Overview of Breast Augmentation
Breast augmentation is a surgery that increases the size of the breasts. It is commonly done by placing an implant in the breast, or sometimes by transferring fat from another part of the body. This type of surgery is one of the most performed cosmetic surgeries in America.
In 1992, the FDA (Food and Drug Administration), the organization responsible for ensuring the safety of medical products in United States, limited the use of silicone-filled implants due to concerns about their safety. Despite this, silicone implants continued to be used in patients undergoing breast reconstruction after a mastectomy, which is the removal of one or both breasts.
Many studies were conducted to investigate the risks of silicone implants. When these studies did not find a link between silicone and harmful diseases, the FDA decided in 2006 to allow silicone-filled implants for all patients, not just those enrolled in a clinical study.
By 2017, most patients having breast augmentation surgery were receiving implants filled with a cohesive gel silicone. This type of implant is believed to have lower complication rates and is even recommended by the FDA. They suggest that patients with these implants have an MRI screen every 2 years to check for unnoticed (subclinical) leaks. However, not all patients and doctors follow this recommendation and sometimes the MRI can show a leak where there isn’t one (false positive).
The type of gel used in these silicone implants has changed over time. It is now more cohesive (sticks together better) which can make the implant more firm or “gummy.” This can help to lower the risk of the implant breaking or rupturing. However, it is important to remember that all implants have a risk of breaking or rupturing over time.
Anatomy and Physiology of Breast Augmentation
The female breast is positioned on the front part of the chest, underneath the collarbone, and between the sternum (breastbone) that’s located in the middle and the edge of a muscle called the latissimus dorsi on the side. The bottom boundary of the breast is a crease known as the inframammary fold or ligament. This fold is a skin structure, resulting from the fusion of the superficial and mammary tissues.
Located under the breast are two muscles, the pectoralis major and minor, with the breast tissue lying on top. The breast receives blood supply from a network of vessels under the skin, mainly contributed by three arteries: the internal mammary artery, the external mammary artery, and the intercostal perforators.
The major nerves that supply the breast come from the intercostal nerves, mainly from the third through fifth intercostal nerves. These are the nerves located between the ribs.
Why do People Need Breast Augmentation
Some individuals may choose to get breast implants for various reasons. This might be after a mastectomy, which is a surgical procedure where one or both breasts are removed, usually to treat breast cancer. Additionally, implants might be chosen if someone has developmental disorders that affect the formation of the breasts, or simply if they want to improve how they perceive their body. Hypomastia, or having smaller breasts, can be part of natural body development or it might occur after smaller breasts develop after pregnancy.
People with diverse personalities and backgrounds can decide to get breast implants as a means to boost their self-confidence or improve their self-image. Interestingly, most women who have chosen to have this surgery say in surveys that they would make the same decision if they had to do it all over again.
When a Person Should Avoid Breast Augmentation
Generally, most people can safely have breast enlargement surgery. However, there are few cases when this surgery isn’t recommended. These can include:
1. If a person has an ongoing infection or cancer in the breast, it’s not safe to have the surgery.
2. If a person is pregnant, surgery is also a no-go.
3. If a person has had an autoimmune disease (where the body attacks itself) in the past, getting breast implants might not be advisable.
4. Any ongoing radiation treatment (a type of cancer treatment) or other serious health conditions can make the surgery risky.
5. If someone has had a bad reaction to silicone (a material used in breast implants) in the past, that’s another reason this surgery might not be a good idea.
Lastly, for people who may be mentally unstable or who have unrealistic expectations about the surgery results, doctors usually recommend against getting breast enlargement.
Equipment used for Breast Augmentation
Basic surgical tools are typically all that’s needed for a breast enlargement surgery. Some surgeons might choose to use a light-up tool that helps them see the space they’ve created in the breast for the implant, while others may opt for a special headlight. If the surgeon decides to access the breast through the belly button or underarm, they may need an endoscope, which is a tool that helps them see inside the body, or other special equipment.
Some surgeons also suggest using a specific sleeve to place the implant. This aims to make the process of inserting the implant easier and is part of a method called the no-touch technique. Here, the idea is to touch the implant as little as possible. This might help reduce the chances of causing any harm to the implant and potentially lower the risk of bacterial infection.
Who is needed to perform Breast Augmentation?
