July 15, 2011
Breast augmentation, also known as mammoplasty, is a surgical enhancement procedure to accentuate the size and shape of a woman's breasts. While breast augmentation will make the breasts larger, the surgery will not move the breasts closer together or lift sagging breasts. Breast augmentation is tremendous help to patients who desire a fuller profile, who have lost breast volume due to pregnancy or nursing, or who have undergone breast reconstruction and want to gain a more natural look again.
Reasons for Considering Breast Augmentation:
Enhance body shape if breasts are too small.
Increase breast volume after pregnancy and nursing.
Equalize a difference in breast size (cup size) to gain breast symmetry.
Reconstruct breasts following a mastectomy or injury.
Breast augmentation involves making a small incision to insert a breast implant into the breast area in order to enlarge the breast. The surgery is commonly performed on an outpatient basis at a hospital or state-of-the-art surgical unit while the patient is asleep under general anesthesia. There are several possible locations for the small incision that will be used for inserting the breast implant. The most frequent technique utilizes an incision made in the lower portion of the breast. Another technique, though less frequently used, involves making an incision in the armpit. A third technique makes an incision around the areola (the darker skin surrounding the nipple). A newer technique uses an incision in the belly button, thus reducing the chance of scarring in the breast area. The best technique will be decided together between the patient and the surgeon during the consultation.
During surgery, the breast tissue is raised to create an open pocket under the breast tissue or beneath the chest wall muscle. Inserting an implant behind each breast can increase a woman's breast size by one or more bra cup sizes. Implants typically contain a saline solution (similar to saltwater) although in special cases the implants can contain a silicone gel. In some circumstances, particularly those in which there is breast asymmetry (uneven breast size), an inflatable implant may be used to allow the surgeon to adjust the level of inflation to attain breast symmetry and balance. Surgery typically lasts from 1 to 3 hours.
Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and recovery time. Bandages are applied right after surgery to aid the healing process and to minimize movement of the breasts. Once the bandages are removed, a specialized surgical bra will need to be worn for several weeks. Patients sometimes report minor pain associated with the surgery. This pain can be treated effectively with oral medication. While complications are rare, patients can minimize potential problems by carefully following the directions given by the physician after surgery.
Dr. Rojan Amjadi is board certified by the American Board of Plastic Surgeons, and was trained in plastic surgery at the university of Taxes-Texas Medical Center in Houston. Dr. Amjadi obtained his medical degree from the University of Texas Graduating with honors and he is currently member of the American society of Plastic Surgeons and several other plastic surgical organizations. He has been in practice since 1999 utilizing the most up-to-date, state-of-the-art cosmetic surgical techniques available.
THE FIRST STEP
Choose a Surgeon you can trust
Plastic surgery involves many choices. The first and most important is selecting a surgeon you can trust. A doctor’s board certification is one of the best indications of his or her training. Ask for certification from The American Board of Plastic Surgery (ABPS), the only board of the twenty-four approved by the by the American Board Medical Specialties (ABMS) that certifies physicians in plastic surgery of the face and all area of the body. To be ABPS board-certified, a physician must meet these rigorous standards:
- Graduate from an accredited medical school
- Complete at least five years of surgical training following medical school with a minimum of two years of plastic surgery residency training
- Pass comprehensive oral and written exams
American Society of Plastic Surgeon (ASPS) and American Society of Anesthetic Plastic Surgeon members must:
- Be certified by the ABPS or in Canada by the Royal College of Physicians and Surgeons of Canada.
- Complete continuing medical education including patient safety each year
- Perform surgery in accredited, state-licensed or Medicare-certified surgical facilities.
BEAUTY FOR LIFE:
Enhancing your appearance with breast augmentation
If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can
- Increase fullness and projection of your breast
- Improve the balance of your figure
- Enhance your self-image and self confidence
Also known as augmentation mammoplasty, the procedure involves using implants to fulfill your desire for fuller breast or to restore breast volume lost after mastectomy or injury.
What it won’t do
Breast augmentation does not correct severely drooping breasts. If you want your breast to look fuller and to be lifted due to sagging, a breast lift may be required in conjunction with breast augmentation. Breast lifting can often be done at the same time as your augmentation or may require a separate operation. Your plastic surgeon will assist you in making this decision.
Is it right for me?
Breast augmentation is a highly individualized procedure and you should do it for yourself, not for fulfill someone else’s desires or to try to fit any short of ideal image. Breast augmentation may be a good option for you if
- You are physically healthy
- You have realistic expectations
- Your breast are fully developed
- You are bothered by the feeling that your breasts are too small.
