American Medical Association Family Medical Guide - American Medical Association [780]
Breast Augmentation
Breast augmentation uses saline-filled sacs made of silicone or another soft, pliable plastic to enlarge the breasts. After evaluating a woman’s breasts, the surgeon will determine the best site for inserting the implants and for positioning them (under or over the chest wall muscle).
Possible incision sites for breast enlargement
Many breast implants are inserted through an incision in the natural fold under the breast, but they can also be inserted through an incision around the areola (the dark skin around the nipple) or in the armpit.
Breast implant locations
Breast implants can be placed either under (top) or over (bottom) the chest wall muscle. Where to place the implant is a decision that you and your surgeon must make together.
The Procedure
Breast enlargement surgery can be done using general anesthesia, or local anesthesia combined with sedation. Most breast augmentation is done on an outpatient basis.
After making an incision, the surgeon will lift your skin and breast tissue to make a pocket either right behind the breast tissue or under your chest wall muscle. He or she will then insert the implant and center it under your nipples. The incision is closed with stitches. The surgeon repeats the process on the other breast. Gauze bandages may be placed over your breasts to help speed healing.
After Surgery
You will probably feel tired and very sore for the first few days after surgery, but your surgeon will encourage you to get up and walk around immediately after surgery. He or she will prescribe pain medication to relieve the discomfort. Your breasts will look bruised and swollen and your nipples may burn for the first 2 weeks after surgery. The stitches are removed a week to 10 days after surgery. The soreness and swelling usually last about 3 to 5 weeks.
You may be able to go back to work in a few days. Your surgeon will tell you when you can begin exercising or lifting. Your scars will stay noticeably pink for several months and then begin to fade, although they will never disappear completely.
The most common complication of breast enlargement surgery is capsular contracture, in which scar tissue around the implant contracts and becomes tight. The tightening scar squeezes the implant, making the breast feel hard. Surgeons can treat this condition by surgically removing the scar tissue or making parallel cuts in it to widen it and make it more elastic. Another option is to remove or replace the implant.
Other possible complications of breast enlargement surgery include excessive bleeding, infection, and numbness of the nipples or incisions. Sensation usually returns over time but loss of sensation can sometimes be permanent. Breast implants can break or leak after an injury or, occasionally, during routine activity. If an implant leaks, your body will absorb the saline solution contained in the implant, but the implant itself must be removed and replaced. Before having the surgery, make sure you talk with your surgeon about the risks and possible complications.
Breast Reduction
Breast reduction surgery is performed to remove breast fat and skin from very large, pendulous breasts that cause discomfort and restrict a woman’s activities. The surgery makes the breasts smaller, less heavy, and in better proportion to the rest of the body. The best candidates for this surgery are women whose breasts are fully developed and who are seeking physical relief from symptoms caused by large breasts, in addition to an improvement in their appearance. Women who plan to breastfeed should not have breast reduction surgery because the surgery removes many of the milk ducts and can make breastfeeding impossible.
Before surgery, your surgeon may ask you to have a mammogram (see page 141). If the surgeon anticipates having to remove a large amount of breast tissue, he or she may recommend that you donate a unit of your own blood ahead of time in case you need a blood transfusion (see page