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Breast Augmentation: What Is It?

Posted by EditorsChoice Wednesday, 10 October 2007

Modern-day breast augmentation began in 1963 with the introduction of a silicone gel-filled implant manufactured by the Dow Corning company and modified in many ways over the ensuing years. Prior to 1963, breast augmentation was done using ivalon, polyvinyl, polyurethane or silicone sponge materials or liquid silicone injections into the breast tissue.

Today, breast augmentation is accomplished by placing a silicone "bag" filled with salt water either behind the existing breast tissue or behind the muscle of the chest wall.

Women with ptotic (drooping) breasts, as defined by the nipple being lower than the crease or fold beneath the breast, will usually require an additional operation to lift the nipple and remove the excess loose skin. The augmentation and breast lift procedures may be combined in one operation.

When one breast is larger than the other, implants of different sizes can be used to achieve better symmetry.

In my practice, women desiring breast augmentation generally fall into two categories - Young women in their early 20's who have always had small breasts and desire to be one to two cup sizes larger; and women in their 30's, often with two or three children, who have noted a decrease in their breast size after childbirth and nursing who desire a return to their pre-pregnancy breast size and shape.

After adequate sedation given by an anesthesiologist, a solution containing a local anesthetic and a drug to minimize bleeding is injected into the surgical site and an incision is made either in the fold beneath the breast or at the junction of the pigmented skin of the areola with the normal breast skin. Some surgeons place the incisions in the axilla (armpit) or around the navel (bellybutton). I do not utilize either the axilla or navel incisions.

A space (pocket) is then developed by separating the breast tissue from the underlying muscles or by elevating the pectoralis major (chest muscle) from the ribs. Whenever the decision is made to place the implant behind the muscle, I also elevate the serratus anterior muscle (from the side of the chest) so that the saline-filled implant will be totally covered by muscle.
After all bleeding is controlled, the appropriate size implant is then placed in the pocket and filled with sterile saline solution. The incision is then closed, a light dressing is applied over the incision and a soft bra is placed.

Most patients will need 5 to 7 days to recover from surgery before returning to work. Strenuous activity is discouraged for at least 2 weeks. If the implant is placed behind the muscle, it may take as long as three months for the muscle to relax and for the breast to "settle" into its final shape.

No surgical procedure is risk-free. The following risks/complications have been associated with breast augmentation: infection, asymmetry (one breast looks different than the other), numbness (loss of feeling in breast skin and/or sensitivity in the nipple), hematoma (excessive blood accumulation surrounding the implant), pulmonary embolism (blood clot to lung), collapse of a lung (pneumothorax), death.

The most common complications are capsular contracture (shrinkage of the scar tissue [which surrounds all implants] causing a change in the shape of the breast, excessive firmness and sometimes pain) and rupture of the implant or leakage of saline (from a small hole in the implant or a malfunction of the valve used to fill the implant) which cause the implant to deflate. Both of these complications require surgery to correct the problem.