Breast Augmentation (Augmentation Mammaplasty)

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To restore breast volume lost due to weight loss or following pregnancy
• To achieve better symmetry when breasts are moderately disproportionate in size and shape
• To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
• To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer
• To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities

By inserting an implant behind each breast, surgeons are able to increase a woman's bust line by one or more bra cup sizes.

Best Candidates for Breast Augmentation Surgery

Breast augmentation can enhance your appearance and your self-confidence. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Bolitho.

Types of Implants

The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, as well your Dr. Bolitho's recommendations and sound surgical judgment are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you.

Breast implants are medical devices with a solid silicone, rubber shell. The implant shell may be filled with either saline solution (sterile salt water) or elastic silicone gel. Both saline and silicone gel breast implants are approved by the U.S. Food and Drug Administration (FDA). Approval means that an implant has been rigorously researched and tested, and reviewed by an independent panel of physicians for safety.

The size of a breast implant is measured in cubic centimeters (ccs) based on the volume of the saline or silicone filler. Breast implants vary both by filler and in size, but there are additional features to consider:

• Texture: the implant shell may be smooth or textured

• Shape: the implant may have a round profile or one that is anatomic (teardrop or tapered shape)

• Profile: the implant may have a low, medium or high projection (the depth of the implant from the base to the highest point of the implant curve)

• Diameter: the width of the implant measured across it's base (the side of the implant that will be positioned over the chest wall)

Adult women of any age can benefit greatly from the enhancement breast implants provide. It is usually recommended, however, that a woman's breasts are fully developed prior to placement of breast implants. Saline implants are FDA approved for augmentation in women 18 years of age and older. Silicone implants are FDA approved for augmentation in women age 22 and older. Saline or silicone implants may be recommended at a younger age if used for reconstruction purposes.

You should be aware that breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. Regular examinations for breast health and to evaluate the condition of your implants are important whether you have chosen saline or silicone breast implants.

Breast Augmentation Surgery

In your initial consultation, Dr. Bolitho will evaluate your health and explain which breast enhancement surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. Be sure to discuss your expectations frankly with Dr. Bolitho, as he will depend to a large extent on the information and preferences that you provide.

The method of inserting and positioning your breast implant will depend on your anatomy and preferences, and Dr. Bolitho's recommendation. The incision can be made either in the crease beneath the breast, around the areola (the dark skin surrounding the nipple), or in the armpit. The choice of incision is based on your own preference in combination with the recommendation given by Dr. Bolitho, according to your individual anatomy and the type of breast implant used.

Inframammary incision	Periareolar incision	Transaxillary incision

Working through the incision, Dr. Bolitho will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (submammary or subglandular placement) or may be placed beneath the pectoral muscle and on top of the chest wall (submuscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage may be applied over your breasts to help with healing.

The surgery usually takes one to two hours to complete.

The Results

Dissolving stitches are used to close the incisions, which may also be taped for greater support. A waterproof dressing will allow you to shower the day after surgery. A surgical bra is recommended, and will be provided for you after the surgery. Your scars will be firm and pink for at least six weeks. After several months, your scars will begin to fade, although they will never disappear completely.

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. You should be able to return to work within a few days, depending on the level of activity required for your job.

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your own personal goals, then your surgery is a success.

Potential Risks & Side Effects

As with any surgical procedure, bleeding following the operation may cause some swelling and pain. Capsular contracture, or hardening around the breast implant, may occur months or years after breast augmentation. This occurs if the scar or capsule around the implant begins to tighten. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant. Some women have reported alteration in nipple or skin sensation. These symptoms usually disappear within time, but may be permanent in some patients.

While the majority of women do not experience these symptoms, you should discuss each of them with Dr. Bolitho to make sure you understand the risks and consequences of breast augmentation.

Breast augmentation does not interfere with mammograms, but does require a specific technique. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant. Routine mammograms should be performed in women after breast augmentation over 40 years of age.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. Implant manufacturers provide a warranty to cover the costs of replacement of the implant, as well as surgical fees. Inquire about this warranty at the time of breast augmentation.

If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.

A few women with silicone breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as "connective-tissue disorders".