| Breast Augmentation Surgery |
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| Wednesday, 16 November 2005 | |
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What Is Breast Augmentation? Who are good candidates for Breast Augmentation Surgery? Primarily, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of the procedure. Communication with one’s surgeon is crucial in reaching one's goals. The patient must be able to voice her desires to her surgeon if he or she is to understand what the desired results are. The patient should discuss her goals with the surgeon so that she may reach an understanding of what can realistically be achieved. If the patient is planning to still have children in the near future it may a good idea to wait until the patient no longer wishes to have any additional children. However, many women get breast implants, have their children and later get a breast lift if needed. Patients should also discuss the available anesthesia that will be used for the procedure. Most Breast Augmentation procedures are performed under Light Sleep Sedation or General Anesthesia. Either way, this should be discussed beforehand, as most people are hesitant to go under General Anesthesia. If you do go under deep General, you should ascertain that the anesthesiologist is certified. There are significant risks associated with General Anesthesia that are separate from the surgical procedure itself. The patient must be mentally and emotionally stable to undergo any cosmetic procedure. No board certified surgeon would or should agree to work on a mentally unstable person. This is an operation which requires patience and stability in dealing with the healing period. Patients must also realize that cosmetic plastic surgeons are not miracle workers and that there is only so much that can be achieved through surgery alone. What Are My Options In Breast Implants?
Saline-filled (silicone elastomer shell): These implants are more common than any other available type of implant. In the US, the saline-filled implant is the only implant made available to women wanting cosmetic breast augmentation. They are constructed of a tough, semi-permeable silicone elastomer shell with a single valve on the anterior (front) surface of the implant. These implants come in both smooth and textured surfaces and round or contoured (also known as anatomical, teardrop, biodimensional) shapes. Currently in the US there is a moratorium on breast implants over 1200cc. If one desires more augmentation they are often instructed to travel overseas or their doctor may write them a prescription for an overseas order or the patient contacts the breast implant prostheses suppliers themselves and when it arrives at customs the patient picks it up. Take care when choosing a surgeon for reasons of implant size availability only. The only manufacturers of Breast Implants which are approved for use in the United States of America are McGhan Medical & Mentor Corporation. Both companies have developed and/or presently manufacture silicone-filled and double lumen breast prostheses. Both manufacturers carry implant warranties which cover the product replacement in the event of a deflation and also cover some expenses for the revision surgery. New McGhan® Style 10 and McGhan® Style20: "INAMED Aesthetics' McGhan® Style 10 is a smooth surface silicone-filled breast implant designed to provide moderate projection with 20 sizes to choose from. The McGhan® Style 20 is also a smooth surface silicone filled breast implant with full projection and 23 sizes to choose from for surgical planning convenience. Both implants utilize INAMED's patented INTRASHIEL® Barrier Shell technology for reduced silicone diffusion." "Available as part of INAMED's McGhan Medical Adjunct Clinical Study, these 2 new devices represent INAMED Aesthetics' continued commitment to the breast reconstruction patient and the further expansion of its silicone filled breast implant product portfolio. For additional information on INAMED Aesthetics' McGhan® Style 10 and Style 20 silicone filled breast implants or information on becoming a clinical investigator please contact INAMED Customer Care at 800.766.0171." Mentor Saline-filled (silicone elastomer shell) High Profile: (called also the Mentor 3000 saline implants) These implants are the same as above yet they seem to have less rippling, more projection for the same size and less lateral base. This is a wonderful implant for women with small ribcages (smaller chest diameter) but a desire for more projection of the breasts. These women usually sacrificed one or the other # more projection and a less natural diameter or less projection but still a breast diameter in proportion to their body. The Mentor 3000 Series ends all that. Now these women are able to have their cake and eat it too. The High Profile implant is also smoother and as mentioned above has less rippling, or wrinkling most often seen at of the outer edge of the saline-filled implant. Women who do not have smaller ribcages, but still want more projection will find that if they choose to have High Profiles, they are trading cleavage for projection. Saline-filled (silicone elastomer shell) Expandable Implants: This implant was designed by Dr. Hilton Becker under Mentor Corp. in 1984 for use primarily in breast reconstructive (mastectomy) patients - to gradually expand the tissues with out severe trauma to the tissues. By the late 1980's. the Becker expandable implant gradually wound its way into the cosmetic breast augmentation market. A decade later the Becker expandable implant was