Candidates for Surgery

If you are unhappy with your breast size, you are a candidate for breast augmentation. Breast augmentation does require using an implant.

In my experience, changes after pregnancy are the most common reason for augmentation surgery.

Implants

You have the choice of either saline or gel filled implants.

Saline implants use an empty silicone bag, which is filled with sterile IV fluids during your surgery.

Gel implants are restricted to women over 22 years old. Most women find gel implants give a more “natural” feel.

To monitor for gel implant leaks, the FDA suggests an MRI two years after your surgery, then every 3 years thereafter. Your insurance may not cover the cost. Although the Institute of Medicine has found no evidence of any link between silicone and disease, the FDA also wants you to consider that gel implants may affect your ability to get either health or life insurance.

Implants are warranted by the manufacturer against failure (leakage) for as long as you have the implants.

If the implant fails during your lifetime, the manufacturer will replace the failed implant. If the implant fails during the first several years after surgery, in addition to replacing the implant, you will be eligible for additional compensation for out of pocket expenses (to have the implant replaced).

Implant Selection

Implants are available in differing sizes & shapes. Before surgery, an implant of appropriate size and shape will be selected. Your desired breast fullness and your existing breast size will affect your implant selection. You will ultimately decide your implant size, with my help to ensure you select a size that is appropriate for you.

When considering implant size, there are two factors to consider: Remember that pregnancy will affect your breast size and shape. If more children are planned, you might consider deferring implant surgery, or consider a smaller size, allowing room for a larger implant (to help lift your breast when you are done having children).

Since excessively large breasts can cause problems, such as back pain, neck pain, and shoulder grooving, I may suggest a smaller implant size.

Implant Surgery

Treatment is done as an outpatient procedure. In all cases, the implant is centered under your breast tissue. The implant can be placed either below the breast tissue, or below both the breast tissue and the chest wall muscle.

When the implant is placed beneath the breast tissue (above the chest wall muscle), the incision is usually placed in the fold where the breast meets the chest wall.

If the implant is placed beneath both the breast tissue and chest wall muscle, I usually use an incision in the armpit, just in front of your armpit hair.

When your implants are placed below your chest wall muscle, a segment of the muscle must be cut. Post-operative pain is greater when placed below the muscle. This is similar to an athletic muscle injury, which takes weeks to recover.

Anesthesia

Implant surgery is usually performed in the outpatient surgery center. If the implant is placed above your chest wall muscle, “twilight” anesthesia can be used. In twilight anesthesia, you are sedated, but not asleep. A local anesthetic is used for surgical pain.

If you choose to place your implant beneath your chest wall muscle, general anesthesia is required.

Complications: Implant

The most common complications related to implants are the risk of implant failure and capsular contracture.

Capsular contracture is the result of scar tissue tightening around your implant. If this scar tissue tightens, your breasts may feel hard.

Less common complications include calcifications forming around the implant, shadows on your mammogram, and possible loss of some of your natural breast volume. Implant surgery does not change your risk of breast cancer.

Immune Disease: Although there is no apparent link between silicone and immune disease, if you have a family history of immune-related disease (like rheumatoid arthritis or lupus), there a remote chance that implants could change your risks of immune disease. If your family history is positive, I suggest you see a rheumatologist to assess your personal risk for immune disease.

Complications: Surgery

Surgical complications for implant surgery are the same as for any other operation. They include (but are not limited to) bleeding, infection, scarring, implant malposition, and the possible need for
additional surgery.