Breast Augmentation with Elizabeth Kinsley MD
Breast Augmentation is currently the most popular procedure I perform. Though there has been much controversy about breast implants in the past, the procedure is now recognized as a safe and effective way to increase breast size and improve shape. Unlike pills and gadgets, the results with implants are immediate and long lasting.
Because I perform so many augmentations, I realize that most prospective patients are faced with a lot of confusing information, from friends, the media or other sources, so I would like to explain how the procedure is done.
The surgery is done on an outpatient basis, under general anesthesia, and takes approximately 45 minutes. When you wake up, you will be wearing a bra and will have a small bandage over the incisions. I place the implants through any one of the following three incision sites: axillary, periareolar, or inframammary. Using the newest technology allows me to use the smaller, more inconspicuous incision sites even when using silicone implants. Once healed, you can wear a bathing suit or sleeveless top without a visible scar. The incision site does not have any effect on recovery time or postoperative discomfort. Breast augmentation procedures are often to combined with the following procedures — breast lift, liposuction and tummy tuck.
Implants are place either in front of the chest muscle or behind it. I think this was a really important issue when only saline implants were available, but with the superior look and feel of the new silicone implants submuscular placement is not as important. I currently am using textured implants in the subglandular position, and submuscular for smooth or saline implants. The muscle does not really do anything except camouflage the ripples of a saline implant- it does not hold up the implant or prevent it from sagging. Therefore, if silicone is used, I prefer to avoid any potential problems with the muscle (deformity of the breast when the muscle is flexed, eg) and place the implant behind the breast.
Size! Size! Size!
This is the issue that most women are concerned about and rightly so. A change in implant size (or volume) is one of the most common reasons for re-operation after breast implant surgery. In fact, over 40% of women who have another operation on their breast implants will do so to change the size.
So how do you know what size implant to choose? Looking at pictures and talking to friends that have had the procedure certainly helps, as does a consultation with an experienced breast surgeon. Some important things to remember: implants are sized according to the volume of saline or silicone gel that they hold – cc’s or ml’s – not according to cup sizes. Also, what looks good on the girl on the internet or your friend may not look good on you, particularly if she is 5’10” and you are 5’2″ and you are thin and she is not. Lastly, I have done a lot of augmentations over the years and have been asked to make breasts smaller only a handful of times. If a patient is unhappy with the size, it is almost always because she went too small.
I encourage my patients to participate in the selection process by trying on implants of varying sizes. This is not an exact process, but it will give the patient a good idea of what to expect, and give the doctor a good idea of what the patient thinks is too big or too small. In fact, patients have asked so many times to borrow the trial implants to take home and show their husband or friends, that I developed a sizing kit to use at home. The Envision kit contains information about breast augmentation, how to choose an implant size, four “try on” implants, a specially made bra to use with the implants, and an instructional DVD. For more information on the Envision Sizing System go to www.envisionimplants.com I firmly believe that allowing a patient to participate in the decision process is the reason that my rate for reoperation for size is extremely low.
Implants can be smooth or textured, and I use both depending on whether the implant is placed behind the muscle or the breast. When only saline implants were available, I would never place them behind the breast tissue because the implant was far too visible and showed every ripple in the implant. So smooth saline implants are placed behind the muscle if the patient opts for saline. Silicone implants are far superior in feel and visibility compared to saline, and I frequently will place textured implants in front of the muscle. I do not use anatomical or tear drop implants.
You should avoid heavy lifting or strenuous activity for the first week. During the second week, you may resume light activity or exercise (treadmill, etc.), and should be back to normal by the third week.
Bleeding and infection can occur with any surgery, and every precaution is taken to minimize these risks. You should not take any aspirin or anti-inflammatory medicine for two weeks prior to surgery and for one week following surgery in order to reduce the risk of bleeding. If an infection occurs, the implant is removed and then replaced after 3 to 6 months. The risk of infection may seem alarming, but fortunately it is extremely uncommon.
Contracture, or hardening of the implants, is the most common complication of implant surgery. The body will normally form a capsule (scar tissue) around the implant, but if this tissue thickens abnormally, it can make the implant (and breast) appear misshapen and even painful. Fortunately many contractures respond to medical treatment. Occasionally a minor surgery is required to release any scar tissue.
Nipple sensation may be altered after surgery, either increased or decreased, but should return to normal after a few months. Breast-feeding should not be affected by implants, but you should consult with your obstetrician.
The implants can rupture, although this is extremely rare. If a rupture occurs, your body will absorb the saline, a completely safe and natural alternative to silicone, and the implant will go flat. You will need to have the implant replaced (a relatively minor procedure). The new cohesive silicone implants are extremely durable.The major manufacturers offer lifetime replacement warranties.
Most importantly, implants will not affect your risk of getting or detecting breast cancer. As women, this is a concern we all have to face, and it is important to know that you are not doing something that could be harmful to you in the future.