Breast augmentation: Breast implants reshape self-image

Breasl augmentation — surgery to enhance a woman's breasts — ranks as the third most popular type of cosmetic surgery. More than a quarter of a million women opted for breast augmentation in 2003, according to the American Society of Plastic Surgeons.
Improvements in implant materials and surgical techniques make breast augmentation safer than it once was. If you're considering augmentation, be sure you understand what's involved in 1he surgery, develop realistic expectations, and know the possible risks and complications associated with implants

Why do it?
Your reasons for choosing breast augmentation are highly personal. Breast augmentation may help you:
Enhance your breast appearance if you feel your breast size is too small Adjust for a reduction in the size of your breasts after pregnancy Reconstruct your breast after having breast surgery for cancer or other conditions Correct a birth defect ot your breasts, such as having breasts of two different sizes
Besides enhancing the appearance of your breasts, augmentation may Improve your self-image, which in turn can boost your self-confidence.
The best candidate for breast augmentation surgery is a woman looking for an improvement — but not perfection — in her appearance. Your ideal tor how you want your breasts to look and the reality of the outcome of the procedure probably aren't going to match up. Discuss your expectations with your surgeon — be open and honest so that you'll have a realistic expectation of what's to come.

Before surgery: Consider pros and cons
Well in advance of surgery you'll need to consult with your surgeon about your preferences for size, feel and overall appearance of your breasts. Your doctor will describe the surgical techniques and provide you with the package insert of the implant you select. Review this carefully and keep a copy of all pertinent information for your records.
Before you decide to have surgery, consider some important factors regarding breast augmentation:

• Breast implants aren't lifelong devices. You'll probably have additional doctors visits and at least one more surgery to remove or replace your implants.
• You might need more surgery after Implant removal. It you have your implants removed for any reason, you may experience unacceptable cosmetic changes — such as wrinkling, dimpling or droopy excess skin — which might require replacing the implants.
• Breast implants won't prevent your breasts from sagging after pregnancy. Some women actually need a breast lift in addition to breast augmentation to correct sagging breasts. Also, depending on how it's done, breast augmentation surgery may make breast-feeding more challenging.
• Routine screening mammograms may be more complicated. Additional views or ultrasound may be necessary, which results in more time spent obtaining images of your breasts. The quality of the mammogram will depend on the experience and expertise of your technician and the facility you select.
• Insurance probably won't cover the procedure. If it isn't medically necessary, many insurance companies won't cover breast augmentation. If that's the case, be prepared to handle any financial obligations that accompany the surgery and any related surgeries you might need In the future.

Considering these points may trigger many questions with regard to your personal situation. Prepare a list of questions to bring to your doctor. You may also find it helpful to talk with other women who have gone through the procedure. Ask if your doctor has the names of some people you can contact.

The procedure
Breast augmentation surgery — also known as augmentation mammaplasty — can he performed in a surgical center or hospital outpatient facility. You usually go home the same day, but on occasion the surgery might require a hospital stay. Local or general anesthesia may be used. It ail depends on the particulars of your procedure.
To insert the implant, your surgeon makes an Incision in one of three places:

• In the breast fold. An inframammary incision runs along the crease between the underside of your breasl and your chest.
• Along the nipple. A periareolar incision follows the natural line around your nipple and areola. This incision may leave a less noticeable scar than the inframammary incision, but it might also impact your ability to breast-feed or affect sensation in your nipple.
• Under the arm. The axillary incision is made underneath your aim.
  

Breast implants may be smooth or textured, round or shaped like a tear drop. They consist ot a silicone shell filled with salt water (saline) or silicone gel. In general, only salinee-filled implants are available for cosmetic use. Silicone gel-filied implants may be available to women after surgery for breast cancer or to women who had saline implants placed but then experienced unsatisfactory results, such as wrinkling or dimpling.

After making the incision, the surgeon lifts your skin and tissue to create a pocket in your breast, either just behind the breast glandular tissue or beneath the muscle in your chest (pectoral muscle). The surgeon inserts the implant and centers il behind your nipple. When inserted, the implant is empty. The surgeon fills Ihe implant with saline once it's in place. Surgery generally lasts one to two hours.

