Plastic Surgery & Breast Implants
 By Mordcai Blau, MD
Breast Augmentation is the most frequently performed plastic surgery
on women in the U.S. today. Over 300,000 women undergo breast augmentation
every year, with the popularity of the procedure ever increasing, especially
amongst female body-builders.
Breast implants are most commonly used as
aesthetic enhancement on an individual who is lacking in natural breast
tissue due to genetically predisposed or environmentally induced factors.
Because breast tissue is primarily composed of fat cells, in the past,
physicians attempted to inject fat (obtained through liposuction) into
the breast. However, today, this is completely unacceptable due to calcification
(complete hardening of the breast). Hormonal therapy may increase the natural
breast size, slightly, but not enough for the majority of women.
Currently, the
most common way to increase breast size is via breast implants. A breast implant
is a sac of silicone elastomer that is either filled with saline or silicone,
and is surgically implanted under the breast tissue. The proportion of the
breast to body height and weight is taken into consideration, as is the
chest width, location of nipple/areola complex, and cleavage. Because
the concepts of aesthetics are constantly changing, there are many factors
such as implant type, size, and site that should be tailored to the individuals’ specificity.
TYPE OF IMPLANT:
Silicone vs. saline?
This discussion is going to remain for many years. Until 12 Years ago silicone
was the dominant implant in the U.S.A. However, due to possible autoimmune
mediated health problems associated with leakage, saline is now used in 90% of
surgeries. Legal, psychological, and technical factors will eventually determine
which is preferable. Silicone implants are now gaining momentum and the FDA is
going to rule on weather or not to legalize them (which will probably happen).
Although the silicone might have some side effects, it doesn’t seem as
awful as thought to be a decade ago. The advantage of silicone implants is that
it is softer and appears more natural. However, leaks may be found in secondary
tissue. Generally, saline is a bit firmer, but it is without the supposed health
risks because a leak is simply absorbed by the body. The decision should be made
after consultation with an experienced surgeon.
LOCATION OF IMPLANT:
The breast implant
can be placed either under the pectoralis major muscle (sub muscular) or on
top of the muscle and under the breast glands (sub glandular). Sub muscular
implants are more popular because they are less palpable, have lower risk of
capsular contracture, and don’t inhibit mammography. However, it requires
more invasive surgery and longer healing time. Bodybuilders prefer sub-glandular
insertion because the heavily developed pectoralis muscle might flatten the
implant and there will be less projection of the breast. Women with sagging
or drooping breasts may opt for sub glandular placement for the better projection
as well. Disadvantages of sub glandular implants include impairment of proper
mammography and increased risk of capsular contraction.
LOCATION OF INCISION:
There are four areas
of incision:
1. Periareola (lower part of areola 1-1/2 inches)
2. Sub-mammary (on the lower breast crease)
3. Axillary (armpits)
4. Transumbilical (from the bellybutton)
Each has advantages and disadvantages
but the preferred incision is periareola because it is less noticeable.
Arguments against periareola are that it is harder to perform, that there
is interference with sensation of the areola and violation of the breast
tissue. Physicians who are experienced in this method find it easy to
do. Personally, I did not see a difference in nipple sensation compared
to other methods. Instead of inserting the implant through breast tissue
it can be turned under the skin to further preserve the tissue.
SHAPE
OF THE IMPLANT:
Most surgeons have
experience with teardrop (natural implants) and with the round implants.
Preference is toward the round implant because it appears more natural.
Previously, there were high profile implants (which projected more) and
low profile implants (less projection). Recently, medium profile implants
were introduced.
HOW LONG DO BREAST IMPLANTS LAST:
There is no expiration
date for implants. One should be checked by a physician if there are
any symptoms or changes that are not expected including deflation, infection,
change of location, etc. Mammography, ultrasound, or MRI should follow onset
of any of these symptoms. Older patients have to be checked more regularly
by themselves, a physician, or radiologist. Once someone has implants for
over ten years they should consider replacing them.
RISKS (not common but possible):
1. Capsular contraction: Scar tissue
forms around the implant to form a hard
shell. There are several steps to prevent it, such as, size and location
of the implant, as well as medications like Singular and Acculent.
2. Infection or rejection from non-sterile
techniques.
3. Shifting (moving) of the implant. The
pocket for the implant should be adjusted for the patient (this will
usually, prevent shifting).
4. Scars: Less conspicuous in the periareola
compared to sub-mammary incision.
5. Sensation: May be initially decreased.
Usually 90% of sensation will return within 1-2 years of surgery.
6. Violation of breast tissue.
7. Breast Feeding: About 50% of women won’t
be able to successfully breast feed, particularly those with periareola
incision.
8. Synechia: Adhesions (also known as “kissing
breast”), sometimes related to techniques.
In general complications
occur less when using experienced and certified surgeons.
RESULTS:
Plastic Surgery is an art form in combination with science. Each patient and physician
has a different sense of what is aesthetically pleasing (although the basics
are common). During a consultation with a physician, the goals of both
the patient and physician should coincide and be realistic. The results
are not entirely depending on the physician. It is important to understand
that everybody starts with differing anatomical breasts (some patients
are better candidates than others) and there are always unforeseen factors
(also very rare).
WHEN INTERVIEWING A PHYSICIAN:
- Make sure you feel comfortable and trusting.
- See more than one physician.
- Check for credentials.
- Make sure the facility is accredited by a respectable organization and that they belong to a reputable hospital in the area.
- Use the Internet to view before and after pictures.
- It is a big plus if a trusted person refers him.
- Ask for references and phone numbers of previous patients and actually speak to them.
- Do you like the atmosphere of the plastic surgeons office?
- Is the staff accommodating and polite.
- Is the plastic surgeon also an artist in other fields like painting, drawing, sculpting?
Published in RXMUSCLE magazine. |
