Breast Augmentation
Detailed Information Page
What are breast implants?
There are two basic types of implants, saline filled and silicone gel-filled breast implants. Both types have the same basic type of outer envelope made of a solid, rubber-like form of silicone called an elastomer.
Saline filled implants – These implants are made of an elastomer silicone envelope, which is surgically implanted under your tissues, and then filled with sterile saline, a salt-water solution, through a valve.
Silicone gel-filled implants – These implants are the most popular type of implant, as they give one of the most natural look and feel. Made of a silicone outer shell, containing a clear, sticky, thick jellylike form of silicone that approximates the consistency of breast tissue. Silicone gel implants come in many sizes. The size used depends on the amount of augmentation desired or the size the reconstructed breast is to be. Information obtained from the FDA, and for updated information regarding the above, please click the link below:
http://www.fda.gov/cdrh/breastimplants/biavail.html
How does breast implant surgery work?
Breast implant surgery for breast augmentation involves making a single incision in or near the breast and inserting the implant either between the breast and the chest muscle (subglandular placement) or behind the chest muscle (submuscular placement), some surgeons sometimes go between both muscles, this is sometimes referred to as the Dual Plane Technique.
Subgladular placement – this placement may make surgery and recovery shorter, and may be less painful. However, this placement may result in more noticeable implants, more capsular contracture, and more difficult imaging of the breast with mammography.
Submuscular placement – This placement may make surgery last longer, may make recovery longer, and may be more painful. The possible benefits of this placement are that it may result in less noticeable implants, less capsular contracture, and easier imaging of the breast with mammography.
Once you and your surgeon have choosen the placement of your breast implant, it is necessary for you both to determine the location of the incision site. The location of the incision depends upon your body type and your personal preference. You can choose to have the incision, around your nipple (periareolar incision), underneath your breast (inframammary incision), or near your armpit (transaxillary incision). If the incision is made under the arm, the surgeon may use a probe fitted with a miniature camera, along with minimally invasive (very small) instruments, to create a "pocket" for the breast implant.
Periareolar – This incision is the quite concealed, but is associated with a higher likelihood of inability to successfully breastfeed, as compared to the other incision sites. If infection were to occur around this area, after surgery, it could result in the loss of nipple, sentation or surrounding tissue.
Inframammary – The most popular option for both surgeons and patients, this incision is less concealed than periareolar and associated with less difficulty than the periareolar incision site when breast-feeding.
Axillary – This incision is less concealed than periareolar and associated with less difficulty than the periareolar incision site when breast-feeding.
The breast implant surgery itself may be done either under local or general anesthestetic in the hospital. The procedure is usually done as one-day outpatient surgery, however, for some women, an overnight stay is recommended. The procedure takes between one to two hours, depending on whether the implant goes above or beneath the muscle.
First, the surgeon creates a pocket-a space between the tissues-to accommodate the implant. After inserting the implant, he or she closes the pocket and sutures the tissues in place. Then bandage is placed over the incision and a surgical or support bra is placed over the breasts to aid healing. Post surgical swelling is to be expected, as is some pain and discomfort. Most women return to work and resume non-strenuous activities, such as driving, about a week to ten days after surgery.
Questions to Ask Your Surgeon about Breast Augmentation
The following list of questions may help you to remind you of topics to discuss with your surgeon. You may have additional questions as well.
- What are the risks and complications associated with having breast implants?
- How many additional operations of my implanted breast(s) can I expect over my lifetime?
- How will my breasts look if I choose to have the implants removed without replacement?
- What shape, size, surface texturing, incision site, and placement site is recommended for me?
- How will my ability to breast feed be affected?
- How can I expect my implanted breasts to look over time?
- How can I expect my implanted breasts to look after pregnancy? After breastfeeding?
- What are my options if I am dissatisfied with the cosmetic outcome of my implanted breasts?
- What alternate procedures or products are available if I choose not to have breast implants?
- Do you have before and after photos I can look at for each procedure and what results are reasonable for me?
- What are the risks associated with breast implants?
