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Breast Augmentation Surgery:
Research to Results
by Michael V. Kelly, II, M.D.
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I am told that, from the time a girl begins to “develop” -- as her mother
might have referred to it -- through her teen years, until her breast matures
as a young woman, many are preoccupied with their bra size. “Am I
too small?” “Am I going to grow any more?” and, in some cases, “Am
I too big?” The answers to these questions can quite literally
shape a young woman’s perception of herself. If, during her formative
years, she is teased about her shape -- or lack of one -- this becomes
interwoven into the fabric of her self-image. Depending upon the
circumstances of her life, this “issue” may surface later in her life --
when she can finally do something about it.
America’s fixation with physical appearance tends to guide a lot of
our decisions -- about what we wear, what we eat, how we interact with
others who might not look the way they “should,” and sadly enough, it sometimes
impacts our choice of friends. People who have this physical attribute
or that one, research tells us, get the job, the interview, the attention,
the love. This is far from an endorsement of this trend...but simply
an acknowledgment of it. Obviously, each of us comes to grip with
these real or perceived social influences in our own way. And, as
adults, we have options and choices, and hopefully we’ll make reality-based
decisions along the way. The great thing is that, when it comes to
our own body-image, we have the opportunity to make our own intensely personal
decisions based on what we believe is appropriate for us.
For many women, enhancing the size and shape of their breasts becomes
a top priority. Ideally, the first thing they do to accomplish
this objective is to examine their reasons for wanting breast augmentation
surgery, and then to do their homework to make it happen.
As a plastic surgeon, I cannot emphasize strongly enough how important
it is to analyze your motives -- and expectations -- before reaching a
decision about having the surgery. Yes, breast augmentation surgery
can change your appearance. It might have an impact on your self
confidence. But, are there other things you expect the surgery to
do for you? Do you expect it to change the way people treat you?
Will it make you look exactly how you want to look? Do you expect
it to change your life? Does your spouse or significant other want
you to have the surgery to please him, or are you doing it for yourself?
Last, but not least, have you researched the details of the surgical process
and are you confident that the benefits outweigh any concerns you might
have? How you answer these questions will provide your best foundation
upon which to base your decision to have surgery, or not.
Augmentation Mammaplasty -- What is it?
Simply stated, breast augmentation is a surgical procedure to enhance
the size and shape of a woman’s breast using medical implants. The best
surgical “candidates” for this elective procedure are physically healthy
women who want to improve the way they look -- but who don’t expect perfection.
It can be done for a number of reasons, such as when a woman feels her
breasts are too small; to restore breast volume reduced by pregnancy; when
breasts differ in size; and as a reconstructive measure after breast surgery
or mastectomy.
The surgical technique selected depends on a woman’s individual anatomy
and the desired outcome. The breast is made up of milk ducts and
glands surrounded by fatty tissue, and then covered by skin. It is
the fatty tissue that gives the breast its shape and texture, or feel.
Changes occur in a woman’s breasts over the years; some good, some not
so good. Small breasted women are often delighted when pregnancy
enlarges the volume of their breasts temporarily when milk glands expand.
But later, when gravity exerts its downward influence, the stretched skin
envelope “droops” into an older-looking silhouette. In some cases,
a breast lift is also necessary to restore a younger looking profile.
Behind the fatty tissue is the pectoralis major muscle that helps with
flexing and rotating the arm at the shoulder joint. This muscle also
plays a role in the breast’s projection. In one augmentation procedure
the implant is placed above the muscle, and another inserts it below the
muscle. Placement of the implant is something that will be discussed
with the surgical candidate during a pre-op consultation. There are
also several choices as to where the incision will be made; all of which
are chosen to minimize scaring.
Are Breast Implants Safe?
At the beginning of the 1990’s, there was considerable controversy about
the safety of breast implants, specifically the ones filled with silicone
gel. There were multiple lawsuits and class actions that sought compensation
for the way some women claimed their bodies reacted to the implants.
There were numerable allegations about silicone being linked to “systemic”
and auto-immune diseases. These cases were emotionally charged, they
received considerable press coverage, and they ultimately drove at least
one manufacturer to bankruptcy.
