Definition

Breast implantation is a surgical procedure for enlarging the breast. Breast-shaped sacks made of a silicone outer shell and filled with silicone gel or saline (salt water), called implants, are used.

  Purpose

Breast implantation is usually performed to make normal breasts larger for cosmetic purposes. Sometimes a woman having a breast reconstruction after a mastectomy will need the opposite breast enlarged to make the breasts more symmetric. Breasts that are very unequal in size due to trauma or congenital deformity may also be corrected with an enlargement procedure.

  Precautions

A woman in poor health or with a severe chronic disease is not a good candidate for this procedure.

  Description

A cosmetic breast enlargement is usually an outpatient procedure. It may be done under local or general anesthesia, depending on patient and physician preference. The incision is made through the armpit, under the breast, or around the areola (the darkened area around the nipple). These techniques create the most inconspicuous scars. The implant is placed between the breast tissue and underlying chest muscle, or under the chest muscle. The operation takes approximately one to two hours. The cost of a cosmetic procedure is rarely covered by insurance. However, if enlargement is part of breast reconstruction after a mastectomy, health plans may pay for some or all of it. The surgeon's fee ranges from $2,700-$4,200 and up. The procedure may also be called breast augmentation or augmentation mammaplasty.

  Preparation

Before the surgery is performed, the woman should have a clear understanding of what her new breasts will look like. She and her physician should agree about the desired final result. Many surgeons find it helpful to have the patient review before and after pictures, to clarify expectations.

  Aftercare

Driving and normal activities may be restricted for up to one week. Stitches are usually removed in seven to 10 days. Typically, a woman can resume all routines, including vigorous exercise, in about three weeks. The scars will be red for approximately one month, but will fade to their final appearance within one or two years.

  Risks

Risks which are common to any surgical procedure include bleeding, infection, anesthesia reaction, or unexpected scarring. A breast enlargement may also result in decreased sensation in the breast, or interference with breast-feeding. Implants can also make it more difficult to read and interpret mammograms, possibly delaying breast cancer detection. Also, the implant itself can rupture and leak, or become displaced. A thick scar that normally forms around the implant, called a capsule, can become very hard. This is called capsular contracture, and may result in pain and/or an altered appearance of the breast. The older the implant, the greater the chances that these problems will occur.

There has been intermittent publicity about possible health risks from breast implants. Most concerns have focused on silicone gel-filled implants. As of 1992, the Food and Drug Administration (FDA) restricted the use of this type of implant, and ordered further studies. Today only saline-filled implants are used for cosmetic breast surgery. Recent studies have shown no evidence long-term health risks from silicone implants. However, research on the possible links between these implants and autoimmune or connective tissue diseases is continuing.

Normal results

Breasts of expected size and appearance would be the normal results of this surgery.

   Resources:

Books

• Love, Susan M., with Karen Lindsey. Dr. Susan Love's Breast Book. 2nd ed. Reading, MA: Addison-Wesley, 1995.

Periodicals

• "Breast Implant Update." Harvard Women's Health Watch 5 (Sept. 1997): 7.

Organizations

• American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org