- You dissatisfied with your breast lusting shape and volume after pregnancy, weight loss or aging.
- Your breast vary in size or shape
- One breast or both breasts failed to develop normally.
WHAT TO EXPECT DURING YOUR CONSULTATION
The success and safety of your breast augmentation procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desire and lifestyle.
Be prepared to discuss:
- Why you want the surgery, your expectations and desired outcome
- Medical conditions, drug allergies and medical treatments
- Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drug
- Previous surgery
- Family history of breast cancer and results of any mammograms or previous biopsies
Your surgeon may also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Examine your breast and may take detailed measurements of their size and shape, skin quality, placement of your nipples
- Take photograph for your medical records
- Discuss your option and recommend a course of treatment
- Discuss likely outcomes of breast augmentation and any risk or potential complications
- Discuss the use of anesthesia during your breast augmentation
Preparing for the surgery:
Prior to surgery, you may be asked to
- Get lab testing or a medical evaluation
- Take certain medications or adjust your current medication
- Get baseline mammogram before surgery and another one after surgery to help detect any future changes in your breast tissue
- Stop smoking well in advance of surgery
- Avoid taking aspirin, anti-inflammatory drug and herbal supplements as they can increases bleeding
WORDS TO KNOW:
Areola: pigmented skin surrounding the nipple.
Breast augmentation: Also known as augmentation mammoplasty, breast enlargement by surgery.
Breast implant: Medical device placed in your body to enhance an existing breast size or to reconstruct your breast. Breast implant can be filled with either salt water (saline) or silicone (elastic gel).
Capsular contracture: A complication of breast implants surgery which occurs when scar tissue that normally forms around the implant tightens or squeezes the implant and becomes firm.
General anesthesia: Drugs and/or gases used during operation to relieve pain and alter consciousness.
Hematoma: Blood pooling beneath the skin.
Inframammary incision: an incision made in the fold under the breast.
Intravenous sedation: sedative administered by injection into a vein to help you relax.
Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
Mammogram: An x-ray image of the breast.
Mastectomy: The removal of breast tissue, typically to rid the body of cancer.
MRI: Magnetic Resonance Imaging; a painless test to view tissue similar to x-ray.
Periareolar incision: An incision made at the edge of the areola.
Saline implants: Breast implants filled with salt water.
Silicone Implants: Breast implants filled with an elastic gel.
Submammary or subglandular placement: Breast implants placed directly behind the breast tissue, over the pectoral muscle.
Sutures: stitches used by surgeon to hold the skin and tissue together.
Transaxillary incision: An incision made in the underarm area.
QUESTIONS TO ASK MY PLASTIC SURGEON:
Use this checklist as a guide during your consultation
- Are you certified by the American Board of Plastic Surgery?
- Are you a member of the American society of plastic surgeons or the American society for Aesthetic Plastic surgery?
- Were you specifically trained in the field of plastic surgery?
- How many years of plastic surgery trained in the field of plastic surgery?
- Do you have hospital privileges to perform this procedure? If so, at which hospitals?
- Is the office-based surgical facility accredited by a nationally or state recognized accrediting agency, or is it stated-licensed or medical-certified.
- Am I a good candidate for the procedure?
- What will be expected of me to get the best results?
- Where and how will you perform my procedure?
- What shape, size, surface texturing, incision site and placement site are recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How are complicated handled?
- How many additional implant-related operations can I expect over my lifetime?
- How will my ability to breastfeed be affected?
- How can I expect my implanted breast to look over time? After pregnancy? After breastfeeding?
- What are my options if I am dissatisfied with the cosmetic outcome of my implanted breast?
- How will my breasts look if I choose to have the implants removed in the future without replacement?
- Do you have before-and –after photos I can look at for this procedure and what results are reasonable for me?
Special instructions you receive will cover:
- What to do on the day of surgery?
- Post-operative care and follow-up?
- Breast implant registry documents (when necessary)
Your plastic surgeon will also discuss where your procedure will be performed. Breast augmentation may be performed in an accredited office-based surgical center. Outpatient ambulatory surgical center or a hospital.
Procedural steps: What happens during breast augmentation?
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step-2: The incision:
Incisions are made in inconspicuous area to minimize visible scarring. You and your plastic surgeon will discuss which options are appropriate for your desired outcome. Incision options include:
Incisions vary based on the type of implant, degree of enlargement desired, your particular anatomy, and patient-surgeon preference.
