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The human breast is associated deeply in the minds of men and
women with the female image. Since early times, women who
developed less than the normal or desired amount of breast tissue
have wished that something could be done.
Early attempts by surgeons of yesteryear included moving skin and
fat from the buttock up to the breast, with uniformly miserable
results because of lack of blood supply in the transferred tissue.
The first successful attempts were about 30 years ago, when
artificial materials were seriously tried. The silastic rubber
prosthesis filled with either silicone gel or saline (salt water)
provided a long-term solution, after several other materials were
tried with less-satisfactory results.
Our personal experience with breast implants spans more than 20
years, using both saline-filled and gel-filled implants. While
nothing made by human beings will ever be perfect, the
overwhelming majority of our augmentation patients obtain the
desired results.
Much has been made of the breast implant controversy, with TV
talk-show hosts drawing large ratings by showing bare breasts on
camera. The scientific evidence linking silicone implants with
connective-tissue disorders is still lacking, now some seven years
after the first headlines. A recent study by European scientists
confirmed the safety of implants.
So, what implant options are available? Under present FDA rules,
saline implants must be used in all cosmetic breast augmentations
unless certain specific criteria are met. In those cases where a
congenital deformity of the breast is present (such as Poland's
Syndrome, tuberous breast deformity, or certain other problems), a
patient may be included in a manufacturer's study, and obtain
gel-filled implants. In some cases of severe breast sagging, when
a breast lift procedure (mastopexy) is being done at the same
surgery, a patient may also be included in the study.
The breast augmentation procedure is an outpatient surgery, best
performed under general anesthesia, and most patients can return
to office jobs or light housekeeping work in 4 or 5 days. The
operation itself takes about an hour and fifteen minutes, with
another one or two hours spent in recovery, before discharge home.
An adult caregiver must drive the patient home and stay the night
with the patient. Most patients can be left alone, if necessary,
on the next day.
A skin incision of slightly over an inch is necessary, usually
placed in the lower part of the breast, just above the crease
beneath the breast. Occasionally a patient prefers to have the
incision in the armpit. This is possible in selected cases, but if
sagging of the breast is a problem, this alternative may not be
best for you.
The implants are usually placed under the pectoral muscle on the
chest, since this technique results in decreased incidence of scar
capsule contracture. This is the most common complaint following
breast augmentation and is the result of the body's normal healing
process and its natural tendency to 'wall off' anything not a part
of itself. The prevailing opinion among surgeons is that placing
the implant under the muscle keeps it from forming such a hard
layer of scar tissue and makes the tissue more pliable.
Other problems, much less common, are hematoma (a collection of
blood around the implant) and infection. Rarely, a patient will
form a hypertrophic scar or keloid at the skin incision site,
which may require secondary surgery to correct. Another uncommon
problem is decreased sensation in the nipple following surgery.
When this occurs, it is usually temporary, resolving in three or
four weeks.
As we have already discussed, under present FDA regulations, most
patients may only receive saline-filled prostheses, unless certain
criteria are met for being placed in a study involving gel-filled
implants. Saline implants, of course, are also called
'inflatable,' and can be subject to 'deflation' as well. Since the
filler is only saline, however, the body absorbs the salt water
uneventfully. When this occurs, the patient only notices that one
side is not the same size as it was. The manufacturers have taken
this into consideration, and offer a free-replacement, lifetime
guarantee on the implant. In addition, they will reimburse the
patient for expenses involved in making the exchange for up to ten
years.
A word of caution is in order: a slight degree of sagging of the
breast can be helped by breast implants. Basically, if the nipple
rides below the crease underneath the breast in the upright
position, without a brassiere on, a procedure to lift the breast
skin may be necessary in addition to the implant. This is called a
mastopexy, and additional information is available on another page
at our website.
To schedule an appointment to discuss this procedure with Dr.
Johnson, click here.
For more information regarding the safety of
this procedure, please log onto
www.breastimplantsafety.org.
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