replaced by the Spectrum breast implant (sometimes referred to as the Spectrum-Becker). The Spectrum implant is a permanent solution to expansion breast augmentation with the the Becker-designed valve, filling tube and reservoir system. The original Becker saline-expandable implant (gel also available) is still available although highly restricted by the FDA. But it's not the restriction that makes it inappropriate as an expansion breast augmentation device # it's the expensive price. Hence, the reason why the Spectrum implant has taken over the market of expansion breast augmentation. The Spectrum expandable implant comes in ranges, or different sizes, like standard implants. The implants cannot be filled up indefinitely. You must have a general idea of what size you would like to be post-operatively # then build on this size. They come in textured and smooth models and can be placed either sub-glandular or sub-pectoral. When they are first implanted, especially if you are small breasted in comparison to your size goal, your surgeon may not fill them to their starting volume. The gradual filling will give your tissues and muscles, if applicable, time to adjust and not traumatize or over exert the tissues to the point of fissures, tears or excessive stretch marks. Just remember with augmentation, stretch marks are always possible. There is a dime-sized filler port in each implant, that is left in near your incision (crease, peri-areolar) for ease of injection until after it is determined that you are at your volume goal. You will probably have another fill (usually in 50cc increments) about 1 week post-operatively then on to 2 weeks, then perhaps a few weeks later. Most patients report that the fill-ups do cause them minor discomfort and that after all the settling and dropping you have accomplished over the weeks is for naught. You see, you become rounder, fuller, higher and tighter after each fill up so your body has to get back to work to accommodate the implant all over again. You should expect to pay about $400US more for a Spectrum and remember, until the filler port is removed (through your original incisions) you will be able to feel them and the area may become chafed if your bra or support garment rubs up against this area during natural body movement. It is reported that the extrusion rate for the filler ports is about .76% # very rare. Although a saline filler is the most popular regardless of either implant shell, there are other options. If some women meet certain criteria (reconstruction, thin skin, asymmetry, congenital deformities, replacing an already existing silicone-filled implant, etc.), they may be eligible for silicone filled implants, which brings us to the next option... Silicone-filled (silicone elastomer shell): So much controversy has arisen in the last two decades pertaining to the silicone-filled breast implant. Certainly enough to cause alarm in even the most skeptical person. Now that the Internet era is in full swing, more and more anti-implant websites are popping up. Silicone sensitivity may be a problem in some patients; just as one may be sensitive to latex, nut oils or eucalyptus. However, there are far too many happy women with NO complaints whatsoever with implants in for literally decades. According to our nation's FDA (US) there is no conclusive evidence regarding illnesses and silicone. However, there is evidence of granuloma and macrophage accumulation with silicone injections and gel bleed from mammary prostheses. Lower molecular silicones do tend to migrate and cause granulomatous fibroses (nodules of inflamed tissue) as well. Thankfully, today's implant shells are safer, more durable and last longer than their predecessors. Although the lower weighted silicone permeates this elastomer shell due to the belief that "same does not hold same." This being the lower weight extruding through the higher cross-linked elastomer shell. Capsular contracture (CC) and thicker capsules have been reported to occur more often with silicone filled implants than in saline-filled implants due to the permeation of lower molecular silicones, called "gel bleed", into the surrounding tissues. The body treats this like an irritant, comparable to a grain of sand in an oyster, and continues to surround it with fibrous collagen. Cohesive Silicone-filled (silicone elastomer shell): In use since 1995, this French implant's filler is a thicker silicone gel that enables the patient to be free of silicone seepage even in the unlikely event that a rupture should occur. This implant is presently in clinical trials in the United States. Cohesive-Silicone filled implants are an approved medical device in Australia. Hydrogel-filled (silicone elastomer shell): The Hydrogel mammary prosthesis has a filler which is a silicone elastomer shell filled with either a biologically inert hyaluronic acid fluid, polysacharide gel or a hydrophilic polycrylamide gel. The hyaluronic filler is the same substance as the injectable filler, Restylane®, which is used for the lips and wrinkles. The hyaluronic acid-filled implants were denied approval or additional clinical trial time. Not because of its filler but the implant manufacturer was unable to present evidence in time, proving the safety of the medical device - as a whole. Germany currently has this implant available from a supplier in Ireland. "The MDA's review revealed inadequacies in the manufacturers' biological safety assessments and concluded that there was not enough information to fully assess either of the filler materials. No definite risk has been identified. There