New Breast= Implant + Your Breast
Many factors will affect the outcome of your surgery. The number one factor that determines your outcome is
what your breast looks like before any surgery. Your new postoperative breast will be the sum of the size and shape of the implant plus the size and shape of your existing breast. Your
breast may present a number of limiting factors that affect the results.
The chest wall is the foundation upon which the breast sits. The chest may be tall and narrow or short and wide.
The circumference of the chest may be a barrel shape or wide and flat due to the way the ribs are curved. The breastbone may be
flat, depressed, or protrude.
The quality of the skin over the breast may vary in appearance, pigmentation, and in how it heals. It may be thick or thin, and its
elasticity will vary. It may have stretch marks. The layer of fat under the skin will vary in thickness from patient to patient and in different parts of the breast. It may vary from one
side to the other. The amount and distribution of glandular tissue within the breast also varies. Pregnancy and breastfeeding will affect all of these elements.
The nipple areola complex varies greatly in its size, shape, color, and position on the breast. The nipple may project more, less,
or be inverted. It may be of large or small diameter. The position of the nipple relative to the inframammary crease is one of the factors that determines a need for a lift. They may be
farther apart or close together.
Achieving symmetry is one of the goals of surgery. However no one starts out perfectly symmetrical, so it is impossible to have a perfectly
symmetrical result. Some types of symmetry can be corrected but other are exaggerated by breast implants.
On examining a patient I look at the shoulders first. In most patients the right shoulder sits lower than the left, the right nipple and
inframammary crease are usually lower as well. Usually the left breast is slightly larger than the right.
Volume differences may be corrected by implants. Although if you fill two particular size implants to different volumes, the one with more
fluid will be firmer. If you use different size implants, then the implant diameters will differ and therefore another asymmetry is introduced. An even more difficult problem is having one
nipple higher than the other. Implants often exaggerate this asymmetry.
Another fairly common symmetry issue is the levels of the inframammary crease. The creases are usually at different levels. The bottom of
the implant sits at the crease level; therefore the upper edges of the implants may sit at different levels.
Also critical is the amount of soft tissue coverage over the implant. Soft tissue consists of skin, fat, breast, and muscle. The thickness
of this tissue determines its strength and how well it will hold up the implant over time. It also determines whether there will be visible wrinkling and how easy it will be to feel the
implant through the tissue. It also determines the final breast shape and how natural or unnatural it looks. One way to think of this is the ratio of breast tissue to implant. If the
final result is 50% your tissue and 50% implant, it will look and feel very natural. If it is 90% implant and 10% your breast, then it will look and fell very unnatural. Some women prefer
this unnatural, fake, or "Baywatch" look.
Another implant to tissue relationship is the distance between the breasts, or the cleavage. If that
distance is narrow before surgery it tends to stay narrow after surgery. If it is wide before surgery, it will tend to stay wide.
One must be careful using a wider implant to narrow the cleavage as the inner edge of the implant may be under some very thin soft tissue.
This may create visible wrinkling even with an implant under the muscle. Another limitation in narrowing the cleavage occurs when the nipples lie far apart.
The center of the implant needs to sit under the vertical line of the nipple. This determines where the inner edge of the implant is and
therefore the distance between the breasts. Though this could be improved by using wider diameter implants, an unacceptably large size may be required to achieve the desired distance
between the breasts.
Benefits of Breast Enhancement
Women seek breast enhancements for a variety of perceived benefits. Most simply want to look better in
certain types of clothes or swimsuits, thus increasing her clothing options. Certainly when a woman believes she looks better, she feels better about herself. The woman will look and feel
more feminine. It may very well increase her self confidence. We see this whether a woman never had a large enough breast to begin with, or if she is restoring her size after breast feeding,
or if she is trying to achieve better symmetry of the breasts due to a developmental condition.
Along with improving the shape and size of the breast, other goals are just as important. Every effort is made to maintain breast
function, softness, and sensitivity. It is also critical to minimize interference with breast cancer detection. If a woman is planning on having more children then the procedure should be
planned so that there is no interference with breast feeding.
