An Overview of Breast Enlargement and Breast Implant Surgery
Once a woman has made the decision to have breast implants or breast augmentation surgery, she will begin preparing for it. An initial step is to meet with a surgical consultant, who will not only go over all the costs of the procedure, but will also help the patient choose the best implants for her body type and desired results, from the size to the filling. Among the issues that affect which implants will be chosen are the surgeon's preference, the patient's preference, and the patient's lifestyle, including regular activities they plan to continue.
As well, the decision to have a breast lift in tandem with the breast enlargement will be discussed. The procedures are often done together, if the patient's breasts show signs of sagging, for example, or if the enlargement will be significant.
Types of Implants
There are two types of breast implant: silicone and saline. In both cases the "type" refers to the filling - the substance used to give the implant mass and form.
Saline
Saline-filled breast implants were originally manufactured in France as early as 1964, and can be inserted through a smaller incision than silicone-gel implants because they are inserted empty, and filled with saline solution (salt water) after the placement. They are actually a silicone shell around a salt water bladder, and they are the most commonly used implant in the United States but not the rest of the world. This is directly related to the U.S. having greater restrictions on the use of silicone. While good results are obtained, they are prone to cosmetic problems like wrinkling and rippling, as well as being fairly noticeable by sight or touch.
Silicone Gel
Generally preferred by surgeons and patients alike are silicone-gel breast implants, which were first developed by two plastic surgeons for Dow Corning Corporation in 1961, with the first implantation taking place the next year. They've gone through four generations, since then, but have generally retained their teardrop shape, though the current version offers round implants as well.
These implants are an elastomer-coated shell filled with thick silicone gel, and while their use is restricted in the United States and Canada, they are widely used elsewhere around the world. The thickness of the gel makes it more cohesive, and reduces the potential for leakage, while the firmer texture holds it's form better, making the implants, especially the teardrop-shaped ones, seem much more natural to the touch and sight.
The fifth-generation silicone implant is likened to a "gummi bear," in terms of solidity, and is still in early testing stages in the United States, but has been used since the mid 1990's in other countries. They are the most stable implants in use, to date.
The Procedure
Once the decision about the type of implant has been decided, the surgery is scheduled. The procedure is generally over within two hours, and is usually done on an out-patient basis, though sometimes an overnight stay in a hospital is recommended.
The patient is usually placed under general anesthesia, and then the surgeon will make the incision. There are five types of incision in common use:
- Inframammary: this is the most common choice. The incision is placed below the breast in the infra-mammary fold, to allow for precise dissection and placement. Because silicone gel implants require longer incisions, this option is best for those. It can lead to thicker scarring, and the scars may be more visible in women with small breasts that don't drape over the fold.
- Periareolar: this insicion is placed along the areolar border, and it offers the best approach when perfoming a mastopexy (breast lift) in tandem. Silicone implants can be difficult to place using this method, and it does have a higher risk of capsular contracture, but because the incision is along the edge of the areola (either the inferior half or the medial half), scarring is not very visible, even in women with light-colored skin.
- Transaxillary: the incision is placed in the armpit in this approach, which allows implants to be placed with no visible scarring on the breast. It may or may not be an endoscopic procedure, but either way it virtually guarantees a symmetric result.
- Transumbicilical (TUBA): this technique is less common, and involves the incision being placed in the navel. Again, there are no visible scars on the breasts, but implant placement is more difficult. This procedure may or may not be performed with an endoscope, and is generally only used to place saline implants, as silicone gel implants can too easily burst during insertion.
- Transabdominoplasty (TABA): is similar to the TUBA procedure in that the implants are tunneled into place from an incision point in the abdomen. It's generally only used when an abdominoplasty is being performed at the same time.
Once the incision is made, the surgeon will create a pocket and place the breast implant within it. Again, the there are different kinds of placement, all in relative position to the main pectoral muscle. Just as the patient's existing anatomy and desired results from their breast enlargement surgery helped determine which breast implants would be use, and which incision was best, so, too do the same factors help determine the placement of this pocket. The different types of placement are:
- Subglandular: the implants are placed between the breast tissue and the pectoral muscle. This position is largely felt to give the most natural looking results.
- Subfascial: the pocket is similar to the subglandular position except that it's also created beneath the fascia of the pectoral muscle. It is thought that this technique helps maintain the position of breast implants.
- Subpectoral: after the lower (inferior) attachments of the pectoral muscle are released, the implant is placed beneath it, so it sits partly behind the muscle, and partly in the subglandular position. This technique has greatly reduced incidences of capsular contracture, one of the risks associated with breast augmentation surgery.
- Submuscular: this procedure is used most often for implants inserted as part of a breast reconstruction procedure. None of the muscular attachments are released, and the implants are inserted behind the pectoral muscle.
After the pockets have been formed and the breast implants have been inserted, and, in the case of saline implants, filled, the surgeon will suture the incisions, which will then be dressed with tape and / or gauze to prevent the patient from irritating the stitches. In many cases a surgical bra is prescribed immediately, and it must be worn even after the stitches are removed.
Sutures are generally removed after a week to ten days, but recovery time may take longer - up to three weeks - though patients who don't have highly active jobs are generally able to return to work in about a week. The scars from breast enlargement surgery will be highly visible for at least six weeks, but usually begin to fade several months after surgery.
Risks
As with any surgery, there are risks associated with breast augmentation. They include a burning sensation in the nipples, and sometimes a loss of sensation, itching, scarring, excessive bleeding, and the possibility of infection, but most of those are easily handled. In some cases breast implants can rupture, and have to be removed, and then reinserted, which means another surgery cost.
The most serious risk is capsular contracture, which is when the capsule or pocket around the implant begins to contract, or tighten. This forces the filling inside the implants far forward, and the increased tension makes them feel hard instead of malleable. It can be treated by scoring the scar tissue around the implant, but removal and replacement of the implants may be required.