There are several comments I want to make. First, while the cases
were going on, a federal district court judge in Oregon ruled that evidence
based on “junk science” (that not meeting the threshold of scientific proof
necessary to merit being presented to juries) would be barred from implant
litigation. Secondly, after the cases were settled, both Harvard
University and the Mayo Clinic conducted studies on silicone gel and found
no link between the silicone and auto-immune diseases. And third,
no national medical association, or even the Food and Drug Administration,
has yet to state that sufficient evidence exists to prove that silicone
gel causes systemic disease. In fact, within the last week, an independent
panel of 13 scientists convened by the Institute of Medicine at the request
of Congress has concluded that silicone breast implants do not cause any
major diseases. This confirms what the implant manufacturers said
all along.
A lot of people ask why, if there was no proven link to illness, did
the manufacturers agree to settle the claims for such a staggering amount
of money. My answer to that is, “I don’t know.” Many people suggest
that the liability system failed in this case because it was designed to
resolve one claim by one person at one time, rather than for the use of
thousands of people seeking redress from one defendant at the same time.
During the height of the controversy, the media devoted a lot of time
covering the individual plaintiffs and their charges, but they are conspicuously
silent now that science can find no link to disease. The case that
ended in a verdict for the manufacturer received virtually no press coverage
compared to some of the other high profile cases that went the other way.
I tend to agree that “advocacy produces justice, but only when both sides
have equal opportunity to present their case.”
The bottom line in the implant controversy is that the FDA subsequently
restricted the use of silicone gel implants in this country. Today’s
implants consist of a silicone rubber shell, and are commonly filled with
saline solution (salt water). The FDA published a consumer publication
in 1996 called Implants: An Information Update, that explains their breast
implant regulations and their position on related medical issues.
(It can be obtained by calling the FDA directly at 800-532-4440.)
Implant size and shape...
There are many different sizes and shapes of breast implants...some
are globular in shape -- which provides a round curve in the upper part
of the breast -- and others that are more anatomical with a gentle
slope to offer more upper breast “fullness.” Most women think of
their breasts in bra cup sizes. If she is a 34B now, she can envision
becoming a 34C or larger, for example. Since an implant will add
volume to the total breast tissue, we also consider dimensions like breast
width, height and projection in selecting the implant.
Width is one of the more important dimensions because it impacts the
amount of cleavage between the breasts and the outside curve that a woman
may want to be in better balance with her hips. Another consideration
in implant selection is the amount of breast tissue in place.
It will have to cover the implant or there may be visible implant edges.
The Surgery Itself
Before scheduling the surgery, we do a thorough evaluation of the candidate’s
physical health, and take a health history, as well. It is critical,
at this point, that the surgeon learn of any problem that could have a
negative impact on the healing process, or could jeopardize the patient’s
overall condition. Some of the things we want to know about are infections,
a history of healing difficulties, certain medications and smoking.
Smoking can radically delay the healing process so I require my patients
to sign an agreement that they won’t smoke.
Each case is different; some are performed on an outpatient basis and
others require an overnight hospital stay. The surgery itself takes
less than two hours and is performed under a general anesthesia.
An incision will be made -- as we have discussed in the pre-op conference
-- the deflated implant inserted and positioned, and then filled with saline
in place. The incisions are closed with sutures and may also be taped
for extra security. Most of the discomfort can be controlled by medication.
Patients may feel a little sore and somewhat tired for several days
following the surgery, and the breasts may remain swollen and sensitive
for up to a month. They may also feel tight as the skin adjusts to
the new breast size. As with any invasive procedure, complications
can occur, such as effects of the anesthesia, infection, swelling, bleeding,
pain, and delayed healing. In addition, other longer-term problems
are possible, including: deflation of the implant, contraction of the scar
tissue capsule around the implant, calcium deposits around the implant,
and shifting of the implant. They are relatively rare, and will be
discussed in detail during the pre-op conferences. Be sure to ask
for a copy of the manufacturer’s insert that comes with your implant for
complete information.
During the recovery period, we suggest that the patient wear a special
postoperative bra for extra support during the healing process. Most
women are comfortable returning to work within a few days, although patients
should avoid any strenuous activities that could pull on the stitches.
Patients heal faster when they follow our recommendations about exercise
and resuming normal activities.
The skin sutures -- if used -- are usually removed in a week.
The incision scar may be firm and pink at first, but after several months,
they will begin to fade -- although they will never disappear completely.
Your breasts will feel different after the surgery, and it may take
a little while to get used to the fuller appearance. Just as the
decision to have breast augmentation in the first place was intensely personal,
so should be your response to how you look. The results may be just
a slight new fullness, or there may be an appreciable difference.
But remember, you define success...in the way you look, the way the new
size makes you feel, and in the boost to your self confidence. The
whole world looks better when you do. |
