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Introduction to Breast Augmentation
Breast Augmentation

Todd B. Koch, M.D., F.A.C.S.

article courtesy Todd B. Koch, M.D., F.A.C.S.

CLICK HERE to visit the website of Todd B. Koch, M.D., F.A.C.S.

If you are unhappy with the size or shape of your breasts, Breast Augmentation may be the right choice for you. The insertion of a breast implant can increase the size of your breast and improve the shape. Childbirth, breast feeding, weight loss, aging can contribute to these changes. Your breasts may not have developed to a size that meets your expectations or your breasts may not be the same size. Breast Augmentation is one of the most common cosmetic surgical procedures performed in the United States today.

What is a breast implant? Breast implants are soft sacs, often referred to as a shell, filled with a saline (saltwater) solution or a synthetic silicone gel. The shell is made up of silicone, a rubber-like substance. Silicone gel implants has caused much controversy because of fears that it produces ill effects in women. At the present time there has been no scientific or medical evidence to support this premise. Research is on going to settle this issue.

Silicone gel implants first became available in the early 1960’s. Early on it was not known how long they would last. It was hoped that maybe they would last a lifetime. Unfortunately, this was not the case. Over time it was discovered that the shell of the implant would breakdown. Some believed that this may be contributing to certain health problems. The FDA began an extensive investigation into the safety of breast implants. In 1992, pending further investigation, limitations were placed on the use of silicone gel implants. The FDA reserved the use of silicone implants for women; requiring breast reconstruction, with congenital birth deformities, requiring breast lifts and problems related to saline implants. Women who did not fulfill these criteria were only allowed to have Breast Augmentation with saline implants. On November 17, 2006 the FDA lifted these restrictions and agreed to allow the use of silicone gel implants again.

Saline Breast Implants were first developed in the late 1960’s; they never gained in popularity the way silicone gel implants did. Saline implants are not as natural as silicone gel implants. Saline implants are more round in appearance, firmer to the feel, more palpable, and more likely to develop rippling or folds that may become visible or palpable. Frequently, saline implants are placed under the chest muscle to add an extra layer of tissue to help camouflage the implants and make them more natural. Placing the implants under the muscle makes it easier to perform mammography and can decrease scar tissue formation.

The Breast Augmentation surgery is performed as an out-patient procedure allowing you to retire to the comfort of your own home. The procedure takes less than one hour to perform. A general anesthetic is used in all my cases. The location of the incision varies but is most commonly placed around the areola or underneath the breast in the natural fold. Less common locations for the incisions include the axilla and umbilicus. The small size of these incisions will allow access for only a saline implant or a very small gel implant. After the incision is made a space is created to accommodate the implant. The implant can be placed in different locations: subglandular (under the breast tissue), subfascial (under the fascia), submuscular (under the muscle) or dual plane (partially under the muscle and under the breast tissue). The selection of the appropriate location is dependent on many factors such as soft tissue coverage, quality of the breast tissue and skin, breast sagging, physical activity and many other issues. At this point in the operation, I like to use a trial implant which I can inflate to all different volumes allowing me to select the most appropriate size. The final size is determined by taking into consideration many different factors: height, weight, elasticity of the skin, chest wall and breast dimensions, and each patient’s individual personal desires. My goal is to create as natural a result as possible. However, I am frequently making some compromises either on shape or volume to accommodate a patients wishes.

After the breast implant has been placed the patient is evaluated to determine symmetry, positioning and overall cosmetic result. The incisions are closed and a sports bra is applied. There is a fair amount of discomfort associated with the surgery but this is controlled with a pain medication and at times muscle relaxant.

When a foreign body such as an implant is placed in the human body a membrane of scar tissue will form around it. This is referred to as a “capsule”. Since a breast implant is soft, the wall of scar tissue sometimes can shrink compressing the implant making it immobile and feel firm. This is called “capsular contracture”. In most cases this occurs to a mild degree, but in some cases the contracture can become severe distorting the shape of the breast, making the breast feel hard and limiting the mobility of the implant. If a person develops a severe contracture, pain may develop limiting function and physical activity. Sometimes medication can help but additional surgery may become necessary. I’m a firm believer in postoperative breast implant displacement exercises. When these exercises are performed appropriately they can minimize the formation of any significant contracture.

Most women are able to return to work in few days and full physical activity within two weeks. As with any surgical procedure there are risks to consider such as bleeding, infection, scarring, numbness, shifting of the implant, palpability, deflation, rupture, capsular contracture, limitations in performing a mammogram, problems with breast feeding, and the need for future surgery to replace the implant if it leaks or ruptures. All breast implants will require replacement at some time.

Women who undergo Breast Augmentation surgery feel more confident about their appearance. Discover how easy it is to find clothes that fit and compliment their new figure. They look and feel better in a swim suit or low cut dress.

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