Step-3: Implant choice
Breast size and shape are important, so be honest and open about your expectations when talking with your surgeon. Implant type and size will be determined not just on your desired increase in size but more importantly on your breast anatomy, skin elasticity and body type.
Option for Breast Implants:
- Saline implants: Saline implants are filled with sterile salt water. They can be filled with varying amounts of saline which can affect the shape, firmness and feel of the breast. Should the implant shell leak, a saline implant will be absorbed and naturally expelled by the body/
- Silicone implants: Silicone implants are filled with an elastic gel. The gel feels and moves much like natural breast tissue. If the implant leaks, the gel may remain within implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel may not collapse. If you choose these implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants, so there may be additional options available.
- Currently saline implants are FDA-approved for augmentation in women 18 years of age and older.
- Currently silicone implants are FDA-approved for augmentation in women 22 years of age and older.
- Saline or silicone implants may be recommended at a younger age if used for reconstruction purpose.
- See www.breastiplantsafety.org for current information.
Step 4: Inserting and placing the implant
After the incision made, a breast implant is inserted into a pocket either:
- Under the pectoral muscle (a submuscular placement),or
- Direct behind the breast tissue, over the pectoral muscle(a submamary/subglandular placement)
The method for inserting and positioning implants depends on the type of implant, degree of enlargement desired, your body type, and surgeon’s recommendations.
Step 5- Closing the incisions
Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin. Over time the incision lines will fade.
Step 6- See the results
The results of breast augmentation are immediately visible. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover and realize the fulfillment of your goal for fuller breasts.
Important Facts about the Safety and Risks of Breast Augmentation
The decision to have breast augmentation surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and/or staff will explain in detail the risks associated with the surgery. Your plastic surgeon and/or staff will explain in detail the risks associated with the surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks or potential complications.
The risks include:
- Unfavorable scarring
- Bleeding (hematoma)
- Poor healing of incisions
- Changes in nipple or breast sensation, may be temporary or permanent
- Capsular contracture, which is the formation of firm scar tissue around the implant
- Implant leakage or rupture
- Wrinkling of the skin over the implant
- Anesthesia risks
- Fluid accumulation
- Blood clots
- Pain, which may persist
- Deep vein thrombosis, cardiac and pulmonary complications
- Possibility of revisional surgery
Breast implants do not impair breast health. Careful review of scientific research conducted by independent groups such as the Institute of Medicine has found no proven link between breast implants and autoimmune or other systemic diseases.
Other important considerations:
- Breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants.
- Pregnancy, weight loss and menopause may influence the appearance of augmented breast over the course of your lifetime.
My Breast Augmentation Recovery
After a post-surgical recovery period of 24 to 48 hours and an additional reduced activity period of few days, you will likely experience soreness and swelling for a few weeks. Exercise and normal activity can resume at the direction of your plastic surgeon.
Over time, post-surgical swelling will decrease and incision lines will fade.
You will be given specific instructions that may include: how to care for your breast following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, and when to follow-up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressing/bandages after surgery? When will they be removed?
- Are stitches removed? When?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
When you go home
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing. Our doctor will give you specific instructions on how to care yourself.
The results will be long-lasting
The results of your breast augmentation surgery will be long-lasting. You will find it easier to wear certain styles of the clothing and swim wear. Like many women who have had breast augmentation, you may also have a boost in self-confidence.
Implants may need to be replaced or revised
It’s important to know that your breast implants are not permanent and may require replacement during your lifetime. You should expect to have future visits with your plastic surgeon to discuss changes in your breasts.
Over time, your breasts can change due to aging, weight fluctuations, hormonal factors and gravity. If after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift or implant exchange to restore a more youthful contour.
Continue to follow your plastic surgeon’s instructions and attend follow-up visits as scheduled.
How much will breast augmentation surgery cost?
Cost is always a consideration in elective surgery. A surgeon’s cost for breast augmentation may vary based on his or her experience, the type of breast implant used, as well as geographic office location. Many plastic surgeons offer patient financing plans, so be sure to ask.
Cost May include
- Surgeon’s fee
- Hospital or surgical facilities costs
- Anesthesia fees
- Prescription for Medication
- Post-surgery garments, and
- Medical tests
Most health insurance plans will not cover cosmetic breast surgery, related complication or another surgery to revise the appearance of your breasts.
Some carriers even exclude breast diseases in patients who have breast implants. You must carefully review your health insurance policy.
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