Breast
augmentation can enhance your appearance and your self-confidence, but it
won't necessarily change your looks to match your ideal, or cause other people
to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.
The
best candidates for breast augmentation are women who are looking for
improvement, not perfection, in the way they look. If you're physically
healthy and realistic in your expectations, you may be a good candidate.
Types
Of Implants
A
breast implant is a silicone shell filled with either silicone gel or a salt
water solution known as saline. Because of concerns that there is insufficient
information demonstrating the safety of silicone gel-filled implants at the
present time, they should be available only to women participating in approved
studies. Some women requiring replacement of the implants may also be eligible
to participate in the study.
Saline-filled
implants continue to be available to breast augmentation patients on an
unrestricted basis, pending further FDA review. You should ask your doctor
more about the specifics of the FDA decisions.
All
Surgery Carries Some Uncertainty And Risk
Breast
augmentation is relatively straightforward. But as with any operation, there
are risks associated with surgery and specific complications associated with
this procedure. The most common problem, capsular contracture, occurs if the
scar or capsule around the implant begins to tighten. This squeezing of the
soft implant can cause the breast to feel hard. Capsular contractures can be
treated in several ways, and sometimes require either removal or
"scoring" of the scar tissue, or perhaps removal or replacement of
the implant.
As
with any surgical procedure, excessive bleeding following the operation may
cause some swelling and pain. If excessive bleeding continues, another
operation may be needed to control the bleeding and remove the accumulated
blood.
A
small percentage of women develop an infection around an implant. This may
occur at any time, but is most often seen within a week after surgery. In some
cases, the implant may need to be removed for several months until the
infection clears. A new implant can then be inserted. Some women report that
their nipples become oversensitive, undersensitive, or even numb. You may also
notice small patches of numbness near your incisions. These symptoms usually
disappear with time, but may be permanent in some cases.
There
is no evidence that breast implants will affect fertility, pregnancy, or your
ability to nurse. If, however, you have nursed a baby within the year before
augmentation, you may produce milk for a few days after surgery. This may
cause some discomfort, but can be treated with medication as prescribed by
your doctor.
Occasionally,
breast implants may break or leak. Rupture can occur as a result of injury or
even from the normal compression and movement of your breast and implant,
causing the man-made shell to leak. If a saline-filled implant breaks, the
implant will deflate in a few hours and the salt water will be harmlessly
absorbed by the body.
If
a break occurs in a gel-filled implant, however, one of two things may occur.
If the shell breaks but the scar capsule around the implant does not, you may
not detect any change. If the scar also breaks or tears, especially following
extreme pressure, silicone gel may move into surrounding tissue. The gel may
collect in the breast and cause a new scar to form around it, or it may
migrate to another area of the body. There may be a change in the shape or the
firmness of the breast. Both types of breaks may require a second operation
and replacement of the leaking implant. In some cases, it may not be possible
to remove all silicone gel in the breast tissue if rupture should occur.
A
few women with breast implants have reported symptoms similar to disease of
the immune system, such as scleroderma and other arthritis-like conditions.
These symptoms may include joint pain or swelling, fever, fatigue, or breast
pain. Research has found no clear link between silicone breast implants and
the symptoms of what doctors refer to as "connective-tissue
disorders."
While
there is no evidence that breast implants cause breast cancer, they may change
the way mammography is done to detect cancer. When you request a routine
mammogram, be sure to go to a radiology center where technicians are
experienced in the special techniques required to get a reliable x-ray of a
breast with an implant. Additional views will be required. Ultrasound
examinations may be of benefit in some women with implants to detect breast
lumps or to evaluate the implant.
While
the majority of women do not experience these complications, you should
discuss each of them with your physician to make sure that you understand the
risks and consequences of breast augmentation.
Planning
Your Surgery
In
your consultation, your surgeon will evaluate your health and explain which
surgical techniques are most appropriate for you, based on the condition of
your breasts and skin tone. If your breasts are sagging, your doctor may also
recommend a breast lift.
Be
sure to discuss your expectations frankly with your surgeon. He should be
equally frank with you, describing your alternatives and the risks and
limitations of each. You may want to ask your surgeon for a copy of the
manufacturer's insert that comes with the implant he will use - just so you
are fully informed about it. And, be sure to tell your surgeon if you smoke,
and if you're taking any medications, vitamins, or other drugs. Your surgeon
should also explain the type of anesthesia to be used, the type of facility
where the surgery will be performed, and the costs involved. Because most
insurance companies do not consider breast augmentation to be medically
necessary, carriers generally do not cover the cost of this procedure.
Preparing
For Your Surgery
Your
surgeon will give you specific instructions on how to prepare for surgery,
including guidelines on eating and drinking, smoking, and taking or avoiding
certain vitamins and medications. If you develop a cold or infection of any
kind, your surgery will probably be postponed.
While
making preparations, be sure to arrange for someone to drive you home after
surgery, and to help you out for a day or two, if needed.
Where
Your Surgery Will Be Performed
Your
surgeon may prefer to perform the operation in an office facility, a
freestanding surgery center, or a hospital outpatient facility. Occasionally,
the surgery may be done as an inpatient in a hospital, in which case you can
plan on staying for a day or two.
Types
Of Anesthesia
Breast
augmentation can be performed with a general anesthesia, so you'll sleep
through the entire operation. Some surgeons may use a local anesthesia,
combined with a sedative to make you drowsy, so you'll be relaxed but awake,
and may feel some discomfort.
The
Surgery
The
method of inserting and positioning your implant will depend on your anatomy
and your surgeon's recommendation. The incision can be made either in the
crease where the breast meets the chest, around the areola (the dark skin
surrounding the nipple), or in the armpit. Every effort will be made to assure
that the incision is placed so resulting scars will be as inconspicuous as
possible.
