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Breast Augmentation (Enhancement) Basics

For hundreds of thousands of women a year, a breast augmentation can help boost self confidence, reconstruct breasts damaged by surgery or tumor removal, and correct asymmetrical breasts. Of course, the most common reason that women seek breast implants is for cosmetic purposes; they are unhappy with their appearance for one reason or another and want an enhancement to help them look and feel better. 

For each woman the desired surgical results are going to be different.  Some may want minor alterations, while others seek a drastic change, and that isn't just size; shape is a major consideration as well.  For this reason it is important that patients are as educated as possible going into surgery.  Consultations with the operating physician play an important role in ensuring surgical success.

How It's Done

There are many different types of implants and techniques available for women seeking breast augmentation; therefore surgery will be different from case to case.  The one thing that they have in common, however, is that they are performed under general anesthesia, or, in rare cases, local anesthesia with a heavy sedative, and can be performed as an outpatient procedure or in a hospital as an inpatient procedure.  Surgery can last between 1 and 2 hours.

The basics of the surgery is this: the physician will make an incision, position the implant into the desired placement, and then stitch together the skin where the incision was made.  There are three variables that can determine the results and success of surgery: type of implant, site of incision and placement of implant.

Types of Implants

All implants used today are made of a silicone shell with either a saline or silicone filling.  The use of silicone filled implants, which has been around since the early 60's, was banned in 1992 by the FDA until further information could be obtained.  Silicone gel-filled implants, however, may still be used for reconstruction or to replace silicone implants in women that have already had them.  These implants are also available as part of an FDA study, and may be used in women willing to participate in the study.  It is widely expected that silicone gel-filled implants will once again be made available by the FDA.

Silicone Implants

The three basic types of silicone gel-filled implants are:

• Single lumen (chamber), fixed volume implant that is pre-filled with silicone gel.
• Double lumen inflatable implant, with the inner lumen pre-filled with silicone-gel and the outer lumen has a valve through which saline can be placed during operation.
• Double lumen inflatable implant, with the outer lumen pre-filled with silicone-gel and the inner lumen has a valve that allows saline filling during operation, and allows for correction or adjustment postoperatively.

All silicone gel implants have a natural shape that gives breasts a natural appearance after surgery.  They are filled with a cohesive gel that will not spill out or "bleed" in the event of rupture.  This type of filling lowers or eliminates the risk of infection and other complications that were associated with earlier silicone implants that would leak silicone into the surrounding tissue if rupture occurred.

Saline Implants

The three basic types of saline-filled implants are:

• Single lumen implant with a valve, filled during operation.
• Single lumen adjustable implant, filled during operation and possible readjustment after surgery.
• Pre-filled saline implant.

Saline implants come in either a round or anatomical shape.  The anatomical shape gives the breast a natural appearance, with a slope towards the bottom of the breast, while a round implant makes the breast appear the way it would sound: round.  Implants can be either smooth or textured.  Smooth implants are believed by many surgeons and patients to be more natural in appearance and to the touch.  With a smooth texture the implant moves more freely in the breast pocket, acting more like natural tissue, and has less of a tendency to ripple than does a textured implant.  Textured implants are firmer, stay in place, and are designed to reduce the possibility of capsular contraction (see complications section), although this is a widely debated topic.

Incision Sites

There are four places on the body in which an incision can be made for implant insertion. They are:

• At the areola
• On the lower crease of the breast
• Through the belly button
• Through the armpit

Different physicians prefer different techniques.  It is important to discuss with your surgeon which option they prefer and why.  Silicone implants come pre-filled and therefore cannot be inserted through the belly button or armpit.

Implant Placement

The placement of breast implants is either sub-glandular or sub-muscular.  Placement below the muscle (sub-muscular) can be partial or complete.  With partial sub-muscular placement, the bottom third of the implant is not covered by muscle.  With both partial and complete placement bellow the muscle there are usually fewer instances of complications and mammography tests are easier to perform.  When implants are placed over the muscle (sub-glandular), insertion is faster and easier, and there is usually a shorter recovery period. 

Other factors including your exercise routine and amount of existing skin tissue could determine which placement is best for you.  You should discuss placement options with your surgeon prior to augmentation.

Technology

Technology has come a long way since the first silicone implant in 1962.  Implants now are safer and more natural looking then ever, but as possible complications and unnatural occurrences persist, technology continues to advance. On November 17, 2006, the FDA lifted a 14-year ban on the use of silicone gel breast implants after years of research over their safety. However, they have limited the cosmetic use to women ages 22 and older.

Recovery / Post Op

After surgery you will experience some pain, bruising, and swelling.  The extent of these after effects and how long they last varies for every patient, but incision and placement site can be contributing factors.  There will be scaring from the incision, and some slight bleeding usually happens for the first few days.  Heavy exercise should be avoided for several weeks based on your doctor's recommendation.  Return to work can usually happen one or two weeks after surgery.

Complications

The most common problem associated with breast implants is capsular contracture.  When an implant is inserted, a layer of tissue forms around the implant, referred to as a capsule.  If this capsule contracts it can put pressure on the implant, causing the breast to feel hard.  Other cosmetic complications include:

• Leakage or rupture
• Rippling
• Loss of sensation of the nipple or breast tissue
• Calcium deposits
• Placement shift

There are also risks associated with the surgery itself, including:

• Hematoma
• Infection
• Reaction to anesthesia
• Blood clot
• Hemorrhage

Am I A Candidate?

Women who wish to have breast implants for cosmetic purposes must be at least 18.  Patients are usually dissatisfied with small, sagging, or asymmetrical breasts.  Candidates should be in good health and not currently pregnant or breast-feeding.

Cost

The national average surgeon fee for 2005 was $3,406 as reported by the American Society of Plastic Surgeons (ASPS).  With facility and anesthesia costs the final price tag can range from $5,000 to $7,000 and up. The ASPS listed surgeon fees at an average of $3,593 for saline implants and $4,055 for silicone implants.

Breast Augmentation (Breast Implants) Surgery Information Guide

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