Breast Augmentation (Implants)
Breast Augmentation is for a woman who feels that her breasts are too small or if there is an imbalance in the size of her breasts. Breast augmentation provides a very effective cosmetic enhancement and instills new confidence in the individual.
Conceptually, a breast augmentation with a mammary prosthesis is a very simple procedure to understand. Essentially you make an incision, dissect a space at some level below the breast, insert a prosthesis and close the opening wound with sutures. Obtaining the optimal cosmetic result with no change in sensation and have it look and feel like a beautiful un-operated breast is not simple.
Things to know about breast implants:
The new gel-filled implants are mechanically a much better device than the old implants. The cosmetic results will never equal the old gel implants though. The government recommends that after the second year the patient obtain an MRI of their breasts every third year. It has also been recommended that when the implants have been implanted for ten years that they are replaced with new implants.
Silicone rubber bags filled with IV solution. They are not as strong a mechanical device as the gel implants, but I have seen some last longer than thirty years. If the implant fails it is obvious due to the decrease in the volume of the breast. There is about a 1% decrease in volume per year. The saline implant is the safest device.
Textured vs. Smooth Envelopes (bags):
Studies have shown that textured implants delay the formation of the healing complication called fibrous contracture, but do not prevent it long term. The rare cancer that has occurred after breast augmentation is only related to the textured prosthesis. The texture on the prosthesis stimulates the wound to make fluid to which most plastic surgeons believe needs to be drained immediately postoperatively. The implants that have the “anatomical shape” need to keep their orientation, and the texture helps the implant from changing its position.
Breasts implanted with smooth implants feel softer and the implant is less easily felt with the smooth surface. Most plastic surgeons have experienced more frequent failures with the textured prosthesis as compared with the smooth surfaced prosthesis.
Anatomically Shaped vs. Round Shaped Prosthesis:
Most women desire fullness in the upper part of their chest. The round shaped prosthesis gives more fullness in the upper part of the chest. The anatomically shaped prosthesis is shaped to decrease the fullness in the upper part of the chest.
Am I a good candidate?
Physically, if you do not have any general medical contraindications you may be a good candidate. Of course, Dr. Bartlett’s evaluation of your viability as a good candidate is an important factor as well.
Should I choose a saline prosthesis or silicone gel prosthesis?
The saline filled prosthesis hidden by chest muscles and the fascia that covers them will give a result similar to but not quite as good as silicone gel filled prosthesis. If you do not “hide” the saline prosthesis it gives a very poor cosmetic result. It essentially comes down to a patient’s preference..
Is the gel prosthesis safe?
The new cross linked gel prostheses are much different from the old gels. The solid silicone envelope or bag has an inner lining to prevent sub-microscopic diffusion of gel through the bag. The gel is more viscous and this should decrease the fatigue stresses in the bag. Fatigue is one factor that weakens the bag with time. The gel is very cohesive. The gel wants to stay together even if the bag fails. The above factors and others make this a very strong and durable prosthesis. Of course nothing is as safe as sterile saline.
What size prosthesis is appropriate for me?
I will tell you what I think is appropriate but your wishes are what I try to fulfill. If you insist that you have a prosthesis size that I strongly think will cause you problems, I will ask you to find someone else to do your surgery.
Your present breast volume is measured with templates. You will tell me the cup size that you feel you would like reach with the augmentation. I know what the approximate volumes of different cup sizes with different chest circumferences are. By subtracting your present volume from the volume you want to obtain we obtain the volume of the implant.
Will I have a great deal of pain after surgery?
You will need to take the muscle relaxing medication and pain medication that is prescribed for you to make this tolerable the first night and day post-operatively. Most patients tell me that the intensity is down to a 1 or 2 (on a scale of 0 for no pain and 12 for maximal pain) by the 5th day after surgery.
When will I have my “final result”?
In most patients it takes from 6 to 12 weeks for the muscle to elongate and let the prosthesis settle into the most inferior aspect of the space surgically created for it. There will be some subtle additional settling for about 2 years after surgery.
Will I keep my sensation to my nipple?
Because of where and how I make the space for the prosthesis I have not had a patient with permanent loss of nipple sensation for at least 15 years.
What is fibrous contracture?
When any medical device is implanted in someone’s body, the body will cover it with scar tissue to isolate it from the immune system. If the scar becomes reactive it will try to squeeze it into as small a volume that is possible. The geometric shape that will contain the most volume with the smallest surface area is a sphere – thus the term “spherical contracture”. To my knowledge my patients have an extremely low rate of fibrous contracture.
Where do you make your incision?
I make my incision just above the fold created by the lowest part of your breast meeting the chest wall. I have operated many patients through an armpit approach, across the nipple approach, and around the areola of the nipple approach.
There were unacceptable incidences of fibrous contracture, asymmetry, bleeding complications and loss of sensation when using these other surgical incisions or approaches. If your healing is normal and you keep the incision site covered with Micropore paper tape for 3 months after surgery, the scar becomes almost invisible.
If I become pregnant after augmentation will my breasts look OK?
This really is impossible to answer. Some women’s breasts become very large with pregnancy and nursing their baby, while some hardly change at all. The same woman may have considerable increase in volume with one pregnancy and not with another. Of the women that do have considerable increase in volume and then return to their pre-pregnancy volume or smaller, some will maintain shape and others will lose their shape.