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Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size
and shape of a woman's breast for a number of reasons:
1. To enhance the body contour of a woman who, for personal reasons,feels her breast size is too small.
2. To correct a reduction in breast volume after pregnancy.
3. To balance a difference in breast size.
4. As a reconstructive technique following breast surgery.
By inserting an implant behind each breast, surgeons are able to increase a woman's bust line by one or more
bra cup sizes. If you're considering breast augmentation, this brochure will give you a basic understanding
of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all
of your questions, since a lot depends on your individual circumstances. Please ask the surgeon at the Riley
Surgery Center if there is anything you don't understand about the procedure.
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The best candidates for breast augmentation
Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.
Types of implants
A breast implant is a silicone shell filled with either silicone gel or
some other nontoxic solution such as a saltwater solution known as saline. Newer
types of fill include polysaccharide (sugar) solutions. Why the silicone shell
for all implants? For one, silicone (made out of sand, just like glass)
virtually excludes allergic reactions. Nobody can live on earth if they are
allergic to sand (or water or air, main elements on earth). And, by galvanizing
the silicone shell, chemical reactions with the shell (that could theoretically
create another substance humans can be allergic to), the shell becomes
"inert", meaning non-toxic and impossible to react with. The filling,
however, remains a problem. An implant made entirely from galvanized silicone is
too hard to consider. The silicone gel-filled
implant remains the benchmark in breast augmentation surgery, due to it's
"natural feel". Because of safety concerns of the silicone gel-filled implants
by the American Food & Drug Administration (FDA), the safer saline-filled
implants are advocated. However, these implants do have their drawbacks. Common
complaints include "abnormal feel", "wrinkling" and leakage of the saline-filled
implants. To address these complaints, polysaccharide-filled implants (Hydrogel)
were devised which combines natural feel and safety, although
"wrinkling" remain a main problem. It is, in any case, important to realize
that no "life-time" guarantee can be given for any type of implant,
although some manufacturers of newer types of implants do claim this for their
implants. More important is the guarantee that some manufacturers offer to
replace the implants free of charge in the event of implant failure under normal
circumstances. "Normal circumstances" exclude for example high speed
trauma (e.g. car accidents) and sharp penetrations (e.g. knives). "Implant
failure" refers to any circumstance where the implant is the direct reason
for replacement surgery. These include implant rupture (where the shell is
ruptured and the content leaks away, causing a variety of problems) or leakage
(which does not necessarily cause problems, but change in size of the breast is
apparent). Do realize that implant failure, especially for the latest
generations of implants, is relatively scarce (under normal and abnormal
circumstances) and most women who had breast augmentation surgery carry
their implants happily for life.
Newest types of silicone gel filled implants include the so-called "High Cohesive
Silicone Gel Implants". The content of these implants do not spill or leak
away, even if cut or ruptured and this fact do seem promising. Because of the
natural feel of these 'wrinkle-free' implants, along with the manufacturers'
guarantee to replace failed implants free of charge, these (high-end priced)
"High Cohesive Silicone Gel Implants" are the implants of choice at the
Riley Surgery Center, even though FDA approval is still pending (this could take
years). Other types of implants, however, can also be offered on
request, including saline- or polysaccharide filled implants.. "High
Cohesive Silicone Gel Implants" are kept in stock at the Riley Surgery
Center and surgery can be planned virtually immediately. Do realize that
requesting other types of implants generally require a waiting period in order
to get the right sized type of implants, usually around a week.
All surgery carries some uncertainty and risk
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most troublesome problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard and pain can be experienced. With the new rough-surfaced implants however, capsular contraction as a complication is diminishing. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.
As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. This, however, is a rare complication, especially if suction drainage is applied post-operatively. A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. Infection risks are kept to a minimum by preoperative antiseptic bathing of the patient, peri-operative (before, during and after the operation) antibiotic treatment and peri-operative lifestyle adjustments, including cessation of cigarette smoking and healthy diets. Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear with time, but may be permanent in some patients. There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by the doctor. Occasionally, breast implants may break or leak. Rupture can occur as a result of injury, causing the silicone shell to leak. If a saline-filled or polysaccharide-filled implant breaks, the implant will deflate in a few hours to days and the body will harmlessly absorb the solution. If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur. For these reasons, it is recommended that silicone gel filled implants, especially the first generation types, be replaced at a maximum of fifteen years. This involves another surgery. Experience with later generations of silicone gel filled implants is still short, but evidence suggests that these last longer. Nevertheless, in the meantime the recommendation to replace them after a maximum of fifteen years stands. Saline or polysaccharide filled implants can be left in for life.
A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. However, extensive research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as "connective-tissue disorders".
