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Two different circumstances most frequently create an interest in surgical breast enlargement. The first involves congenital underdevelopment of or an imbalance in the amount of naturally existing breast tissue relative to the other body measurements such as hip circumference and height.In this instance, there may be problems with breast asymmetry or shape deformities. The second situation is caused by a natural loss of breast volume which follows a large weight loss or the child–bearing years. The breast often takes on a collapsed or deflated appearance and clothing no longer fits as nicely through the chest.Surgical augmentation of the breast is accomplished by using an artificial implant that is placed beneath the breast tissues. The implant varies in size according to the wishes of the patient. The implant itself contains a jacket and a “Filler” of a saline (salt–water) solution identical to that used intravenously in hospitals.
While the once popular silicone gel is no longer used as a filler, silicone in its more solid “Rubber like” form is still used to create the implant’s jacket, which maintains the volume of the saline filler. In recent years, some patients have raised concerns about the potential for implanted silicone to cause diseases.To date, however, these claims have not been substantiated by carefully performed scientific studies that have examined the health of thousands of previously augmented patients. The number of breast augmentation procedures performed annually are once again increasing.During the consultation for breast augmentation, the physician and patient use simulation to decide the amount of breast augmentation that best meets the patient’s needs.During the actual surgery, the implant is placed under the existing breast tissue or under the chest muscle, depending on the patient’s pre–existing breast shape and size. The procedure can be done with local anesthetic and sedation or under general anesthesia.
Scars are an unavoidable result of the incisions required to place breast implants, but they generally are small and can be placed inconspicuously. In some cases, the implants can be placed with the aid of a lighted rod called an endoscope, which permits even smaller incisions and scars. Incision placement is influenced by such factors as apparel preferences and implant placement.
Some discomfort arises from the stretching of the breast tissues, but it largely resolves within two to three days and is well–controlled with medications. Patients should not wear blouses or brassieres until the sutures are removed seven to 10 days postoperatively. Patients generally return to work within one week, but should avoid strenuous activities over the three to four weeks required for bruising and swelling to resolve.
Postoperative complications include blood accumulation or infection adjacent to the implant. Both problems occur infrequently, but can necessitate a second operation or temporary removal of the implant. Because implants are a medical device, they can fail at any point after implantation. This is uncommon, but it would require implant replacement surgery because leaking would cause the involved breast to shrink to the preoperative size. Some patients develop a firm layer of scar tissue around their implants which can make the breast hard to the touch or painful. Called “Capsular contracture,” this can cause the breast contour to be asymmetrical and may require secondary procedures for improvement. Nipple sensation can be increased or decreased by the procedure. Although this is almost always temporary, it can be permanent. Most patients are able to breast–feed following augmentation.Breast implants do cause some interference with the ability of mammography to detect early breast cancers. This is an important consideration that patients should discuss with a physician, particularly patients with a first–degree relative who has had breast cancer. All augmented patients need to inform their radiologists of their implants so the screening technique can be favorably modified.Despite these limitations, approximately two million women are estimated to have undergone breast enlargement surgery. The overwhelming majority are satisfied with the results.