The following is information regarding breast augmentation which is important to review, understand and discuss with family or friends before choosing to proceed with this surgery.
GOALS OF AUGMENTATION MAMMOPLASTY
The purpose of augmentation mammoplasty is to create more normal proportions in women with under developed breasts or to recreate fullness in women who have lost volume due to pregnancy or weight loss. The operation is designed to preserve breast function, specifically sensitivity, the ability to breast feed and to satisfy psychological needs. In any given patient, these goals may be only partially met.
LIMITATIONS OF THE PROCEDURE
This procedure cannot stimulate normal breast tissue to increase in size, nor can it create younger skin or eliminate “stretch marks”. In addition, if sagging is severe, this cannot be eliminated with implantation alone. Asymmetries such as difference in breast shape or position, rib cage irregularities or difference in nipple areolar size may not be corrected by this procedure. Although the procedure may improve body image and a sense of well being, the procedure cannot solve personal, marital or work related problems.
ALTERNATIVES TO THE PROCEDURE
Loss of breast volume and breast sagging are normal features of aging, and in themselves are not a disease which requires surgery. Upper body exercise will tone the pectoralis muscles giving the upper chest a fuller appearance. However, as there are no direct muscle communications to the breast tissue itself, exercise will produce little, if any, change in breast shape. Other surgical procedures are available, primarily involving transferring tissue from elsewhere in the body instead of a synthetic implant. However, transferring skin and/or fat grafts have produced only temporary improvement in most women. More complicated procedures such as transferring skin and muscle flaps, as used in breast reconstruction, could be performed, but these are extensive surgical procedures which leave significant scars in the area from which the tissue has been transferred. Most commonly, synthetic implants are used for breast augmentation. Saline implants, either smooth or textured, are the primary implants available for implantation today.
BREAST CANCER AND AUGMENTATION MAMMOPLASTY
There is no evidence that the incidence of breast cancer is increased or decreased by the presence of breast implants. As the implants are placed behind the breast tissue, not in the breast tissue, physical examination is not affected. Mammograms can be performed in patients with breast implants, but it is important to realize that mammograms may be more difficult to perform and special views may be required. In addition, a radiologist experienced in viewing mammograms of patients with breast implants is required. For these reasons, mammograms in patients with implants may be more expensive than routine mammograms. It is also known that a small amount of breast tissue may be obscured by the presence of implants and very early cancers may be missed in patients with implants. Silicone has been found to produce a very rare cancer (fibrosarcoma) in laboratory rats. This is not breast cancer and has not been found to occur in humans.
SURGICAL TECHNIQUES / ANESTHESIA / RECOVERY
The breast implants can be placed in two positions: underneath the breast tissue either in front of or behind the chest muscle. With implants placed above the chest muscle directly under the breast tissue, there is a higher incidence of noticeable scar formation which may lead to hardness or other deformity of the breast. In addition, with implants in this position, mammography is somewhat more difficult to perform. When the implant is placed behind the chest muscle against the rib cage, scar tissue is less prominent and the breasts tend to remain softer. In addition, mammography is easier. The procedure is generally performed under general anesthesia as an outpatient. For the first 24-48 hours there is discomfort in the chest area which may limit upper body and arm motion. Showers can be resumed within 24-48 hours following surgery. Most patients are able to return to work within one week of surgery. Depending upon the individual, supportive dressings may be used or the patient may be instructed to go braless for a certain period of time. It is necessary to refrain from heavy upper body exercise for 4-6 weeks following surgery. Lower body exercises can be generally resumed 2-3 weeks following surgery. In some patients, instructions are given to massage the breasts for a certain period of time postoperatively. The most common incisions used for placement of implants are either in the crease beneath the breasts or in the margin of the nipple. Implants can be placed through incisions high in the armpit, but these are technically more difficult and have a higher incidence of complications. With the nipple incision there may be limitations as to the size of the implant which can be placed or the position in which it might be placed. The incision directly underneath the breast in the breast crease allows the most direct access for implant placement. Over time the incision will fade, although it will not disappear completely. In some patients the incision may remain red or slightly firm for several years following surgery. The sutures in the surgical incisions are clipped or removed at 10-14 days following surgery.
RISKS / COMPLICATIONS
The most common complication following this surgery is a collection of blood or tissue fluid around the implant. If this causes swelling or deformity of the breast, it may require a second operative procedure to remove the collected fluid. Infection is uncommon and usually responds to antibiotic therapy. However, in rare instances the implants must be removed before the infection can be eradicated. The implants cannot be replaced for a minimum of 3-6 months following such an event. There may be temporary increased or decreased nipple sensation. In a small percentage of patients this change in sensation is permanent. It is impossible to guarantee absolute symmetry in terms of shape, size or nipple position. There may be problems due to composition of the implant itself. Specifically, there may be a palpable wrinkling or irregularity of the covering. There can be thinning of the tissue overlying the implant or severe tightening of scar tissue around the implant producing firmness and/or discomfort. Stretch marks may be produced or accentuated by placement of the implant. Breast feeding may be impossible. There may be calcification in the normal scar tissue or enlargement of lymph glands in response to the presence of the implant. Implant failure can occur, which is generally due to leakage of the saline from the implant. While this produces no negative effects on the patient, a second surgical procedure would be required to replace the implant. To date there is no evidence linking saline implants with an immune reaction although long term effects are not known.
Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation or of greatest concern -- other complications and risks can occur, but are even more uncommon. Any and all of the risks and complications can result in:
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Additional surgery
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Hospitalization
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Time off work
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Expense to you
NO GUARANTEE -- The practice of medicine and surgery is not an exact science, although good results are expected, there cannot be any guarantee nor warranty expressed or implied by anyone as to the results that may be obtained. Many factors beyond the control of the surgeon affect both long and short term outcome, including but not limited to each patient’s individual tendencies toward scarring, skin quality, genetic makeup, and other health factors. On occasion secondary surgeries may be indicated or desired to obtain the optimal result. If such procedures are performed, there may be additional charges incurred by you.
COMMENTS
If a smoker -- must be off cigarettes for 2 weeks before surgery and 2 weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers.
Must be off all aspirin containing products for 3 weeks before and after surgery. (Check all medications with us. Some medications, such as Motrin and Advil may also affect clotting.) You must stop all herbal medications 2 weeks prior to surgery.
If there is any item on this consultation sheet that you do not understand, mark it and call the office. An explanation will be provided. Share the information that we provide to you with interested family members and/or friends. Our aesthetic coordinator, Connie Chudoff is available for any questions at 856-325-6768.