Breast Augmentation (Augmentation Mammaplasty)

pectoralis major muscle

Illustration 1

Breast Implant

Illustration 2

Breast Implant Placement

Illustration 3

Breast Layout

Illustration 4

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.

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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.

Round implants are more likely to give you a round curve in the upper part of your breasts.

Anatomical implants are more likely to give you a gentle slope in this area, because the top of the implant is shaped more like a natural breast.

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:

  • Deflation of the implant
  • Interference with mammography
  • Contraction of the scar tissue capsule around the implant (capsular contracture)
  • Replacement or revision surgeries
  • Calcium deposits in the tissue capsule around the implant
  • Changes in nipple and breast sensation
  • Shifting of the implant

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
Saline-Filled Breast Implants

Saline-filled breast implants (silicone envelopes filled with  salt water) were already in use in 1976 when the Food and Drug Administration (FDA) began regulating medical devices. Under this 1976 law, manufacturers could continue selling devices already on the market ("grandfathered"). But the 1976 law made it clear that at some time in the future, FDA would require manufacturers to submit their research data showing that these products are safe and effective. Women need to know that until this call for research data occurs, laboratory, animal, and human tests on some of these "grandfathered" products-including saline breast implants-may not have been completed by the manufacturer or reviewed by FDA.

Women considering saline-filled breast implants for breast enlargement or reconstruction should receive the following information about implants (and, when appropriate, other options for reconstruction) before surgery is scheduled. This will allow them time to review the material and discuss possible risks and benefits with her doctor. For some women, breast implants can improve their quality of life. Some breast cancer survivors believe that getting implants has been an important part of their recovery. However, other women find external breast forms to be satisfactory.

Reconstruction options include breast implants or surgery using tissue from a patient's own abdomen, back, or buttocks to form a new breast. This surgery requires sufficient fat tissue and a longer operation, and like any other procedure, it is not always successful.

For each woman, whether her goal is augmentation or reconstruction, the benefits may be different. With her doctor's advice, each woman must decide whether or not she wishes to accept the possible risks in order to achieve the expected results.

Breast implant surgery presents the same general risks associated with anesthesia and any other surgery. After the surgery, there are other special risks related to saline-filled breast implants. (The manufacturer's package insert for these devices gives additional, more detailed information. Your surgeon has a copy and can provide it to you.)

Most common risks

Deflation.

Breast implants cannot be expected to last forever. Some implants deflate (or rupture) in the first few months after being implanted and some deflate after several years; yet some seem to be intact 10 or more years after the surgery. It is not known when deflation is most likely to happen.

The implant can break due to injury to the breast or through normal wear over time, releasing the saline (salt water) filling. Researchers are doing studies to determine rupture rates over time. Whenever a saline-filled implant does deflate, it usually happens quickly and requires surgery to remove and, if desired, replace the ruptured implant. Since salt water is naturally present in the body, the leaked saline from the implant will be absorbed by the body instead of being treated as foreign matter.

Making Breast Cancer Harder to Find.

The implant could interfere with finding breast cancer during mammography. It can "hide" suspicious-looking patches of tissue in the breast, making it difficult to interpret results. The implant may also make it difficult to perform mammography. Since the breast is squeezed during mammography, it is possible for an implant to rupture during the procedure. It is essential that every woman who has a breast implant tell her mammography technologist before the procedure. The technologist can use special techniques to minimize the possibility of rupture and to get the best possible views of the breast tissue.

Because more x-ray views are necessary with these special techniques, women with breast implants will receive more radiation than women without implants who receive a normal exam. However, the benefit of the mammogram in finding cancer outweighs the risk of the additional x-rays.

Capsular Contracture.

The scar tissue or capsule that normally forms around the implant may tighten and squeeze the implant. This is called capsular contracture. Over several months to years, some women have changes in breast shape, hardness, or pain as a result of this contraction. No good data are available on how often this happens. If these conditions are severe, more surgery may be needed to correct or remove the implants.

Other known risks

Calcium Deposits in the Tissue Around the Implant.