There is an extremely high satisfaction rate with breast enhancement surgery. However it is not
for everybody. As with any cosmetic procedure patient selection is critical. The keys to success in this procedure are good health and realistic expectations on the part of the patient. When
these goals have been met, many women tell us it's the best thing they ever did for themselves.
Risks of Breast Augmentation
Although breast augmentation is a very common operation with a high level of success, it is incumbent
upon every patient to understand the natural course of events and potential complications for any breast that has an implant placed under it. Patient understanding of limitations, tradeoffs,
and complications is critical. Complications can be due to a number of factors. There are complications due to the patient's underlying health, complications of anesthesia, complications due
to surgical trauma, and complications due to the implants. There is often a fine line between what is considered a side effect of surgery and what a true complication is.
One of the limitations of breast augmentation is that stretch marks on the breast will not be eliminated by implants. Also, the skin
may be too tight to accommodate a very large implant. If there is severe sagging of the breast a lift may be required either at the same time or at a later date. Breast implants do not
prevent the natural aging of the breast. Many asymmetries may persist and actually be aggravated by breast implants.
A breast augmentation patient will also have to accept certain tradeoffs. Where incisions are made there is always a scar. Every effort
will be made to make this scar as inconspicuous as possible. Most of the time, the patient will be able to feel the implant under the skin. The less breast tissue you have the more likely you
are to feel the implant. A saline breast implant is also slightly firmer than natural breast tissue, though many women actually prefer the firmer feel. One of the most important tradeoffs is
the anticipation of future operation. Breast implants are not lifetime devices.
Most complications due to poor underlying health can be avoided by restricting the operation to
healthy patients. Likewise many of the potential anesthetic problems can be avoided by operating only on healthy women.
Possibilities of Surgical complication
Breast implants are not considered lifetime devices. You should anticipate additional surgery and doctor visits over the course of your life.
Even though the implants are covered by a lifetime replacement policy, you should anticipate additional expenses related to future implant surgery.
DEFLATION
Breast implants deflate when the saline solution leaks out of the implant due to the development of a defect in the implant shell. It may deflate rapidly or progressively over the course of
several days and is noticed by a loss of size and shape of the implant. The rupture rate is less than 4% in the first seven years. They may deflate due to some type of trauma but usually they
just wear out over time and deflate. Deflated implants require additional surgery to replace the implant.
CAPSULAR CONTRACTURE
The scar tissue or capsule that normally forms around the implant may tighten and squeeze the implant and is called capsular contracture. Capsular contracture is more common following
infection, hematoma, and seroma. It is also more common with placement above the muscle. Symptoms range from firmness and mild discomfort, to pain, distortion, palpability of the implant,
and/or displacement of the implant. Additional surgery is needed in cases where pain and firmness are severe. My recommended treatment of capsular contracture is implant removal with removal
of the scar tissue, followed by re-augmentation 3 months later. Capsular contracture may happen again after these additional surgeries. Capsular contracture may occur on one or both
sides.
PAIN
Pain of varying intensity and duration may occur and persist following any surgery. In addition, excessively large size, improper placement, surgical technique, or capsular contracture may
result in pain associated with nerve entrapment or interference with muscle motion.
DISSATISFACTION WITH COSMETIC RESULTS
Dissatisfying results such as wrinkling, implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, or hypertrophic (irregular, raised scar)
scarring may occur. Asymmetry in implant position, nipple location, or size may occur. Unsatisfactory surgical scar location may occur. Results of surgery are unpredictable for any individual
patient. You may be disappointed with the results of your surgery.
REOPERATIONS
Some complications may require additional surgery or other treatment to correct them and will result in additional expense to you. In rare cases, a satisfactory solution may not be
possible.
INFECTION
Infection can occur with any surgery. Infection may occur even though special precautions are taken, and despite the administration of antibiotics. Most infections resulting from surgery
appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with an implant present are harder to treat than infections in
normal body tissues. If an infection does not respond to antibiotics, the implant must be removed. Another implant may be placed 6 months after the infection is resolved.
