BREAST AUGMENTATION

The following information is regarding breast augmentation which is important to review, understand and discuss with family and/or friends before choosing to proceed with surgery.


Goals of Breast Augmentation:  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 to 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 of 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 textures, 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 on 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 on 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 the 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 or behind the chest muscle. With implants placed above the chest muscle directly under the chest tissue, there is a higher incidence of noticeable scar formation that 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 on 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 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 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 implants. 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 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 and /or of greatest concern. Any and all of the risks can result in additional surgery, time off work, hospitalization and expense to you.

The practice of medicine and surgery is not an exact science. Although good results are expected, there can be NO 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 short and long-term outcome, scarring, 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 you are a smoker, you must be off cigarettes for three weeks before surgery and for three weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers. 

You must be off all products containing aspirin (Aspirin, Motrin, Advil, NSAIDS) for three weeks before surgery and three weeks after surgery. You must stop all herbal medications 2 weeks prior to surgery. (Check all medications with us.)




BREAST REDUCTION 

The following information is regarding breast augmentation which is important to review, understand and discuss with family and/or friends before choosing to proceed with surgery.

Goals of Breast Reduction:  The purpose of breast reduction surgery it to reposition the nipple areolar complex in a more normal location the chest wall and to reduce excess skin and breast tissue, thereby producing a more natural shaped breast. This tends to correct excessive sagging, as well as reducing the breast size. As a side benefit to the physical changes of breast reduction, shoulder, neck and back discomfort are usually relieved. In any given patient, these goals may be only partially met.

Limitations to the Procedure:  Breast reduction surgery will not help back, neck, or shoulder pain due to other physical problems such as arthritis. Stretch marks in the skin will not be improved by this surgery. Absolute symmetry in shape and size of the breast, as well as nipple position is rarely achieved following this surgery. Subsequent breast sagging may occur as a result of aging, pregnancy, loss of skin elasticity or the effects of gravity on the remaining breast tissue. Significant weight gain or loss may also change the shape of the breast. Redevelopment of breast tissue following reduction has been reported, but has been extremely uncommon.  There is no procedure available to reduce the size of the breast without surgical incisions so that some degree of scarring is unavoidable following breast reduction surgery.


Alternatives to the Procedure:  If no treatment for the condition of enlarged breasts is undertaken, one can expect further increases in back, neck and shoulder discomfort with aging. Weight reduction and exercise in patients who are obese may lead to a small reduction in breast size, but breast tissue itself is not affected by weight loss. Without surgery, supportive garments can be worn which help to relieve some symptoms, but will not correct the underlying basic problem. Suction lipectomy, which is a form of fat removal, will help reduce that portion of the breast which is fatty tissue, but will not remove the glandular part of the breast enlargement.

Breast Cancer and Breast Reduction:  There is no evidence that the incidence of breast cancer is increased after breast reduction surgery. Studies show that it could decrease the chance of having breast cancer.  Lifelong breast examination including physical examination and mammographic screening is still required following breast reduction surgery. Typically, there are mamographic changes noted after breast reduction surgery which are characteristics for this surgery and generally easily recognized by radiographers. It is recommended that a new baseline mammogram be obtained 6-12 months following breast surgery. In patients over 35 years of age, a preoperative mammogram is obtained to screen for any suspicious areas in the breast tissue prior to surgery.

Surgical Techniques/ Anesthesia/ Recovery:  The procedure takes place in the operating room and requires approximately 3 hours of operating time. The procedure is generally performed under general anesthesia. Blood transfusions are usually not required. If you desire, you may donate your own blood prior to surgery although I do not recommend this. Drains are utilized during the surgery and removed prior to your discharge. Immediately following surgery the chest area is wrapped in an ace bandage and I generally use the patient’s old brassiere as an external supportive dressing at the time of discharge. Showers may be resumed 24-48 hours following drain removal. There will be stitches around the nipple and underneath the breast which are removed 7-21 days after surgery. The breast area is generally quite black and blue following surgery which may take several weeks to resolve. It is not uncommon to see areas of drainage or small scab formation along the incision which may require special ointment or dressings for several weeks. It is necessary to refrain from heavy upper body physical exercise for 4-6 weeks following surgery. Lower body exercises can generally be resumed 2-3 weeks following surgery. I request that you refrain from driving for one week postoperatively. The average absence from work is 3-6 weeks.   

Risks/ Complications:  The most common complication following this surgery is a collection of blood or tissue fluid in the breast tissue. Drains are utilized to help alleviate this problem, but if a large collection of fluid develops, it is necessary to remove this in the operating room under light anesthesia. Infection is extremely rare and usually responds to antibiotic therapy. As mentioned above, it is common to see areas of scabbing or partial wound separation along the incision lines. This is treated with antibiotic ointments and special dressings when necessary. There may be temporary increased or decreased nipple sensation which usually returns to normal within 3-6 months. In a small percentage of patients, there is permanent change in nipple sensation or even loss of nipple tissue. Some degree of asymmetry in shape, size or nipple position is usually noted. In some patients, excessive scarring can develop in which there are elevated, red, painful scars which generally improve with time, but may persist for several years following surgery. In rare instances, scar revision is required to alleviate symptoms. There may be a loss of pigmentation in the skin, particularly in the nipple areolar area. Nipple retraction or change in contour may occur.

 Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation and /or of greatest concern. Any and all of the risks can result in additional surgery, time off work, hospitalization and expense to you.

Long term changes in the breast may include the inability to breast feed, as well as the development of breast lumps due to scarring or changes in the breast fat. In some instances, breast biopsy may be required to distinguish these normal postoperative changes from the development of breast pathology.

The practice of medicine and surgery is not an exact science. Although good results are expected, there can be NO 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 short and long-term outcome, scarring, 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 you are a smoker, you must be off cigarettes for three weeks before surgery and for three weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers.


You must be off all products containing aspirin (Aspirin, Motrin, Advil, NSAIDS) for three weeks before surgery and three weeks after surgery. You must stop all herbal medications 2 weeks prior to surgery. (Check all medications with us).