Usually, during a surgery, there are several key people involved. This includes the surgeon, who is the main doctor responsible for performing the surgery. There’s also an assistant who’s specially trained to help the surgeon during the procedure. An anesthesiologist is the doctor who gives you medicine to make you sleep so you don’t feel any pain during the surgery. Lastly, a nurse will be there to help keep the operating room organized and safe. They are often called ‘circulating’ nurses because they move around the room, helping everyone on the surgical team.
Preparing for Breast Augmentation
Preparing for surgery to remove the appendix is the same as getting ready for any other kind of operation.
How is Breast Augmentation performed
Breast implants come in two main types: saline-filled and silicone-filled. However, both types of implants are enclosed by an outer shell made from silicone.
Saline-filled implants contain a sterile saltwater solution. These implants are typically inserted when they’re empty, and then your surgeon uses a small port to add the desired amount of saline, inflating the implant to the right size. This saline port is then removed and the implant seals itself. As the implants can be filled to different amounts within a range specified by the manufacturer, this gives your surgeon a great deal of control over the final size. Some saline implants are already prefilled by the manufacturer, but these might not be commonly used in the U.S.
The outer surface of the implant can be either smooth or textured. Textured surfaces are used in certain shaped implants to prevent them from rotating and to lower the risk of capsular contracture, which is when the scar tissue around an implant tightens, when the implant is placed under breast tissue (subglandular). If the implant is placed under chest muscle (submuscular), this texturing doesn’t reduce the risk. Currently, saline implants are approved by the FDA for use in breast augmentations in women over 18, and for breast reconstructions in patients of any age.
Silicone-filled implants are made from a solid silicone outer shell and filled with a silicone gel. The outer surface of these implants can also be either smooth or textured. Silicone gel implants are approved by the FDA for use in women above 22 years old. However, surgeons may sometimes use these implants in patients under 22 if it’s in the patient’s best interest. Silicone implants usually offer a more natural feel and are therefore more beneficial for women with smaller breasts or less soft tissue in their breasts. Also, silicone implants generally show fewer wrinkles on the edges compared to saline implants.
The implants can be placed either over or under the chest muscle, respectively known as subglandular and submuscular placement. Both positions have their pros and cons, and the best method depends on the patient’s body and the surgeon’s preference. Common locations where your surgeon might make an access incision include under the breast fold, near the armpit, or around the nipple. The procedure can be done under general anesthesia, conscious sedation, or in particular cases, local anesthesia. Typically, breast augmentation takes 45 to 90 minutes and is carried out as an outpatient operation. Most patients recover quickly and can return to light work and activities within one week, although returning to full activity might take up to six weeks.
Possible Complications of Breast Augmentation
While the chances of complications occurring after the placement of implants, like breast implants, are generally low, they should not be ignored as no artificial implant is meant to last for a lifetime. It’s actually quite unpredictable – an implant can either break at any time or it could potentially last for your entire life. Doctors, based on their experience, generally expect implants to last from 15 to 20 years. As for replacing the implants, doctors don’t quite agree. Some suggest replacing them every 10 to 15 years, while others advise waiting until there is a problem, like leak or rupture, with the existing implant.
After getting an implant, a patient could face some complications such as infection, scarring, unevenness of breasts, collection of blood causing a bruise (Hematoma), build-up of fluid (Seroma), breast pain, changes in appearance, or changes in the feeling of their breast or nipple.
As time goes by, other complications may appear, such as the implant moving from its original position, the implant losing air or springing a leak and complications from scar tissue around the implant, known as capsular contracture. The actual reason for capsular contracture is not definite, but doctors think it might be because of longstanding, low-level infections. The most commonly found bacteria in these cases are Staphylococcus epidermidis and Propionibacterium acnes. The severity of the capsular contracture is categorized on a scale from 1 to 4, and in serious cases, may require surgical intervention or even the removal of the implant.
Patients considering implants should be aware that many women with breast implants end up needing further breast surgery at some point in their lives. Recently, it has been reported that a specific type of cancer called anaplastic large cell lymphoma (ALCL) might be slightly more likely in women with breast implants. The exact link between implants and ALCL is yet to be determined.
What Else Should I Know About Breast Augmentation?
Breast augmentation is a common procedure that many women choose to undergo. In fact, the American Society of Plastic Surgeons has reported that almost 290,000 such procedures were performed in 2016 alone. Many women who have undergone this surgery have a more positive self-view and are pleased with their decision to have the surgery.
Given the high number of women with breast implants, it’s important for all doctors to understand the procedure and implants, even if they don’t specialize in this field. This knowledge is crucial when treating these women for other health conditions.
