Breast Augmentation: Research to Results
I am told that, from the time a girl begins to “develop” -- as her mother might have referred to it -- through her teen years, until her breast matures as a young woman, many are preoccupied with their bra size. “Am I too small?” “Am I going to grow any more?” and, in some cases, “Am I too big?” The answers to these questions can quite literally shape a young woman’s perception of herself. If, during her formative years, she is teased about her shape -- or lack of one -- this becomes interwoven into the fabric of her self-image. Depending upon the circumstances of her life, this “issue” may surface later in her life -- when she can finally do something about it.
America’s fixation with physical appearance tends to guide a lot of our decisions -- about what we wear, what we eat, how we interact with others who might not look the way they “should,” and sadly enough, it sometimes impacts our choice of friends. People who have this physical attribute or that one, research tells us, get the job, the interview, the attention, the love. This is far from an endorsement of this trend...but simply an acknowledgment of it. Obviously, each of us comes to grip with these real or perceived social influences in our own way. And, as adults, we have options and choices, and hopefully we’ll make reality-based decisions along the way. The great thing is that, when it comes to our own body-image, we have the opportunity to make our own intensely personal decisions based on what we believe is appropriate for us.
For many women, enhancing the size and shape of their breasts becomes a top priority. Ideally, the first thing they do to accomplish this objective is to examine their reasons for wanting breast augmentation surgery, and then to do their homework to make it happen.
As a plastic surgeon, I cannot emphasize strongly enough how important it is to analyze your motives -- and expectations -- before reaching a decision about having the surgery. Yes, breast augmentation surgery can change your appearance. It might have an impact on your self confidence. But, are there other things you expect the surgery to do for you? Do you expect it to change the way people treat you? Will it make you look exactly how you want to look? Do you expect it to change your life? Does your spouse or significant other want you to have the surgery to please him, or are you doing it for yourself? Last, but not least, have you researched the details of the surgical process and are you confident that the benefits outweigh any concerns you might have? How you answer these questions will provide your best foundation upon which to base your decision to have surgery, or not.
Augmentation Mammaplasty -- What is it?
Simply stated, breast augmentation is a surgical procedure to enhance the size and shape of a woman’s breast using medical implants. The best surgical “candidates” for this elective procedure are physically healthy women who want to improve the way they look -- but who don’t expect perfection. It can be done for a number of reasons, such as when a woman feels her breasts are too small; to restore breast volume reduced by pregnancy; when breasts differ in size; and as a reconstructive measure after breast surgery or mastectomy.
The surgical technique selected depends on a woman’s individual anatomy and the desired outcome. The breast is made up of milk ducts and glands surrounded by fatty tissue, and then covered by skin. It is the fatty tissue that gives the breast its shape and texture, or feel. Changes occur in a woman’s breasts over the years; some good, some not so good. Small breasted women are often delighted when pregnancy enlarges the volume of their breasts temporarily when milk glands expand. But later, when gravity exerts its downward influence, the stretched skin envelope “droops” into an older-looking silhouette. In some cases, a breast lift is also necessary to restore a younger looking profile.
Behind the fatty tissue is the pectoralis major muscle that helps with flexing and rotating the arm at the shoulder joint. This muscle also plays a role in the breast’s projection. In one augmentation procedure the implant is placed above the muscle, and another inserts it below the muscle. Placement of the implant is something that will be discussed with the surgical candidate during a pre-op consultation. There are also several choices as to where the incision will be made; all of which are chosen to minimize scaring.
Are Breast Implants Safe?
At the beginning of the 1990’s, there was considerable controversy about the safety of breast implants, specifically the ones filled with silicone gel. There were multiple lawsuits and class actions that sought compensation for the way some women claimed their bodies reacted to the implants. There were numerable allegations about silicone being linked to “systemic” and auto-immune diseases. These cases were emotionally charged, they received considerable press coverage, and they ultimately drove at least one manufacturer to bankruptcy.
There are several comments I want to make. First, while the cases were going on, a federal district court judge in Oregon ruled that evidence based on “junk science” (that not meeting the threshold of scientific proof necessary to merit being presented to juries) would be barred from implant litigation. Secondly, after the cases were settled, both Harvard University and the Mayo Clinic conducted studies on silicone gel and found no link between the silicone and auto-immune diseases. And third, no national medical association, or even the Food and Drug Administration, has yet to state that sufficient evidence exists to prove that silicone gel causes systemic disease. In fact, within the last week, an independent panel of 13 scientists convened by the Institute of Medicine at the request of Congress has concluded that silicone breast implants do not cause any major diseases. This confirms what the implant manufacturers said all along.