HEMATOMA / SEROMA
Hematoma is a collection of blood inside a body cavity, and a seroma is a collection of fluid. Hematoma and seroma may contribute to infection and/or capsular contracture. Swelling, pain, and
bruising may result. If a hematoma occurs, it will usually be soon after surgery. However, it can also occur at any time after injury to the breast. Seroma may occur soon after surgery or,
rarely, years later. While the body absorbs small hematomas and seromas, large ones will require surgery for proper healing.
CHANGES IN NIPPLE AND BREAST SENSATION
Feeling in the nipple and breast can increase or decrease after implant surgery. The range of changes varies from intense sensitivity to no feeling in the nipple or breast following surgery.
Changes in feeling can be temporary or permanent and may affect sexual response or the ability to nurse a baby.
BREAST FEEDING
At this time it is not known if a small amount of silicone may diffuse (pass through) from the saline filled breast implant silicone shell and may find its way into breast milk. If this
occurs, it is not known what effect it may have on the nursing infant. Although there are no current methods for detecting silicone levels in breast milk, a study measuring silicon (one
component in silicone) levels did not indicate higher levels in breast milk from women with silicone-filled gel implants when compared to women without implants. (Most modern day pacifiers
and baby bottle nipples are made from silicone.) The periareolar incision site may significantly reduce the ability to successfully breast feed.
ASYMMETRY
No one has perfectly symmetrical breasts. Implants can correct volume asymmetry but may make nipple asymmetry more obvious. The breasts usually heal at different rates and some degree of
asymmetry is expected during healing. If the implants heal in asymmetric positions (too high, too low), a second surgery may be needed.
WRINKLING
Visible and palpable wrinkling of implants can occur. Some wrinkling is normal and expected. This may be more pronounced in patients who have saline-filled implants with textured surfaces or
thin breast tissue. It may be possible to feel the implant fill valve. Some patients may find palpable valve and wrinkles cosmetically undesirable. Palpable valve, wrinkling and/or folds may
be confused with palpable tumors and questionable cases must be investigated.
SYNMASTIA
This can develop with implants above or below the muscle. The skin over the breastbone can pull away and the implants can slide closer together, reducing or eliminating cleavage. The degree
can vary from mild to severe. Secondary surgery may be required and correction may be extremely difficult to accomplish.
DISSATISFACTION WITH SIZE
Every effort is made to help the patient select an appropriate size implant. We never guarantee a particular cup size as there is too much variability among bra manufacturers.
BREAST TISSUE ATROPHY/CHEST WALL DEFORMITY
The pressure of the breast implant may cause the breast tissue or chest wall tissue behind the implant to thin and shrink. This can occur while implants are still in place or following
implant removal without replacement. This is more likely to occur with high profile implants.
CONNECTIVE TISSUE DISEASE
Concern over the association of breast implants to the development of autoimmune or connective tissue diseases, such as lupus, scleroderma, or rheumatoid arthritis, was raised because of
cases reported in the literature of small numbers of women with implants. A review of several large epidemiological studies of women with and without implants indicates that these diseases
are no more common in women with implants than those in women without implants. The effects of breast implants in individuals with pre-existing immune system and connective-tissue disorders
are unknown. There is the possibility of unknown risks associated with silicone breast implants and tissue expanders.
SECOND GENERATION EFFECTS
There have been concerns raised regarding potential damaging effects on children born of mothers with implants. A review of the published literature on this issue suggests that the
information is insufficient to draw definitive conclusions.
REMOVAL / REPLACEMENT OF BREAST IMPLANTS
Future revision, removal, or replacement of breast implants and the surrounding scar tissue envelope involves surgical procedures with risks and potential complications. There may be an
unacceptable appearance of the breasts following removal of the implant.
LONG TERM RESULTS
Subsequent alterations in breast shape will occur as the result of aging, weight loss or gain, pregnancy, or other circumstances not related to augmentation mammoplasty. Sagging of the breast
may normally occur.