Potential Risks associated with breast implants
Capsular Contracture –
During capsular contracture, the scar tissue or capsule that normally forms around the implant tightens and squeezes. Capsular contracture is generally more common following infection, hematoma, and seroma. It is also more common amongst women who have chosen to have subglandular placement. Symptoms range from firmness and mild discomfort, to pain, distortion, palpability of the implant, and/or displacement of the implant.
Additional surgery is needed in cases where pain and /or firmness is severe. This surgery ranges from removal of the implant capsule tissue to removal and possible replacement of the implant itself.
In some cases, capsular contracture may happen again after these additional surgeries.
Breast Feeding –
As far as the ability to successfully breast feed after receiving breast implants, one study reported that 64% of women with implants with were unable to breast feed compared to 7% without implants. It should be noted, that many woman cannot breastfeed naturally, and even if they opted for implant surgery, they could be in the field that could not have breast fed anyway. It is thought that the periareolar incision site may significantly reduce the ability to successfully breast feed.
Additional Surgeries –
There is a high likelihood that women who have received breast implant surgery will need to have additional surgery at some point to replace or remove their implants. Problems such as deflation, rupture, capsular contracture, infection, shifting, and calcium deposits can require removal of the implants. Most women choose to have their implants replaced. For those who do not, cosmetically unacceptable dimpling and/or puckering of the breast may result.
Dissatisfaction with Cosmetic Results –
Dissatisfying results such as wrinkling, asymmetrical implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, hypertrophic (irregular, raised scar) scarring, and/or sloshing may occur. Careful surgical planning and technique minimize, but do not always prevent results such as these.
Pain –
Pain of varying intensity and duration may occur and persist following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain associated with nerve entrapment or interference with muscle motion. You should tell your doctor about severe pain.
Infection –
As with any surgery, infection can occur during or after the breast implant operation. Infections with an implant present 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. In this event you can choose to have another implant surgery once your infection has been eliminated.
Interference with mammography –
Breast implants may delay or hinder the early detection of breast cancer either by hiding suspicious wounds, injuries, or tumors or by making it more difficult to include them in the mammogram image. Implants increase the difficulty of both taking and reading mammograms. Mammography requires breast compression that could contribute to implant rupture.
For these reasons you may wish to undergo a preoperative mammogram and another mammogram six months to one year after implantation to establish a baseline. It is essential that you tell your mammography technologist that you have an implant before the procedure. The technician can use special techniques to minimize the possibility of rupture and to get the best possible views of your breast tissue. These special techniques require more x-ray views, therefore exposing you to more radiation. The benefit of the mammogram in finding cancer outweighs the risk of the additional x-rays.
Hematoma/Seroma –
A hematoma is a collection of blood inside a body cavity. A seroma is a collection of the watery portion of the blood (in this case, around the implant or around the incision). Postoperative hematoma and seroma may contribute to infection and/or capsular contracture. Swelling, pain, and bruising may result. If a hematoma occurs, it will usually be soon after surgery. However, a hematoma may also occur at any time after injury to the breast. While the body absorbs small hematomas and seromas, larger ones will require the placement of surgical drains for proper healing. A small scar may result from surgical draining. Implant deflation/rupture can occur from surgical draining if damage to the implant occurs during the draining procedure.
Alteration of Nipple and Breast Sensation –
The feeling in your nipple and breast may change following breast implant surgery. Your feeling can range from intense sensitivity to no feeling at all. These changes may be temporary or permanent. They may affect your ability to nurse a baby as well as your sexual response.
Extrusion –
Extrusion (when the breast implant comes through the skin) may result from unstable or compromised tissue covering and/or interruption of wound healing.
Calcium Deposits in the Tissue Around the Implant –
Deposits of calcium may be seen on mammograms and can be mistaken for cancer. In this event, it may be necessary to undergo additional surgery such as biopsy and/or removal of the implant to distinguish the calcium deposits from cancer.
Necrosis –
Necrosis, the formation of dead tissue around the implant, may prevent wound healing and require surgical correction and/or implant removal. Permanent scar deformity may occur following necrosis. Factors associated with increased necrosis include infection, use of steroids in the surgical pocket, smoking, chemotherapy/radiation, and excessive heat or cold therapy. If you are a smoker, it is recommended that you do not smoke during the few months preceding and following your surgery.