A lot of people ask why, if there was no proven link to illness, did the manufacturers agree to settle the claims for such a staggering amount of money. My answer to that is, “I don’t know.” Many people suggest that the liability system failed in this case because it was designed to resolve one claim by one person at one time, rather than for the use of thousands of people seeking redress from one defendant at the same time.
During the height of the controversy, the media devoted a lot of time covering the individual plaintiffs and their charges, but they are conspicuously silent now that science can find no link to disease. The case that ended in a verdict for the manufacturer received virtually no press coverage compared to some of the other high profile cases that went the other way. I tend to agree that “advocacy produces justice, but only when both sides have equal opportunity to present their case.”
The bottom line in the implant controversy is that the FDA subsequently restricted the use of silicone gel implants in this country. Today’s implants consist of a silicone rubber shell, and are commonly filled with saline solution (salt water). The FDA published a consumer publication in 1996 called Implants: An Information Update, that explains their breast implant regulations and their position on related medical issues. (It can be obtained by calling the FDA directly at 800-532-4440.)
Implant size and shape...
There are many different sizes and shapes of breast implants...some are globular in shape -- which provides a round curve in the upper part of the breast -- and others that are more anatomical with a gentle slope to offer more upper breast “fullness.” Most women think of their breasts in bra cup sizes. If she is a 34B now, she can envision becoming a 34C or larger, for example. Since an implant will add volume to the total breast tissue, we also consider dimensions like breast width, height and projection in selecting the implant.
Width is one of the more important dimensions because it impacts the amount of cleavage between the breasts and the outside curve that a woman may want to be in better balance with her hips. Another consideration in implant selection is the amount of breast tissue in place. It will have to cover the implant or there may be visible implant edges.
The Surgery Itself
Before scheduling the surgery, we do a thorough evaluation of the candidate’s physical health, and take a health history, as well. It is critical, at this point, that the surgeon learn of any problem that could have a negative impact on the healing process, or could jeopardize the patient’s overall condition. Some of the things we want to know about are infections, a history of healing difficulties, certain medications and smoking. Smoking can radically delay the healing process so I require my patients to sign an agreement that they won’t smoke.
A location less frequently used is in the axilla (armpit.) There is a higher risk of infection and scarring, the latter being difficult to correct. Another location sometimes used is through the umbilicus (navel). This procedure is not approved by certain national plastic organizations and the manufacturer's warranty of the breast implants is null and void. Each case is different; some are performed on an outpatient basis and others require an overnight hospital stay. The surgery itself takes less than two hours and is performed under a general anesthesia. There are two incisions that will be made -- as we have discussed in the pre-op conference -- the deflated implant inserted and positioned, and then filled with saline in place. The incisions are closed with sutures and may also be taped for extra security. Most of the discomfort can be controlled by medication.
Patients may feel a little sore and somewhat tired for several days following the surgery, and the breasts may remain swollen and sensitive for up to a month. They may also feel tight as the skin adjusts to the new breast size. As with any invasive procedure, complications can occur, such as effects of the anesthesia, infection, swelling, bleeding, pain, and delayed healing. In addition, other longer-term problems are possible, including: deflation of the implant, contraction of the scar tissue capsule around the implant, calcium deposits around the implant, and shifting of the implant. They are relatively rare, and will be discussed in detail during the pre-op conferences. Be sure to ask for a copy of the manufacturer’s insert that comes with your implant for complete information.
During the recovery period, we suggest that the patient wear a special postoperative bra for extra support during the healing process. Most women are comfortable returning to work within a few days, although patients should avoid any strenuous activities that could pull on the stitches. Patients heal faster when they follow our recommendations about exercise and resuming normal activities.
The skin sutures -- if used -- are usually removed in a week. The incision scar may be firm and pink at first, but after several months, they will begin to fade -- although they will never disappear completely.
Your breasts will feel different after the surgery, and it may take a little while to get used to the fuller appearance. Just as the decision to have breast augmentation in the first place was intensely personal, so should be your response to how you look. The results may be just a slight new fullness, or there may be an appreciable difference. But remember, you define success...in the way you look, the way the new size makes you feel, and in the boost to your self confidence. The whole world looks better when you do.
