at 800/532-4440.
How does a breast implant work?
The breast implant is placed either under your breast tissue (subglandular position) or under your pectoralis muscle (submuscular position).
(See Illustration 3)
Dr. Jensen can help you decide which placement is best for you.
If the implant is saline-filled, it is usually inserted empty, and then filled once it is in place. One advantage to this type of implant is that it can usually be placed through a small incision.
(See Illustration 4)
The incision is made as inconspicuously as possible, either in the breast fold, under the arm, or around the nipple.
If the incision is made under the arm, endoscopic techniques involving the use of a probe fitted with a tiny camera, may be used to visualize the creation of the surgical pocket.
Dr Jensen can explain more about each type of incision to help you decide which is best for you.
Why Dr. Jensen prefers endoscopic breast augmentation.
With endoscopic breast augmentation, Dr. Jensen uses an endoscope, an instrument that enables him to see images of the patient's internal body structure through small incisions. This tool enables him to better position the implants and often results in fewer scars, because only a few small incisions are required.
Are all implants alike?
Most saline-filled breast implants share some standard features, like a silicone rubber shell and a valve for filling with saline solution. However, to better meet each individual woman's needs, breast implants come in different shapes and sizes.
Some implants are round, and some are anatomical. The shape of the implants you choose can affect the shape of your augmented breasts.
Both types of implants can increase your breast size. Depending on the look you want to achieve, you may prefer one type of implant over the other.
Determining implant size
Many women tend to think of their breasts in terms of bra cup size. For instance, if you're a 34 A now, you may know you would like to be about a 34 C after your augmentation. At the same time, you may have concerns about breast shape and proportions that bra cup size alone can't describe. You may know that you'd like to have a certain amount of cleavage, or more of an "hourglass" figure. You should discuss your personal preferences with Dr. Jensen; so that he can take that into account in choosing the right implant size and shape for you.
An implant will add volume to your total breast tissue. For this reason, the larger you want your cup size to be, the larger the volume (measured in "ccs") of the implant Dr. Jensen will consider. However, cup size may not be your only consideration.
Dimensions like breast width, height, and projection describe breast shape, and may help both you and Dr. Jensen think more specifically about the individual results that you want. For this reason, implant size can also be chosen based on dimensions.
Breast width is an especially important dimension, because it determines how much cleavage there is between your breasts. Breast width also determines the outside curve of your breasts, which you may want to increase to balance better with your hips.
Dr. Jensen will also evaluate your existing breast tissue coverage. If you do not have much breast tissue for coverage of the implant, your doctor may warn you that if you go as large (in breast width) as you'd ideally like to, you may risk having visible or palpable implant edges. You may even risk significant surgical complications.
What about the surgery itself?
Beyond any discussion of breast shape and size, Dr. Jensen will want to evaluate your current physical health and health history before scheduling you for surgery. Breast augmentation is elective surgery. Before you proceed, you and Dr. Jensen will have to decide whether the benefits of breast augmentation surgery outweigh the risks in your case.
If you have any condition that could compromise the healing process, or if surgery could jeopardize your condition, Dr. Jensen mayprefer not to operate until the condition is resolved. Infections, a history of poor wound healing, some medications, and even smoking may be reasons not to operate.
The surgery may be performed in the Hospital (Rogue Valley Medical Center or Providence Hospital) or in our own outpatient surgery center. The surgery is usually performed on an outpatient basis, not requiring an overnight hospital stay. General anesthesia is most commonly used, although local anesthesia may also be an option. Dr. Jensen can discuss the choice of anesthesia with you in more detail.
The surgery usually lasts one to two hours. Dr. Jensen will make an incision and create a pocket. Then, the implant will be placed in the pocket, filled and positioned. Finally, the incision will be closed with dissolving stitches, and possibly taped.
How will I feel after surgery?
You'll probably feel somewhat tired and sore for several days following the operation, and your breasts may remain swollen and sensitive to physical contact for as long as a month. You may also experience a feeling of tightness in the breast area as your skin adjusts to your new breast size. The full results of your augmentation may not be visible until your breast tissue (and muscle, if the implant has been placed submuscularly) adjusts.
If the implant is placed submuscularly, you may feel more discomfort for several days longer than if it is placed in the subglandular position. You may also have difficulty raising your arms above your head until you heal, and Dr. Jensen may at first restrict your arm motion. The "tradeoff" is that submuscular placement may reduce the risk of complications later like severe contraction of the tissue capsule around the implant (called "capsular contracture"), visible or palpable implant edges, or interference with mammography.
Postoperative care is usually quite simple, perhaps involving use of a postoperative bra or jog bra for extra support and positioning while you heal. At Dr. Jensen's recommendation, you will most likely be able to return to work within a few days, although you should avoid any strenuous activities that could raise your pulse and blood pressure for at least a couple of weeks.
Dr. Jensen and his staff can tell you more about the usual recovery process, and may have other specific recommendations based on your individual case. If any unusual symptoms occur after surgery, such as fever or noticeable swelling or redness in one breast, you should contact the Center immediately.
What about complications?
Undergoing any invasive surgical procedure means running the risk of complications like the effects of anesthesia, infection, swelling, bleeding, pain and delayed healing. In addition, there are potential complications specific to breast implants, including:
In addition to known complications, there are unanswered questions about whether silicone breast implants could increase your, or your child's, risk for connective tissue disorders. Studies so far have ruled out a large risk for such disorders, but for statistical reasons based on study size and methods, larger studies will be needed to rule out any risk.
Separate concerns have been raised about the unknown risk of breast implants and cancer. At this time, there is no scientific evidence that women with silicone breast implants are more susceptible to cancer than other women.
In addition to the information booklet mentioned above, the FDA has published a summary of potential complications called Information for Women Considering Saline-filled Breast Implants. This summary has been reprinted at the end of this page and is also available separately from Dr. Jensen. You should thoroughly read and understand this information before deciding to proceed with surgery.
FDA Information for Women Considering