What should I know about breast augmentation (breast implants)?
Augmentation of the breast consists of the insertion of a silicone bag (prosthesis) under the breast (submammary) or under the breast and chest muscle (subpectoral) and then filling the bag with saline (saltwater).
- Smooth implants have less chance of rippling (waviness of skin) than textured (roughened) implants.
- Smooth implants have a higher incidence of capsule contracture (hardening of the implant) than textured implants.
- Implants placed under the muscle result in more pain postoperatively but have a lower incidence of capsule contracture and rippling.
- Infection and bleeding are rare but must be treated promptly.
- A certain number of patients may need another surgery to correct a problem.
- The aesthetic results of breast implants are best appreciated by the patient who feels the need for larger breasts.
What is breast augmentation?
Augmentation of the breast consists of insertion of a silicone bag (prosthesis) under the breast (submammary) or under the breast and chest muscle (subpectoral) and then filling the bag with saline (salt water). This prosthesis expands the breast area to give a fuller breast (increased cup size), give a better contour, and give more cleavage.
How is the incision made for breast implants?
The incision (cut) may be placed at various locations such as: under the breast at the breast fold; periareolar which is at the edge of the areola (brown area consisting of nipple and surrounding area); within the areola; in the armpit (axillary); or in the umbilical area.
The thinnest scar is usually in the areola. The umbilical incision approach is used with an endoscope (tube with a light for visualization and placement of the breast implant).
Breast Reconstruction for Breast Cancer Patient with a Mastectomy
What are the risks and benefits of immediate breast reconstruction?
There are sometimes findings on the final pathology report that make chest-wall radiation advisable in order to reduce the risk of local recurrence. If a prosthesis for the breast has been implanted, the radiation treatment will still work, but the radiation may significantly compromise the cosmetic appearance of the prosthesis. There may also be healing problems that delay chemotherapy, potentially increasing the risk of breast-cancer recurrence. These and other factors should be discussed and carefully considered before committing to immediate breast reconstruction.
What are smooth and textured types of breast implants?
There are two types of breast implants?
- The smooth surface implant requires a large pocket and is associated with a 10% incidence of capsule contracture (tightening of the scar around the implant causing firmness or hardness). The smooth implant has only an occasional occurrence of rippling or wrinkling which gives the overlying skin a wavy appearance.
- A textured (roughened surface) implant is associated with a 3% incidence of capsule contracture but has a 7-9% occurrence of rippling.
What are the choices of implant positions?
- The easiest surgical placement of the implant is under the breast tissue (submammary).
- A slightly more difficult surgical placement is under the chest muscle (submuscular or subpectoral) but this position is associated with a lower incidence of capsule contracture and slightly less occurrence of rippling. There is more pain postoperatively than with a submammary placement.
What are the options for breast implant size?
The ultimate size of the breast is mainly a personal decision by the patient. Cup size is an inexact estimate of the final size since cup sizes vary with the bra manufacturer and how tight or loose the patient wears her bra as well as how much breast tissue is already present. Describing the preferred cup size does aid the surgeon, but it also helps to look at pictures or photos to show the physician the desired final look.
The most accurate method of estimating the implant size (in ounces) is to fill a plastic bag with measured amounts of water and place in a bra with the patient's estimated cup size. One can see with the bra on and covered by a sweater what the final result will approximate.
Patients most often comment that, "I wish I had gone larger," although there is a rare patient who feels she is too large.
An average adult has about ________ square feet of skin.
What are risks and complications of breast augmentation?
Although infection is rare, it can be a very distressing problem. Signs of infection are fever, redness, swelling, and discomfort. If the infection does not respond rapidly to antibiotic treatment, the implant must be removed and the implant can be replaced three (3) months after the wound is completely healed.
If bleeding occurs into the implant pocket after surgery, the implant must be surgically removed, the bleeding controlled, the wound washed out, and the implant replaced. Signs of bleeding include marked swelling, increasing pain, and bruising.
3. Capsule contracture
Hardening of the breast with distortion and sometime pain may require surgical incision of the fibrous scar capsule around the implant (capsulotomy) or partial or total removal of the scar capsule (capsulectomy). The implant can be immediately placed back in the new packet. About 30-35% of patients have recurrent capsule contracture.
Other means of treating the contracture is replacement of a smooth implant with a textured one or placing the implant in a new pocket either under the breast or under the muscle.
If capsule contracture occurs multiple times, the patient may decide to remove the implants permanently.
Sometimes the implant will slip out of the position in which it was initially placed and appear too high, too low, or to one side. Most of the time, this requires surgical repair.
5. Problems with Mammography
The implant will block some areas of the breast from being visualized on mammography. This is usually less if the implant is placed under the muscle.
6. Autoimmune Disease
With all the confusion in the newspaper, magazines and on the T.V. or radio, there has been a fear that silicone implants may cause autoimmune disease. At this time there is no scientific evidence that silicone causes autoimmune disease.
According to the FDA, breast implants can cause anaplastic large cell lymphoma, in rare cases.
Implants that have been in a patient for many years may cause calcifications in the scar capsule around the implant. These calcifications can almost always be distinguished from the calcifications which may indicate breast cancer.
An implant may leak from weakness in the patch or valve area, a hole from incomplete inflation, or other factors. The more modern saline implants have been estimated to leak in 1-5% of cases.
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How long do breast implants last?
It is not known how long implants will last. In the body, the wall of the implant may weaken and become disrupted. This is more likely when there is an impact injury, such as from the steering wheel of a car or fall. The implant may or may not last a lifetime and depends upon the manufacturing process and other, as yet, unknown factors.
Most patients are extremely happy with breast augmentation. There is a certain amount of increased self esteem and self confidence which may result.
The patient who desires augmentation should not be influenced by family or friends as to whether or not the surgery should be performed and what size is most desirable. This is a very personal matter to most patients and satisfaction is best when the patient makes the decisions.