Breast augmentation (enlargement) is the most commonly requested cosmetic breast operation. While most often performed for women whose breasts have not developed sufficiently in size, breast augmentation is also helpful in restoring lost breast volume and correcting mild droop after pregnancy and nursing as well as in women whose breasts have drooped and lost volume through the aging process or as the result of significant weight loss.
At your initial consultation, an extensive discussion will cover every aspect of the proposed procedure. An examination will determine the health, size, shape and density of the breasts and recommendations will be made for an appropriately sized implant. We will be “trying on” various sized implants and ultimately it will be your choice (with some guidance from Dr Jacobs) as to the size chosen. In circumstances of unequal breast size, two different size implants will be used to restore volume symmetry – a larger implant in the smaller breast and a smaller implant in the larger breast. In order to do this, you are requested to wear a non-padded bra to this examination.
Next, a decision will be made as to the type of implant: saline filled or silicone gel filled. Both of these implants are safe! Examples of each implant will be demonstrated and the characteristics, pros and cons of each will be discussed. Some of the differences are as follows:
Saline implants: This is a silicone rubber sac which is filled through a valve with saline (salt water) at the time of surgery. Minor breast size differences can be addressed by placing slightly different amounts of saline in each implant – ie there is some flexibility as to volume. These implants can be placed through a very small incision. Once in place inside the breast, they feel more like a miniature “water bed.” Should implant rupture occur (a rare occurrence), they will deflate virtually immediately and painlessly -- the diagnosis is obvious. There is no harm to the body from the saline which is released. Treatment consists of surgical replacement with a new, identical implant. The cost of these implants is slightly less than silicone gel.
Silicone gel implants: This is a silicone rubber sac (identical to a saline implant sac) which is filled with silicone gel. The gel (thick, clear and colorless) is engineered to have a consistency similar to your own natural breast tissue. Hence, when it is implanted, there will be a very natural feel to the breast. These implants come pre-filled so that there is no opportunity to “fine tune” the volume at the time of surgery. A decision on the volume of each implant must be made pre-operatively. They do require a slightly longer incision for placement in the breast. Implant rupture is even rarer than with saline implants and the diagnosis is usually made by a mammogram or MRI of the breasts. Should rupture occur, the silicone gel is usually trapped by the scar tissue (capsule) which naturally forms around each implant. Treatment consists of surgical replacement with a new, identical implant.
Next, a decision will be made as to the location of the incision on the breast. For most cases, an incision around the edge of the areola (pigmented skin around the nipple) or in the fold beneath the breast will be the best choice. Both incisions result in a permanent scar which tends to heal extremely well. Some surgeons offer a TUBA procedure (trans-umbilical breast augmentation), in which a saline implant (only) is placed in both breasts via an incision in the umbilicus (belly button). Dr Jacobs does not endorse this procedure because a) the manufacturer’s warranty on the implant is immediately voided when the implant is forcibly pushed through a long tube for placement, and b) the procedure itself does not allow the surgeon to be absolutely certain that the implant is placed properly and symmetrically in the breast pocket.
Finally, a decision about implant location – either over or under the muscle – will be made. There are many factors which enter this decision, including the size and thickness of the innate breast tissue, the usual physical activities of the patient and ultimately patient preference. Pros and cons of each location will be discussed. One point is certain: the location of the implant within the breast does not influence the possibility of capsular contracture (see below).
WHAT TYPE OF ANESTHESIA IS USED?
All operations are performed under sedation or “twilight sleep” anesthesia – general anesthesia is used only rarely and then only in a hospital setting. The anesthesiologist will monitor your vital signs for your safety and administer small, frequent doses of a variety of medications through a vein. The result is a gentle, relaxed sleep while your operation is performed. There is no pain and no awareness and you will awaken quickly and comfortably in the operating room just minutes after the completion of surgery. There is usually no hangover or nausea afterwards.
HOW IS THE OPERATION PERFORMED?
Photographs are taken immediately prior to surgery. You will be taken to our operating room and prepared for surgery. A local anesthetic will be injected but you will not feel it because you are sleeping. An incision is made and a pocket – either over or under the muscle – is created for the implant. The wounds are closed with dissolving sutures on the inside so that there are no stitches to be removed afterwards – only some tapes on the skin. The procedure takes about 90 minutes to perform. At the end of the operation, you will be placed in a post-operative bra and brought to the recovery room. When you have recovered appropriately, you will be discharged in the care of another responsible adult.
