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Breast Augmentation
San Francisco - Oakland - Santa Rosa
Breast
Augmentation
One decision
that more and more women are making everyday is to have breast augmentation (a procedure to enhance the size of your breasts by using breast implants.)
Advances in breast implants and the surgical technique are making breast
augmentation a popular procedure among women of all ages.
The decision to have breast augmentation may result in a more flattering, better-proportioned figure, more clothing options and may enhance your confidence and self-esteem.
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The decision is very
personal. Every woman’s decision is different and is based on individual
needs, desires and expectations. A well-informed decision is critical, since breast
augmentation may not be a one-time surgery.
Who is a candidate
for breast surgery? Women over eighteen years of age are candidates for
breast augmentation. By this age, the breasts are fully developed.
There
are many reasons or conditions to have breast augmentation. These are some of
the more common:
· The breasts are too small
· Weight loss
has changed the shape and size of the breasts
· Your breasts have become smaller and loss elasticity, often after
having children
· One of your
breasts is significantly different.
· You feel uncomfortable wearing
a swimsuit or a tight fitting garment
In addition, you must be emotionally mature, and fully understand your motivation for wanting breast augmentation. You must have realistic expectations, and understand that the procedure will bring great improvement, but not perfection.
Prior to Surgery A personal consultation
is the first step for every patient considering breast augmentation. Dr.
Delgado will ask you to discuss your concerns about your appearance. Dr.
Delgado will then use computer imaging to help visualize your current
size, shape, and asymmetries. During the meeting, he will discuss your
current conditions and what goals you want to achieve. A physical examination
will be made and your medical history reviewed to determine if breast
augmentation is the best for you. If you are a good candidate, Dr. Delgado
will explain:
· various implant size, shape, and contour.
· various placement of incisions.
· implant placement, i.e., over or under beneath the pectoralis
muscle.
· explain the potential complications.
Dr. Delgado may require a work-up by your medical doctor, and possibly a pregnancy test. Various lab work is required and possibly a mammogram.
Dr. Delgado will
give a precise preoperative instruction pamphlet or booklet that will explain
your medications and any preparations that you need to make at home. This preoperative
pamphlet will also give a concise list of all aspirin and aspirin containing compounds,
including anti-inflammatory products that must be stopped two weeks before and
two weeks after surgery. Tylenol may be taken during this time. You will also
be given a list of vitamins and homeopathic drugs to take prior to and after surgery
to reduce bruising and swelling.
Breast Implants There
is no perfect breast implant. All implants have trade offs. There are essentially
two implants used today; saline filled, and silicone filled implants. Both implants
have an outer pliable envelop or shell which is made of silicone. The content
of the shell is either saline (salt water) or silicone gel.
Saline filled
implants are the most commonly used today. The silicone shell is filled with saline
at the time of surgery. If there is a leak from the implant, the salt water is
safely absorbed by the body.
Silicone filled breast implants are only
available to certain patients that are participating in a mandatory adjunct study
by the Federal Drug Administration.
Both types of breast implants come
in many sizes, shapes and surface textures.
Anesthesia Breast implant surgery is performed under general anaesthesia. It is done in an outpatient surgery center or an accredited operatory. It can be combined with other procedures like facial surgery or body contouring.
Procedure
Before general anaesthesia is given, your breasts and chest is carefully outlined
using a surgical marking pen. This acts as a road map during surgery.
Breast implants can be placed through one of three incisions. The most common
being the periareolar incision between the dark and light interface of the areola
and paler breast skin. This incision gives an excellent cosmetic result. It can
also be placed at the skin crease underneath the breasts itself, or lastly, it
can be placed through the armpit region referred to as a transaxillary approach.
The breast implant can be placed either on top of the pectoralis muscle or below
it. For my patients, I usually use periareolar approach and place the implants
below the muscle. During surgery, once the implants are in place, the patient
is sat up to compare the size, position, and the symmetry. A multiple layer closure
is performed for the closure of the incision and deeper tissues. A compression
band and bra is then placed.
Some women have loose skin from childbirth, weight loss, or genetic reasons.
In these cases we may place the implant partially under the muscle, above
the nipple, and partially above the muscle below. This will insure that
the loose skin is fully stretched. However, if the skin of the breast
is very loose or ptotic, a lift in conjunction with the augmentation may
give the best results. Some women do not want breast lifts due to the
additional incisions, and will accept the trade-off of a lower breast
mound.
After
Surgery The first few hours after surgery will be spent in the recovery
room. When you are fully alert, you will be able to go home with the assistance
of a friend or a family member. At this time it is important to sleep with the
head and back elevated to reduce the swelling in the area. Two days after surgery,
you may take the dressings off and take a shower and then re-apply the band and
bra. Instructions are given for suture care.
The discomfort after breast
augmentation surgery is moderate. This discomfort is more noticeable if the patient
has had the implants placed underneath the muscle. These patients will notice
more tenderness and soreness around the chest region. Patients take medications
during the first day or two in order to be comfortable during the recovery. By
the third day, the patient shouldn’t need strong pain medications. However,
some patients have a lower threshold and therefore, may take pain medications
for up to five days.
The recovery period, is generally two weeks. Once
the bruising and tenderness are gone, the patient can return to their normal activities.
It is an absolute priority that patients avoid lifting of any kind for at least
two weeks post operatively. Most patients may drive a car and return to work or
social activities after one week. Strenuous exercise is avoided for three to four
weeks following surgery.
Risks and Complications Each year, thousands of women
undergo breast augmentation surgery and experience no complications. A
highly-trained plastic surgery team which includes a board- certified
anesthesiologist and nurses will reduce the frequency of complications.
However, you must fully understand the risks as well as the benefits of
this surgery. As with all surgery the risk of bleeding, infection, and
risk of anesthesia exists. Additional complications specific to breast
augmentation include deflation/rupture of the implant. Breast implants
deflate when the saline solution leaks through an unfilled or damaged
valve or through a break in the implant shell. The implant deflation can
occur immediately or progressively over a period of days. Since salt water
is naturally present in the body, the saline that has leaked from the
implant will be absorbed safely in the body. Deflated implants necessitate
additional surgery to remove and to replace the implant.
Capsular Contracture:
Natural scarring occurs around the breast implant. If the scar tightens
around the implant, then it can become firm. This firmness is called capsular
contracture. The symptoms range from firmness and mild discomfort to pain
and distortion of the implant. If the symptoms are severe, additional
surgery may be needed.
Infection:
Most infections resulting from
surgery appear within a few days, to two weeks after the operation. All breast
implant patients are treated during and after surgery with antibiotics.
Hematoma :
Hematoma is a collection of blood inside the body cavity. If a hematoma
occurs, it usually occurs soon after the surgical procedure within the
first 24 to 48 hours. Small hematomas are absorbed by the body but large
ones need to be drained surgically in the operating room.
Changes in
Nipple and Breast Sensation:
Feeling in the nipple and breast can increase or decrease after implant
surgery. The range of change varies from intense sensitivity to reduced
sensation of the nipple or breast following surgery. Changes in the feeling
are usually temporary and return after swelling dissipates.
Cancer:
Public studies indicate that breast cancer
is no more common in women with implants than those without implants.
Results
Breast augmentation may be a way to achieve an enhanced appearance of the breasts.
This often can boost a women’s self esteem and confidence.
The
initial two weeks following surgery, the breasts are distorted with swelling and
bruising, but it quickly dissipates. It takes approximately three or four months
for the breasts to set into its new shape. Dr. Delgado will spend significant
effort and time preoperatively to discuss your anatomy and to choose the proper
implant shape and size that will accomplish a natural appearance to your new shape.