BREAST
| BREAST ENHANCEMENT: |
Breast Augmentation
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Synonymous to : Breast Enlargement, Augmentation Mammoplasty, Breast Enhancement
Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure that enhances the size and shape of a woman's breasts with the use of breast implants (silicone or saline). The procedure also enhances breast contour and volume after pregnancy. A breast implant, which is composed of silicone gel or saline within a silicone shell, is different from silicone oil. Most cosmetic plastic surgeons all over the world don’t do silicone oil injection to enhance breast size and volume. This technique is condemned both locally and internationally by most surgeons since the result is unpredictable and often compounded by numerous complications such as extrusion, skin necrosis, and infection. Patients should not allow themselves to be subjected to this procedure because the risks for unwanted complications are very high and results are unpredictable and could lead to deformity. Most surgeons use a breast implant which is composed of material that is non-toxic, non-allergenic, non-teratogenic and bio-compatible to human tissues and thus have less risk for any unwanted results, and with a more predictable outcome.
This is one of the most common cosmetic procedures done worldwide, especially in the United States. It is a straightforward procedure with a very instantaneous and pleasing result. For this reason, the public's attention and interest have focused on the search for a very safe breast implant material. Breast augmentation is the only procedure in cosmetic plastic surgery specialty that is surrounded by controversy and scrutiny. In the past, especially during the late 70's and early 80's, a lot of medical conditions such as breast cancer and auto-immune diseases were wrongfully associated with the use of silicone implants. This prompted the US Food and Drug Administration to regulate the use of silicone breast implants for cosmetic breast procedures until mid-2007. After an extensive clinical research study that involved more than a thousand breast-augmented women, it was found that a silicone breast implant does not cause any malignant disease or breast cancer, or any auto-immune disorder. This led to the approval by the US-FDA of the use of the silicone implant in cosmetic breast procedure.
There are two basic types of breast implants: saline and silicone implants. The implant has an outer membrane composed of a silicone shell. This shell contains either saline (fluid) or silicone (cohesive gel) material. It is prudent for every patient to discuss extensively the advantages and disadvantages of each implant type with their surgeon before they finalize their decision.
We perform our breast augmentation procedure under deep sedation with local anesthesia or general anesthesia. The procedure can be done either as an out-patient surgery, or the patient can be admitted or confined for a day or two in a hospital, depending on the surgeon’s and patient's preference. Whether the procedure will be performed as an out-patient or as a hospital procedure, pre-operative laboratory and medical clearances are required. The surgery usually takes one to two hours to complete. The breast implant can be inserted through an incision at the armpit or breast fold, or at the areolar border. Each choice of incision site has its own advantages and disadvantages in terms of scar cosmesis and nipple sensation. Among the three incisions, the transaxillary approach has the best scar cosmesis since it is concealed and nipple sensation is well preserved. But it is advisable for the patient to further discuss this issue if scarring is a significant concern. After the procedure, there will be some swelling and mild bruising that last for several days to a few weeks. Patients are required to wear breast binders for three to six weeks. This will hold the breast implant in place during the healing process and also help control the swelling. Sutures are removed after seven to ten days.
Any patient planning to have this procedure will require ten to 14 days for the initial consultation, laboratory, medical clearance, surgery, follow-up, suture removal, and early recuperation. After these, patients are safe to travel since wounds are dry and healed.
Possible risks and complications:
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Breast Reduction
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A breast reduction is frequently requested by female patients (also occasionally by male patients) with significantly enlarged breasts causing pain in the shoulders and upper extremities, maceration at the inframamary area, and for psychological reasons such as embarrassment and inability to wear desired clothing. Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort. In most cases, breast reduction isn't performed until a woman's breasts are fully developed. However, it can be done earlier if the large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results.
The procedure involves the removal of fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body. This is done under general anesthesia, with patient confined for a few days in the hospital. This may be indicated for male patients who have persistent gynecomastia for more than two years. Sutures are removed on the fourth or seventh day after the operation. There is swelling of the breasts that usually subsides after several weeks. Be patient regarding the final appearance of the breasts.
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Breastlift / Mastopexy
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Over the years, factors such as pregnancy, nursing, and the force of gravity take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Mastopexy, or breast lift, is performed for women who have sagging breasts with loose skin envelope. It rejuvenates or enhances the breast shape and size to a more youthful appearance. This is done either with excision of breast tissue alone and/or with insertion of a breast implant, depending on the degree of breast tissue laxity and volume. Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bathing suit or clothing. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of sensation in your nipples or breasts. Your surgeon should be able to describe the procedure to you in detail, explaining its risks and limitations and making sure you understand the scarring that will result. This is usually done under general anesthesia, with the patient confined for a few days in the hospital. There could be some swelling immediately after the operation, but it usually subsides after several weeks. Sutures are removed on the seventh or tenth day after the procedure.
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Breast Reconstruction
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Nipple reduction is done to reshape the nipple’s areolar area. This procedure reduces the size of the nipple and the darker skin surrounding the areola. The goal is to give the woman smaller, better-sized and shaped nipple areolar complex in proportion with the breast and the rest of the body. This procedure involves small incisions to remove the excess part of the nipple areolar area. This is usually done in out-patient clinics under local anesthesia. Suture is removed after four to seven days after the operation. There could be some swelling after the procedure, but it subsides after several days or weeks.
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Breast Nipple Reconstruction
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Female patients who have insufficient breast tissue and volume, or a complete absence of the breast due to surgery (after breast cancer or breast siliconoma removal), trauma, or congenital anomaly, could undergo breast reconstruction surgery. The new breast without the nipple areola is called the breast mound. Reconstruction can be done immediately after tumor excision, or delayed for months or years depending on the need for adjuvant treatment or other medical conditions. Usually, the lower abdominal soft tissues are used and transferred to reconstruct the breast mound (TRAM). A breast implant, alone or in combination with a muscle flap, may be used after mastectomy in breast siliconoma or cancer surgery. The nipple-areolar complexes are usually reconstructed best after two to three months, since much of the swelling of the new breast mound would be gone by then and better symmetry would be attained. The length of the operation varies from the technique used by the surgeon. It is done under general anesthesia, with the patient confined for a few days in the hospital.
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Breast Nipple Reduction
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Nipple reduction is done to reshape the nipple’s areolar area. This procedure reduces the size of the nipple and the darker skin surrounding the areola. The goal is to give the woman smaller, better-sized and shaped nipple areolar complex in proportion with the breast and the rest of the body. This procedure involves small incisions to remove the excess part of the nipple areolar area. This is usually done in out-patient clinics under local anesthesia. Suture is removed after four to seven days after the operation. There could be some swelling after the procedure, but it subsides after several days or weeks.
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