Recovery
You'll be tired and sore for the first few days after your surgery, but your doctor will likely prescribe medication to help relieve your pain If you dont have a physically demanding job, you may be able to return to work within a few days Getting back to other normal activities will take longer — at least two to three weeks — as your breasts will be sensitive to direct physical contact. Follow your doctor's advice about when you can return to your regular activities.
Besides stitches, you may also have drainage tubes in your breasts after surgery. These both come out a week or so after the procedure Your doctor may recommend using a compression bandage or sports bra for extra support and positioning of the implants during this time.
You may notice a burning sensation in your nipples for a few weeks, but that will go away as you heal. Expect some pain, swelling, tenderness and bruising as you heal. If you notice warmth and redness in your breast area, though, accompanied by a fever, you might have an infection. Contact your doctor as soon as possible.
The scars you notice after your surgery may initially appear firm and pink. The scars fade gradually over time, but they won't go away completely.

Risks

• Repeat surgery. You run the risk of having more surgeries down the road, either to replace the implants or to remove them altogether. In clinical trials studying the safety and effectiveness of saline-filled breast implants, as many as one in four women had a second operation within five years of getting implants.
• Rupture. Implants can rupture, causing fluid to leak into your breast and surrounding tissue. This could happen as a result of a blunt-force injury — If you're in a car accident, for example — or from tiny cracks in the implant shall that can occur over time.
• Deflation. A rupture or a slow leak can cause an implant to collapse, deflating the size of your breast. This may result in breasts thai are noticeably different in size or in a change to the cosmetic appearance of your breast, such as sagging or wrinkling.
• Capsular contracture. Fibrous scar tissue forms a capsule around your breast implant. This tissue gradually builds up over time, constricting your implant — a painful and potentially disfiguring condition. Surgery is usually necessary to correct capsular contracture
• Infection. An infection can occur from implants. Your body thinks the implants are foreign and attacks them — the same way it would a virus or bacteria. Medication may help, although antibiotics aren't always successful in treating an infection resulting from breast implants. Replacing the implant may be necessary if you develop a severe infection, and you may have to wait six months to a year after removal before you can get a new implant placed.
• Hematoma. Blood and other fluids can pool around the implant, causing pain, infection or other complications.
• Pain. You may experience more pain than what's considered normal after surgery. This may indicate a bigger problem. If your implant ruptures or moves from its original position, pain and discomfort may result. Capsular contracture — the squeezing of your breast implant — can also be painful. You may need to have the implants replaced to remedy the problem.

Other possible risks Include dissatisfaction with the results of your surgery. You might experience changes in the sensation of your breasts and nipples that take time to get used to. Or you might be able to feel the implant beneath the surface of your breast tissue

Debunking myths
You may be worried about getting implants because of rumors you've heard A committee at the Institute ol Medicine (IOM) reviewed the current research and concluded:

• Breast implants don't increase your risk of breast cancer. The IOM reviewed evidence that breast implants don't cause breast cancer or the recurrence ol breast cancer. However, it's still essential that you undergo routine screening for breast cancer — breast self-exams, mammograms and clinical breast exams — just as you would if you didn't have implants.
• Breast Implants don't weaken your immune system. When your body detects something foreign in your system, such as a virus or bacteria, it responds by kicking your immune system into high gear. However, the IOM found no evidence to suggest this happens with breast implants. Nor did it lind evidence linking Implants to any sort of autoimmune or connective tissue disorder.
• Breast-feeding is safe. If your breast milk has absorbed some of the silicone from the implants, don' t worry. Your baby isn't in danger. Because breast milk is the best thing you can feed your baby, the IOM encourages women with implants to breast-feed.
• Saline-filled implants are greatly improved. Women with saline implants used to complain about sloshing — hearing the liquid inside the implant — and being able to teel the implant beneath the surface of the skin (rippling effect). Some women preferred silicone gel-filled Implants, claiming they looked and felt more natural However, better results from saline implants are now possible by slightly overfilling the implant and placing it behind, rather than on top of, the chest muscle.