When calcium deposits, which are not harmful, occur, they can be seen on mammograms. These deposits must be identified as different from the calcium that is often a sign of breast cancer. Occasionally, it is necessary to surgically remove and examine a small amount of tissue to see whether or not it is cancer. This can frequently be done without removing the implant.

Additional Surgeries.

Women should understand there is a fairly high chance they will need to have additional surgery at some point to replace or remove the implant when and if it wears out.

Also, problems such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the implants. Discuss the risk of these additional surgeries with your physician.

Many women decide to have the implants replaced, but some women do not.

Infection.

Infection can occur with any surgery. The frequency of infection with implant surgery is not known, but a prospective patient should ask her surgeon what his or her experience has been. Most infections resulting from surgery appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with foreign bodies present (such as implants) are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the implant may have to be removed. After the infection is treated, a new breast implant can usually be put in.

Hematoma.

A hematoma is a collection of blood inside the body (in this case, around the implant or around the incision). Swelling, pain, and bruising may result. The chance of getting a hematoma is not known, but a woman thinking about breast implants should ask her surgeon about his or her experience. If a hematoma occurs, it will usually be soon after surgery. (It can also occur at any time after injury to the breast.) Small hematomas are absorbed by the body, but large ones may have to be drained surgically for proper healing. Surgical draining causes scarring, which is minimal in most women.

Delayed Wound Healing.

In rare instances, the implant stretches the skin abnormally, depriving it of blood supply and allowing the implant to push out through the skin. This complication usually requires additional surgery.

Changes in Feeling in the Nipple and Breast.

Feeling in the nipple and breast can increase or decrease after implant surgery. Changes in feeling can be temporary or permanent and may affect sexual response or the ability to nurse a baby. (See the paragraph on breast-feeding below.)

Shifting of the Implant.

Sometimes an implant may shift from its initial placement, giving the breasts an unnatural look. An implant may become visible at the surface of the breast as a result of the device pushing through the layers of skin. Further surgery is needed to correct this problem.

If the implant shifts, it may become possible to feel the implant through the skin. (Placing the implant beneath the muscle may help to minimize this problem.)

Other problems with appearance could include incorrect implant size, visible scars, uneven appearance, and wrinkling of the implant.

Unknown risks

In addition to these known risks, there are unanswered questions about saline-filled breast implants. For example, can the implants bring on symptoms of autoimmune diseases such as lupus, scleroderma, and rheumatoid arthritis? Can they bring on neurological symptoms similar to multiple sclerosis in some women? Can the implants increase the risk of cancer? (Because saline-filled implants contain only salt water, any risk that might be related to silicone gel would not occur with this type of product.) There is some concern, but little information, about possible risks from the silicone rubber material of the envelope. Also, questions have been raised about the potential for the saline to become contaminated with fungus or bacteria. If so, these organisms might be released into the woman's body if her implant deflated.

Autoimmune Diseases.

According to scientific studies, women with breast implants in general are not at an increased risk for autoimmune or connective tissue diseases. However, these studies are too small to detect whether there might be a slightly increased risk of any one of these rare diseases. Also, these current studies have looked only for the symptoms of known autoimmune diseases, rather than the variety of symptoms that some women report experiencing. Some of the reported symptoms include:

  • Swelling and/or joint pain or arthritis-like pain:
  • General aching
  • Unusual hair loss
  • Unexplained or unusual loss of energy
  • Greater chance of getting colds, viruses, and flu
  • Swollen glands or Iymph nodes
  • Rash
  • Memory problems, headaches
  • Muscle weakness or burning
  • Nausea, vomiting
  • Irritable bowel syndrome.

Breast-Feeding and Children.

Questions have been raised about whether or not breast implants present safety concerns for nursing infants of women with breast implants. Some women with breast implants have reported health problems in their breast-fed children.

Only very limited research has been conducted in this area and at this time there is no scientific evidence that this is a problem. It is not known if there are risks in nursing for women with breast implants or if the children of women with breast implants are more likely to have health problems.

Cancer.

At this time, there is no scientific evidence that women with saline-filled breast implants are more susceptible to cancer than other women.

 

   


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