are no known cases of harm caused by these breast implants and there is no evidence to suggest that they should be removed from women who have them. The concern is only with the way the safety of the hydrogel fillers has been assessed." http://www.niexecutive.gov.uk/press/hss/001211e-hss.htm The hydrophilic polyacrylamide filler is another story entirely and is becoming popular as an injectable filler for wrinkles and lip augmentation. This filler is similar to the substance used in agriculture to hold water, fertilizer, etc in the soil for longer periods of time. And has also been used to deliver medications in a matter similar to time-release capsules. There are approximately 5 (at the time of this publication) companies engaged in manufacturing injectable implants for soft tissue augmentation (product names include Formacryl™, Argiform™, BioFormacryl, etc.). This same implant product is what is also being used as a breast implant filler and also being injected directly into the breasts. PLEASE use caution when considering polyacrylamide products until further studies have been done regarding the residual unpolymerized acrylamide that is present within the product. Especially with direct injections into the breast. The standard polyacrylamide hydrogel is capable of sustaining bacteria which can cause later infections and inflammation which can lead to capsular contracture, extrusion and excess scar tissue. Soy or Soya-filled (silicone elastomer shell): Approximately 5,000 women were implanted with the Trilucent™ Soya Implant. This implant was manufactured by Lipomatrix Inc./AEI Inc. (formerly Collagen Aesthetics International, Inc.). The shell is as the above - silicone elastomer - but filled with soya bean oil. Although their website states that: "There is absolutely no evidence to suggest that Trilucent breast implants cause cancer. The incidence of breast cancer in the U.K. is approximately 11%. For a genotoxic substance to cause irreparable mutations, and for the mutations to produce a malignancy, involves a series of highly complex steps. There is no evidence that the degradation products of soya bean oil can, in fact, produce this sequence in human beings. Further, cancers such as carcinoma can only occur in epithelial tissue; there is no evidence that any genotoxic products from degraded soya bean oil would come in contact with the epithelial tissue of the breast." Trilucent FAQ - http://www.trilucentinfo.com There was much speculation and rumor regarding the toxicity induced by a possible rupture of rancid soya oil into the body cavity. Also local inflammation in the breasts were reported from patients who had suffered a rupture. Not amazingly, the MDA (The UK Medical Device Agency) advised against pregnancy much less breast-feeding if you have a Trilucent™ soya-filled breast prosthesis. Regardless of any subject matter # be it controversial or fact, this implant has been taken off of the market. Poly Implant Prosthesis (PIP) Hydrogel: This product is Manufactured in France and was distributed by Clover Leaf Products Ltd. The PIP is prefilled with a hydroxypropyl cellulose hydrogel (polysaccharide) gel filler. The same substance which is a main ingredient in Reviderm Intra soft tissue augmentation injectable filler. This implant was voluntarily recalled due to a "request" by the MDA (The UK Medical Device Agency) for more studies "due to the lack of long-term toxicity data or clinical follow-up, together with methodological flaws in some of the pre-clinical tests." For more information regarding their safety concerns see - Medical Devices Agency - MDA Safety Warnings on PIP Implants. http://www.medical-devices.gov.uk Poly Implant Prosthesis (PIP) Saline: This product, also manufactured in France, was distributed by PIP - USA. Due to the implant manufacturer's failure to provide sufficient studies regarding the safety and efficacy PIP salines were denied approval. PIP has since applied for yet another study. *Two other such implant/companies which are allowed to conduct clinical trials are Hutchinson International and Silimed L.L.C. "Silicone-free" Breast Implant Options Polypropylene (PPP) Strings: This material has been used in the body for many years, however as a breast implant it is still in the testing phases. It is silicone-free, not even the envelope or mesh shell is made from silicone or silicone derivatives. I will quote Dr. Gerald W. Johnson, the"inventor of the strings implant using PPP: "I hesitate to call this alternate material a "New" implant, because in the world of surgery it has been used with absolute success in the human body for over 35 years. It just never has been reported in the medical literature to have been used as a material to augment the female breast. If you are genuinely interested in informing yourself on this material, new to the world of breast implants, please click on the following link (Bard Mesh is pure polypropylene- PPP. I have 2 pieces of this Marlex mesh in my body used to repair inguinal hernias) http://www.davol.com/mesh.htm"