While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant. Ultrasound examination results are more sensitive in patients who carry breast implants than those who don't because of the enhanced contrast the implant provides, so it may be more useful in patients with breast implants than a mammogram. While the majority of women do not experience these complications, you should discuss each of them with the physician to make sure you understand the risks and consequences of breast augmentation.
Planning your surgery
In your initial consultation, the surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, the surgeon may also recommend a breast lift. Be sure to discuss your expectations frankly with the surgeon. At the Riley Surgery Center, you can be sure that the surgeon will be equally frank with you, describing your alternatives and the risks and limitations of each. As a routine, at the Riley Surgery Center a copy of the manufacturer's insert that comes with the implant is always attached to the patient's chart (which the patient has every access to) -- just so you are fully informed about it. And, be sure to tell the surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs. In your initial consultation at the Riley Surgery Center, the surgeon will also explain the type of anesthesia to be used and a preoperative evaluation by the anesthesiologist is customary, typically the day prior to the operation. During the consultation, before and after pictures are displayed to help you better understand the concepts presented. Also the costs involved will be discussed.
Preparing for your surgery
The surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Aspirin use should be discontinued at least two weeks prior to the operation. Antiseptic soap is prescribed so you can bathe and shampoo your hair with it on the eve of the operation. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.
Where your surgery will be performed
The surgery is performed at the Riley Surgery Center, featuring a state-of-the-art Surgical Suite. Breast augmentation in our clinic is performed on a day care basis. You do not stay overnight. Ambulatory nurse care is available on request and a same night house (or hotel) visit by our anesthesia nurse is standard.
Types of anesthesia
In the Riley Surgery Center, breast augmentation is performed under general anesthesia, so you'll sleep through the entire operation. Sometimes, upon the patient's request or if general anesthesia is contraindicated, we may use a local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake, with minimal discomfort. In any case, a nurse anesthetist and anesthesiologist are present to make sure you are completely secured during the procedure.
The surgery
The method of inserting and positioning your implant will depend on your anatomy and the surgeon's recommendation. The incision can be made either in the crease where the breast meets the chest, around the aureole (the dark skin surrounding the nipple), or in the armpit. At the Riley Surgery Center, the aureole approach is preferred, although this may not always be possible (for instance if the aureole is too small or if symmetry has to be corrected as well). Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible. Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples. The decision to put the implant above or beneath the pectoral muscle is a resultant of extensive evaluations, some of which are made intra-operatively. For example, implants for small breasts, with little or no breast tissue at all, are generally placed beneath the muscle, so the implant is better protected. Putting the implants behind your chest muscle may also reduce the potential for capsular contracture. In contrast, well trained individuals with strong pectoral muscles may distort the implants with muscle contractions (or even rupture them in the long run) in which case the implants are placed directly behind the breast tissue. Placing the implants directly behind the breast tissue (above the muscle) gives better projection of the augmentation, especially if there is enough breast tissue present to protect the implant. On the other hand, a family history of breast malignancy will make the surgeon reluctant to place the implant above the muscle, as this position interferes more with breast imaging (used to detect cancer) than a sub muscular implant position. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue. You'll want to discuss the pros and cons of these alternatives with the surgeon before surgery to make sure you fully understand the implications of the procedure he recommends for you. Drainage tubes may be used for several days following the surgery. The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which are also taped for greater support. A special surgical bra is fitted (provided) that should be worn for six weeks after surgery to help keep the implants in place and also to create as much comfort as possible.
After your surgery
You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by the surgeon. Pain medication is standard, as well as sleeping tablets to help you get trough the first uncomfortable nights. Antibiotic treatment is prescribed as a preventive measure. Within several days, the dressings are cleaned and you will be given an extra surgical bra. You should wear it as directed by the surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades. Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.
Getting back to normal
You should be able to return to work within a few days, depending on the level of activity required for your job. Follow the surgeon's advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery. Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely. Routine mammograms or ultrasound examinations should be continued after breast augmentation for women who are in the appropriate age group, although the mammography technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
Your new look
For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Regular examination by your plastic surgeon and routine mammograms or ultrasound examinations for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.
Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success. Breast augmentation patients are among the happiest a plastic surgeon has.
The costs
Breast augmentation at the Riley Surgery Center has an all-inclusive price of US$ 3500,00. This includes peri-operative consultations and companionship, implants, pre-operative anesthesia consult, operating room, anesthesia fee, same night anesthesia nurse visit, 2 surgical bra's and before and after photos (which can also be e-mailed to you). Operation report, implants specifications and a cost breakdown are provided on request free of charge. Initial consultation (US$ 50,00), ambulatory nurse care (US$ 30,00 per visit) and all prescribed medication are excluded.
Financing is available. In addition, quoted prices are subject to discounts if you are local or medically associated.
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