Breast augmentation, also known as augmentation mammoplasty, is the surgical procedure for enlargement of breast size. Breast augmentation is meant to improve a women's body contour. These include women with naturally small breast and also those who have lost breast volume following pregnancy and nursing. This operation may help balance breast asymmetries, however it is important to note that difference in the size, shape or orientation of the two breasts is considered normal and is actually the rule. While breast augmentation will enlarge the breasts, the surgery can not change the underlying defects in breast shape and form. If breast size and/or nipple position asymmetries are severe, additional procedures to further improve symmetry may be necessary. Saline filled or silicone gel implants may be implanted by several routes by an incision thru peri areolar (around the areola), inframammary (lower breast folds), transaxillary (arm pits) as well as transumbilical (via the navel) or transabdominal (over the abdominal wall) during an abdominoplasty surgery. The implants can be placed submuscular [under the muscle (partial or full)], subfascial [under the fascia (the lining over the muscle)] or submammary [below the breast tissue and over the muscle and fascia].
What are Breast Implants?
The implant is composed of an outer flexible, silicone shell and filled with either saline or silicone gel. The saline implants are filled intra-operatively while the silicone implants are pre filled. Although smooth round implants are the most commonly used shape, a variety of sizes, profiles and shapes as well as textured implants are available to meet the individual needs of each woman.
Who is a Candidate?
Patients must have realistic expectations. The specific risks and suitability of this procedure for a given individual can be determined only at the time of consultation with your cosmetic surgeon. Women who desire larger breasts or want to improve their breast shape or correct asymmetries are the general candidates. It is important to assure that there are no underlying health issues, including connective tissue diseases. It is also important to perform a physical exam and a mammogram to rule out breast malignancy. Patient with previous augmentation have the option for implant exchange if such procedure is desired or needed.
Although Breast Augmentation can be performed with conscious sedation with local anesthesia, it is best performed in an accredited outpatient surgical facility under general anesthesia. The procedure starts by a small incision (1-2 cm for saline and 5-6 cm for silicone) through a predetermined entry site. A pocket is created for the desired sized implant and the implant is placed and adjusted appropriately. In saline implants, the implants are filled with sterile saline to the desired size. The advantage of saline implant is the ability to adjust the size intra-operatively. With silicone gel implants, the implants are pre-filled. Silicone implants have the softer more natural feel and have a less chance of rupture. The incision is then generally closed with an absorbable suture. In certain cases a simultaneous breast lift or an areolar reduction is necessary. The patient is put into a soft conforming braw.
Recovery-Recuperation and Healing
Breast augmentation is an outpatient procedure and the patients are discharged to the care of a responsible adult and recover at home. Post operative pain is managed with oral medications. A soft bra or compression garment is usually worn for 1-2 weeks postoperatively. At times a compression wrap immediately above the breast tissue is necessary to assure a better outcome. Sutures, if any, are usually removed in 1 week. Light activity may be resumed in 7-10 days. It is important for the patient to avoid lifting their arms above the shoulder level in the first 1-2 weeks following breast augmentation. More vigorous activities may be resumed in 3-6 weeks depending on the patient's ability to heal and pending no post operative complication. Minor complications that do not affect the outcome occur occasionally. Although major problems are rare, a notable complication is ‘Capsular Contracture' which may occur at any time after surgery. Despite the risks, long term experience has shown that this operation has a high patient satisfaction rate.
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