Which Implant; Round or Contoured; Smooth or Textured? The common, and only approved, implants used today for cosmetic breast augmentation in the U.S. are saline-filled, silicone elastomer-shelled styles by McGhan Medical Corporation or Mentor Corporation. Both offer warranty which provides a form of payment to help with the surgery costs should a rupture occur and of course the implants will be replaced for life. This doesn't mean that one cannot get silicone gel-filled or Cohesive gel implants in the US, you can. But you must participate in clinical trials by meeting certain criteria (e.g. have thin skin, no breast tissue, have had a mastectomy, have already had silicone-filled implants, getting a mastopexy (lift) with your augmentation, have a problem with rippling, etc.). If you do not meet the criteria for these silicone implant studies your surgeon should NOT let you have them. If he does, he is breaking the law. Many surgeons over-"prescribe" silicone-filled implants to their patients - do not be one of these patients. Round vs. Contoured The contoured (anatomical, teardrop, or biodimensional) implants are more expensive and there is the possibility of them flipping over or inverting themselves if the surgeon did not form the pocket correctly. Especially in the dominant side. However, this implant's surface is textured to help prevent the displacement of the implant. They create a natural slope instead of a pronounced cleavage look when in the sub-glandular placement. It has been reported by some surgeons that the round implant looks just as natural once it settles into place and as long as it is not overfilled very much. Overfilling creates a pronounced augmentation of the upper pole of the breast. You will read more on overfill very soon. This subject is pretty controversial so go over this at your consultation and view photos of patients with contoured implants. The decision is up to you. Different surgeons will have different opinions and not everyone's body will result in the same look. It is also reported that there is no agreement on optimum fill when volume of anatomical implants are concerned. Smooth vs. Textured Smooth is slightly thinner but thought by some to be stronger as there are no intentional defects like those created in the surface of the outer shell for textured implants. The textured implants are thicker to compensate for their intentionally marred or fuzzy surface. The supposed purpose of the textured surface is the belief that Capsular Contracture (CC) is less frequent with the use of these implants. This has never been proven and the downfalls can be increased palpability (especially in thin skinned women or women with low natural breast tissue). Also there may be an increased rate of rupture with the textured implants as well as a slightly more difficulty rating in removing the implants due to the tissue incorporation. Even if encapsulated, some surgeons report that the textured implants seem stuck on and move less freely than smooth implants. Just remember different surgeons will have different opinions regarding the use of textured or smooth. There is no hard evidence regarding the decreased rate of CC nor does this eliminate the need for manual compression exercises of the implant capsule. Also having a textured implant can be a little more difficult to place with a smaller, endoscopic incision of, say, an inch to an inch and a half (depending upon the size of the implant). Although the minute imperfections of a textured implant are nominal it can rough up the edges of an incision resulting in a slightly more jagged scar. There is also reportedly an increased rate of infection or capsular contracture if the naturally occurring bacteria was not fully eradicated and is forcefully rubbed "into" the implant during insertion. Smooth surfaced implants can easily be placed within an incision an inch to 1.5 inches in length if your skin is pretty elastic. But to be on the realistic side expect an incision of at least 1.5 inches - with the exception of TUBA. Another downfall of textured implants is that in case a patient develops CC, the texture is less likely to release the capsule of tissue when compared to a smooth implant. Sometimes the capsule won't release even with forceful pressure (which is not recommended by implant manufacturers anyway). Many low level CC cases are eradicated my manual manipulation/compression and A regimen of Prednisone and Vitamin E use. Also, textured implants do not displace (move out of the way) as easily as smooth implants when positioned between the metal plates during a mammogram. However, there is much controversy and different opinions regarding this subject just as any other aspect of breast augmentation. I have personally spoken to many surgeons who report, "textured for silicone, smooth for saline". Ask your own surgeon his opinion. Some surgeons report the increased palpability may be from too much overfill as is the firmness or the thicker, textured surface. However, if the implants are not overfilled to at least the manufacturers' recommendation, less resistance is administered so each breath (approximately 30,000 a day) can crease and weaken the implant. Does It Hurt? Although pain thresholds vary # breast augmentation pain is dependent upon the implant placement, incision placement and if you choose to take your meds on time, every time. You can also cause yourself more pain by not abiding by your surgeon's instructions and over-exerting yourself. Many patients report that their discomfort is described as pressure or muscle soreness. I have heard so many times "It feels like an elephant is on my chest!" It is also described as having done too many butterfly curls (with under placement). If you should experience any discomfort that seems out of the ordinary, contact your surgeon. How Much Does Breast Augmentation Surgery Cost? This definitely depends upon your region # surgeon can range from $2,500. to $10,000. and up. Prices may vary due to region, surgery bids, the newness of practice, marketing ploys, the occasional special, demand of surgeon, etc. These prices may or may not