WHAT CAN I EXPECT AFTER SURGERY?
The effects of the local anesthetic will persist for several hours after surgery – so you will be quite comfortable. Ultimately, these effects will wear off and you will have some soreness and a pressure sensation on your chest, which will be handled by the pain medication that has been prescribed for you. The feeling has been described as “like having the weight of two bricks on my chest” and it will last only for a few days. There is more discomfort associated with placement of the implant beneath the chest wall muscle.
There will be some swelling and perhaps some bruising of the breasts and these will disappear within a week or so. Recovery takes about 7-10 days although there is considerable healing during the ensuing months as well. You may drive within 3-4 days and perform only sedentary activities for one week. Strenuous exercise training can be resumed in one month.
Dr Jacobs will schedule several post-operative examinations after your procedure.
WHAT CAN I EXPECT IN THE LONG TERM?
Amazingly, within a week after surgery, your body image in your brain will change and you will accept your new breast size as if you had always been that size!
Your breasts will still be swollen for a while, so please defer shopping for new bras and bathing suits for a few weeks.
You are encouraged to have a post-operative mammogram anytime between six months and a year after your surgery. This will establish a baseline “normal” mammogram so that any future mammograms can be compared to it.
You should return for routine follow-up examination on an annual basis. Any changes in your breasts in-between scheduled appointments should prompt a call to our office.
FREQUENTLY ASKED QUESTIONS
Is there an added risk of cancer if I have breast implants? Absolutely not!!! There is no added risk of breast cancer if you have implants – but you must be aware that breast cancer remains a risk for all women and that periodic self-examination, physician examination and mammograms are essential.
Can I have mammograms if I have breast implants? Yes! There are techniques available which will allow thorough imaging of your breasts even though you have implants. You must be certain, however, to tell your radiologist or mammogram technician that you do have implants in place so that the additional views and maneuvers can be done.
Can I become pregnant if I have implants? Yes! Having implants does not affect your ability to become pregnant. Bear in mind, though, that some women, with or without implants, sometimes have trouble becoming pregnant. Remember, too, that your augmented breasts will become even larger during the course of your pregnancy.
Can I nurse a child if I have implants? Yes! Having implants does not affect your ability to nurse. However, some women, with or without implants, sometimes have an inability to nurse.
Will I still maintain sensation in my nipples? Yes! Immediately after surgery, sensation may be diminished but it usually returns to the same level as before surgery in the vast majority of patients. In some cases, the nipples become super-sensitive (no one knows why) and in rare cases, there may be some diminished sensation.
What is capsular contracture? Any foreign body implanted in a human will prompt the body to produce scar tissue around it. It is the body’s natural attempt to “wall off” a foreign substance. The same holds true for breast implants. The body will normally produce a layer of scar tissue around an implant. In essence, it looks like a balloon within a balloon. In most circumstances, the layer of scar tissue will be thin and pliable and will have no effect whatsoever. In other circumstances, whose true cause remains a mystery to this day, the scar tissue layer becomes thickened. This results in perceived firmness of the augmented breast. (Interestingly, the implant remains as soft as the day it was implanted – but the scar tissue makes the breast firm.) The firmness is totally benign and many patients live with it. Rarely, it may progress to a situation in which there is pain and/or distortion of the breast. This may prompt the need for additional surgery. Capsular contracture may occur days, weeks, months, years or decades after surgery and it may affect either or both breasts at any time.
Do I have to replace my implants periodically? No! There is a common myth that “implants must be regularly replaced or exchanged every ten years.” Nonsense. However, nothing lasts forever and therefore periodic examinations are important to monitor the integrity of the implants. Any change in the implant integrity should be discussed with Dr Jacobs and surgery may be indicated.
Can I switch my implants?
Yes! Some women desire to have larger (or smaller) implants after their original surgery. Other women do not enjoy the feel of saline implants and wish to switch to silicon gel implants. A "remove and replace" operation can be performed, usually through the original scar. It is most important, however, to retain the information about your original surgery (size and type of implant) so that precise decisions can be made as regards new implants. Please bring this information with you at the time of consultation.