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If you are considering breast augmentation in Southern California including Beverly Hills, Santa Monica and Long
Beach from a Board Certified Female Plastic Surgeon continue reading ...
FREQUENTLY ASKED QUESTIONS:
What are the benefits of breast augmentation with implants? This operation is performed to enhance or restore
the size and shape of a woman's breasts. Breasts may be small because of lack of development or changes following pregnancy, weight
loss or congenital abnormalities. Sometimes a woman's breasts are very asymmetric. This operation can improve a woman's self esteem
and quality of life. Studies have shown over 90% of women are satisfied with their results. Currently, silicone gel or saline implants (silastic bags filled with either silicone gel or salt water) are placed either behind the pectoral muscle and breast tissue or in front of the muscle. This is done through
an incision 1-1/2 " - 2" long placed either under the breast, around the areola.
What do breasts look like after augmentation mammaplasty? Silicone gel or saline filled breast implants are the best means now available to
enlarge the breasts by surgery. However, the prospective patient should know that the final appearance, shape and texture are not exactly
the same as normal breasts. The
contours are usually somewhat different than normal breasts. In some patients, these discrepancies may be rather noticeable. Although every
effort is made to place the implants symmetrically, complete symmetry is rarely achieved. Immediately after surgery, the breasts may appear
swollen and firmer; the final shape and size is seen after several months. Please note that silicone gel implants are now available for elective
new breast augmentations since FDA approval late last year.
Are the prostheses safe? Can they cause cancer? To the best of our present knowledge, these prostheses are made of non-reactive,
safe material. Thus, there is no way to say positively that they won't cause trouble 20 years from now, but it is unlikely. The incidence of cancer
in augmented breasts is the same as in normal breasts, actually less in some studies. Additionally, the incidence of collagen vascular disease is
the same or less in studies of women with breast implants.
What kind of anesthetic is used? A general anesthetic is most common when the implant is placed under the pectoral muscle.
What are my limitations in activity post-operatively? You should plan to avoid activities which require much raising of the
arms above the level of the head for 10 days after surgery. With great care, you can drive about 3 days after surgery. Patients can usually return
to work in a few days unless their occupation requires particularly strenuous movements and lifting. In such cases, 2-3 weeks should be allowed.
What are the risks of surgery?
1. GENERAL RISKS of surgery include infection, pain, delayed wound healing, hematoma (a collection of blood at the surgical site), bleeding
or reactions to anesthetic.
2. COSMETIC COMPLICATIONS: You may not be satisfied with the appearance of your implant(s). Incorrect implant size, inappropriate scar location
or appearance, and misplacement of implants may interfere with a satisfactory appearance. Asymmetry (unequal breast size or shape) may occur.
The implanted breast may sag or droop (ptosis) over time, much like a natural breast. Very rarely the implant may change position or break through
the skin, particularly if you have very thin breast tissue covering it. This is more common with saline implant(s).
3. BLEEDING: When blood collects beneath the skin, it causes excessive discoloration. Sometimes lumps which last many months may occur. If blood
collection is discovered, it is usually removed by taking out a few stitches and squeezing the clot out, or inserting a needle and aspirating it.
If bleeding continues, it is sometimes necessary to return to the operating room to stitch the bleeding vessels. This risk increases in people who
take aspirin or who bruise easily. Let your doctor know if this is the case. Do not use aspirin or aspirin-containing products for two weeks before
and two weeks after surgery. (See list of medications that may increase bleeding.)
4. WRINKLING AND RIPPLING: Some wrinkling of the implant shell is normal and expected. If your breast tissue is very thin, these wrinkles can show
up as visible ripples, especially when you lean forward without wearing a brassiere. The wrinkling can also produce little corners on the implants that
can sometimes be felt with your finger if the breast tissue is very thin. This is less likely to occur with silicone gel implants.
5. CAPSULAR CONTRACTURE: The scar tissue that forms around the implant can tighten and squeeze the implant as a natural response to a foreign object
implanted in the body. This firmness can range from slight to very firm. The firmest ones can cause varying degrees of discomfort or pain. Capsular
contracture can occur on one breast or both. Implants under the muscle may result in less contracture.
6. RUPTURE/DEFLATION: Breast implants may not last a lifetime. The silastic shell can break due to normal wear over time, injury , valve malfunction,
breast manipulation (mammograms), or unknown reasons. The usual sign is loss of breast size over days or weeks. The saline (salt water) will be absorbed
by the body without any harm. Surgical replacement will be needed to restore the breast size. Replacement will involve additional costs.
7. NUMBNESS: Sensory changes are expected to some degree immediately after surgery but loss of nipple and breast sensation may be permanent. Increased
sensitivity is less common but does occur. These changes can interfere with comfort, sexuality and nursing (lactation).
8. PAIN: Can be related to the surgery itself or a later response to problems such as tight capsule formation.
9. INFECTION: When severe , may require removal of the implant if it is not controlled with antibiotics. Rarely, this can occur any time after surgery.
Consideration should be given to taking prophylactic antibiotics with dental work or other surgeries. If an implant is removed, replacement may be delayed
for three months.
10. HEMATOMA: May require surgery to remove the collection of blood. Sudden swelling of the breast after surgery should be immediately reported to the doctor.
11. SCARS: Generally do well with all breast incisions. However, healing is unpredictable and occasionally patients may form thickened or red
hypertrophic/keloid scars. Additional surgery may be required. Wound healing complications are higher in smokers therefore, you must stop smoking at
least 2 weeks before and 2 weeks
12. INTERFERENCE WITH MAMMOGRAPHY: An implant can interfere with the detection of early breast cancer because it may "hide" suspicious lesions in the
breast during an X-ray exam. It is especially important for women who are at high risk of developing breast cancer to consider this before having implants.
Additional views are required for routine mammography in patients with implants. Mammography is more effective with implants under the muscle.
13. CALCIUM DEPOSITS: Can develop in the breast tissue at any time after surgery. These are benign but may be confused on an X-ray with breast cancer
calcium deposits and require a biopsy.
14. ALTERATION IN BREAST FEEDING: For women who have not had children, this surgery may alter your ability to nurture children in the future. Spontaneous
lactation may occur after this surgery but is usually self-limited.
15. LIFETIME OF IMPLANT: Implants will not last forever. The FDA currently estimates implants will last about 10 years. This is an estimate. The FDA has not
reviewed all the data about saline implants (1994).
16. UNKNOWN RISKS: In addition to these known risks, there are unanswered questions about saline-filled breast implants. For example, questions have been
raised about whether these devices might cause autoimmune diseases such as lupus, scleroderma and rheumatoid arthritis in some women, or whether they might
increase the risk of cancer. There is no scientific evidence at present that women with either silicone gel-filled or saline-filled breast implants have increased
risk of these diseases, but the possibility cannot be ruled out.
17. PHOTOGRAPHY: Photographing, filming, or videotaping of the treatment or procedure, for educational or diagnostic use, is a standard and required part of patient care.
18. 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.
19. COMPLICATIONS AND ADDITIONAL SURGERY: Any of these problems noted above may require additional surgery, hospitalization, and time away from work.
If this occurs, there will be additional costs for surgical fees, supplies, anesthesia, etc., depending upon the required operation. Complications of
cosmetic surgery generally will not be covered by medical insurance.
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