include, operating room coasts, anesthesia, lab work medications, and more so be sure to ask beforehand and get it in writing. If you are in need of a revision there is little else you can do if nothing was determined beforehand, but pay the fees and move on. So please determine revision stipulations beforehand and get this in writing as well. Such things as CC, infection and others are usually not covered (although some surgeons do cover this). Surgeon error should be covered at the surgeon's expense so please review the practice's revision protocol before booking your surgery. It is better to prepare for the worst and hope for the best than be hit by an avalanche of additional postoperative fees in your time of misfortune. What Age Can I Get Breast Implants? The youngest is usually 18 although in special cases of pronounced asymmetry and reconstruction # prostheses can be used on persons younger than 18. These younger cases are very specific. On the other side of the spectrum, I have known women in their late 60's who have gotten breast implants. When we are older the only thing that may stop us from having breast augmentation surgery is general health so be sure to have a physical to see if you are in good health to properly heal and handle the anesthesia factor. Can A Woman Breastfeed After Breast Augmentation? A lot of women ask if they can breast feed after Breast Augmentation Surgery. The answer is a resounding yes. For the vast majority of women who have a BA breastfeeding is no more difficult with implants than without. In fact, some women who have breast fed with and without implants say that breastfeeding with implants is easier! Breastfeeding is a growing concern with patients who have had Breast Augmentation surgery. In previous years, women who received implants were married and had already finished with childbearing. However, more and more single women, and women who have not finished or even begun childbearing are having the surgery. Particularly with the belly button approach, the breast tissue and ducts are not disturbed, cut or affected. The procedure literally takes place under all of the breast tissue, not going through it. There is no evidence that silicone from the implant shell enters the milk. However, with other incision locations and techniques other than the TUBA and trans-axillary, it is quite possible to disrupt the mild ducts and lines resulting in blocked ducts during a pregnancy. This has been known to happen with a peri-areolar technique resulting in additional surgery to unblock the milk ducts. Although, this happens in reductions as well. What Are The Risks, Complications & Contraindications Of Breast Augmentation? Of course, there is the risk of Capsular Contracture (scar tissue encapsulating the implant, hardening around and squeezing the implant). This rarely ever goes away on its own. Nor does it tend to lay dormant after a revision surgery is performed. It may happen due to bacteria on the implant, surgical implements or airborne and the body attempting to place the foreign body as far away from itself as possible. Or it may develop after an injury. If this happens, you can develop pains, hardening, deformity and deflation of the implant. It sometimes even happens again after the surgery to remove the scar tissue has be performed. There is a chance of rippling (wrinkling or indentations from the implant) being apparent, especially when one has no breast tissue and chooses to go over the muscle. It is possible that the implant can shift and push through layers of tissue, showing through the skin. The implant can deflate or rupture from an injury or from wear and tear from an improperly under filled implant (even your breathing motions can cause creasing in the implant causing it to weaken at these creases). Even an overzealous doctor performing a mammogram can rupture your implant. You can have a complete deflation within several hours if it is an un-encapsulated saline-filled implant. If it is a silicone gel-filled implant, you may not know for months or years. Of course either way, they will have to be replaced. Then there is always a risk of hematoma and scarring. Also, difficulty in early breast tumor detection is possible when you have either silicone gel (more pronounced) or saline-filled silicone shelled implants. Also, there are the risks of disappointment in size. A lot of women wish they "would have gone bigger." Realize that when you are doing the the Rice Test that they will have to add a little more to make up for the tissues and/or muscle flattening the implant a little if you choose the submuscular placements. When you pre-operatively try on the larger bras and fill them out a bit, they are on top of your body, probably lifted, as well, by an under wire. Take this into account and communicate with your doctor, the results you really want. There is also the disappointment in the implants not lifting the breasts as you would like. I thought it would, but I was mistaken. This is not a breast lift this is an augmentation. If it is lift you want as well as augmentation, get them both. After your augmentation surgery, the breasts will be heavier than what you are accustomed to. The heavier weight will speed up the sagging process especially if you go around braless all of the time. There is the possibility of extrusion of the implant, breast tissue atrophy from the force exerted by the implant. This is according to the F.D.A. and you can read the info on their site by visiting: Breast Implants: An Informational Update. |
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