Breast augmentation is a popular procedure and think that that is a testimony to its safety and the good results. If it was not so popular, not so many people will be getting it done. It can improve one’s appearance and this often translates into more self-esteem and sometimes more success.
The best results are obtained when there is an adequate amount of coverage over the implant. By coverage, I mean, the amount of body tissues which are over the implant. More coverage means more natural shape and appearance! I usually suggest placing the implant under the muscle. This added amount of coverage provides for an even better result. The implant shape is round and the optimal shape of the breast is not round but oval. Nonetheless, when the implant is placed in the submuscular pocket appropriately, the breast shape can be maintained. The other issue is how much enlargement can be performed. I think that going up one-and-a-half cup sizes sometimes up to two-cup sizes can give results that are reliable and predictable, but more cup size increases will result in an un-natural appearance. Implants aren’t perfect and one of the problems with implants is that they can have wrinkles in them. If there is not adequate coverage, these wrinkles can often be felt and sometimes seen.
During the examination I will note asymmetries. Every patient has a breast asymmetry and I have never seen anyone that has perfect breast symmetry. I make sure to point out asymmetries before hand because most patients have not noticed small differences in symmetry before surgery. But after surgery, patients look at themselves quite critically and often pickup some of the asymmetries which actually existed before surgery. Sometimes, I can adjust the procedure to address issues of asymmetry such as adding more volume to one side to equalize size.
The incision for the procedure is a little over an inch in length. As far as incisions for implant placement, I feel that the periareolar or the inframammary fold incisions heal well, and leave a very acceptable scar. The reliability with this approach assures the proper placement for the implant and also decreases the chances for complications such as bleeding. The pocket can be made with the least amount of complications and risks! I believe that the axillary approach is also good but requires slightly a longer operative time and it is more difficult to make the appropriate pocket.
As far as implant texture, I believe that a smooth implant is adequate because the implant sits in an exact pocket and it will fit nicely. Also, the implant is softer than the textured ones. I have not noted an increased incidence of capsular contractures with smooth implants.
I most often suggest performing the procedure under a monitored conscious sedation with locally administered anesthetics. Most patients tolerate this well and recover faster from a conscious sedation compared to a general anesthesia. Patients are given oral or IV sedation prior to the procedure. When they are brought into the operating suite, they are already sedated and often do not even remember going into the suite. More sedatives are given during the procedure as local anesthetics are infiltrated into the surgical areas.
The majority of pain occurs in the first 24 hours. Ice packs and narcotic medications help with this. In the next 24 hours, pain will start to decrease and more of a pressure sensation dominates. After about two to three days, most of the pressure subsides and there is some generalized soreness, which will slowly dissipate over the next few weeks. Right after the surgery, the appearance is not perfect or even as desired. Usually, the implants look too high and the breasts are too hard and swollen. The shape is awkward. This is because the amount of swelling which occurs when the implant is placed in the submuscular pocket. The amount of upper pole fullness is a reflection of the swelling in the pectoralis muscle. This swelling dissipates in time and its resolution is aided by the use of compression garments, and sometimes massage. In approximately four weeks, a nice result can be seen but it often takes eight weeks for everything to settle. Exercising is limited for at least three weeks and a full regimen of exercise may not be started for at least 12 weeks.
The implants are durable and carry a warranty that covers replacement if there is any leakage. Luckily, this occurs very rarely. In saline implants,
leakage is manifested by decrease in breast size, a flat tire! Leaks in silicone gel implants are much harder to detect. Sometimes, an MRI is needed to detect these leaks. If leakage occurs, the procedure to replace the implant is relatively uncomplicated and tolerated well.
Other possible complications include, bleeding infection, scarring, asymmetry, and sensation changes. These happen infrequently. The complication that I feel is not completely controllable is something called capsular contracture. Anytime an implant is placed into the body, the body forms a smooth soft tissue around the implant that keeps the implant in place. Sometimes, for reasons that aren’t completely clear, this tissue can become hard and thick. If it becomes very hard and thick, it can displace the implant and cause a breast deformity. It causes the breast to be hard. If this happens, it is not the end of the world. It may require that the implant be removed and the capsule be removed and then the implant replaced. Capsular contracture happens anywhere from 1% to 7% of the time. Capsular contractures that require an operation happen less than 1% of the time in my practice.
Breast implants do not cause breast cancer and mammograms are still performed. Often, the self exam is easier to perform. The tumor can be felt easier if it is against the interface of the implant.