Breast Tissue Atrophy/Chest Wall Deformity -
The pressure of the breast implant may cause the breast tissue to thin and shrink. This can occur while implants are still in place or following implant removal without replacement.
In addition to these complications, there have been concerns associating breast implantation with certain systemic diseases:
Connective Tissue Disease –
A recent study conducted by the FDA indicates that women whose implants have ruptured and have extracapsular silicone gel (silicone outside the fibrous scar around the implant) were 2.8 times more likely than women whose breast implants haven’t ruptured to report that they had the soft tissue syndrome, fibromyalgia. Fibromyalgia is a syndrome characterized by widespread pain, fatigue, and sleep disturbance. The study did not show cause and effect, but a statistical association between extracapsular silicone and fibromyalgia. The study also indicated that patients with extracapsular silicone gel are not more likely than other women to have "other connective tissue disease" such as dermatomyositis, polymositis, and mixed connective tissue disease.
http://www.fda.gov/cdrh/breastimplants/biavail.html
Cancer-
Published studies indicate that breast cancer is no more common in women with implants than those without implants.
What is Silicone?
Silicone is a synthetic plastic, or polymer, that was first developed in the 1930s. It contains silicon, a naturally abundant material, combined with carbon, hydrogen, and oxygen that have been polymerized, a process in which simple molecules are combined to form more complex molecules. Silicone can be processed into three forms: a fluid, a gel, and a solid, rubber-like compound known as an elastomer. Silicone has been used in all its different forms, for medical purposes such as pacemakers, hypodermic needles, penile implants, eye lenses, and lubrication.
How long have silicone breast implants been in use?
Silicone breast implants became available in the early 1960s. They were vastly superior to the previous breast implants, which were made of polyurethane foam, paraffin, steel, and grafts of human tissue. The first silicone implants were firm and therefore required several large surgical incisions, leading to prominent scars. Over time the procedure has improved drastically leading to improved feel, more natural look, and much smaller incisions during surgery.
Are breast implants regarded as lifetime devices?
Breast implants are not regarded as lifetime devices. It is likely that you will undergo implant removal at some point over the course of your life. At this point you have the option of replacing your implant or removing your implant altogether.
What are the main reasons for having my implants removed?
The FDA recommends that you do not have your implants removed if you are having no physical problems. The following are the main physical problems that necessitate removal: a rupturing or leaking of your implant leading to deflation, silicone gel escaping from the implant envelope and scar capsule that is detectable in your breast or elsewhere in your body, or having a spherical capsular contraction that is hard, painful, and deforms the breast.
Are breast implants subject to strain or rupture while traveling in aircraft?
No, breast implants are not subject to strain or rupture while traveling in aircraft.
Is breast implant surgery painful?
The pain associated with breast implant surgery depends upon which specific surgery you choose to undertake, whether you choose submuscular or subgladular placement, and your individual reaction to the surgery. In general, post surgical swelling is to be expected, as is some pain and discomfort.
When can I return to work after implant surgery?
Most women return to work and resume non-strenuous activities, such as driving, about a week to ten days after surgery.
Who is not eligible for breast implants?
Women who have existing malignant or pre-malignant cancer of the breast without adequate treatment and women with active infection anywhere in the body are not eligible for breast implants. Breast implants are also contraindicated for pregnant or nursing women seeking augmentation. Breast implant surgery will only be performed on patients aged 18 and above. There is no upper limit for having surgery.
There are many types of implants available on the market, at Inspire we use a range of implants best suited to the patients needs. More information on the various implants, Q & A, and warranties offered, can be found at the following addresses:
The NagorEnhance® Patient Warranty is Free of Charge to patients
The NagorEnhance® Patient Warranty is a no-fault warranty
To read more about The NagorEnhance® Patient Warranty click on any of the Nagor Links shown above.
You will find more information including risks of surgery on our Questions and Answers page. However, for advice and answers to specific questions, that relate to your individual needs, we recommend a personal consultation at Inspire.
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