John Q. Cook M.D. - 10 Things You Should Know About Breast Augmentation Surgery.

Breast augmentation, or as I often call it, breast enhancement surgery, produces a consistently high level of satisfaction among patients who choose the operation for the right reasons. The probability of long-term happiness with your decision is, in my opinion, enhanced if you select a highly qualified and committed surgeon, the surgery respects the natural anatomy of the breast, and you are educated as to realistic expectations about the surgery.
At the present time in the United States, breast augmentation surgery is carried out with saline, or salt water-filled implants. These implants consist of a silastic shell with a fill valve mechanism. Sterile salt water solution is added to the implant after it has been placed into its location beneath the breast. One of the advantages of the saline implant is that it allows for a smaller access incision than was typically used for silicone gel implants. In very specific circumstances, such as congenital breast abnormalities and significant breast ptosis (droop), the FDA allows the use of silicone gel implants. Physicians who use implants under these circumstances participate in what is called the Adjunct Study that has been designed by the FDA. Although there are minor differences between the implants provided by the two main manufacturers in the United States, the issues of greatest importance include selection of the proper operative plan and the skill of the surgeon.
There are several distinct advantages to placing saline breast implants in the plane underneath the pectoral muscle. These advantages include a better transition in the upper portion of the breast so that an unnatural implant bulge is less likely to result, easier mammographic visualization of the breast, and perhaps a diminished likelihood of contracture, or hardening around the implant. There can be specific aspects of breast anatomy that favor the placement of the implant in the subglandular plane, immediately behind the breast. In the majority of circumstances, however, the best artistic result will probably be obtained with the implant in the plane underneath the muscle.
If the breast has settled due to pregnancy, weight loss, or other factors, more advanced techniques may be necessary for proper breast correction. You can easily check the position of the nipple by standing in front of a mirror and either placing a tape measure, a pencil or other object in the natural fold under the breast. If the nipple is sitting below this level, beware of physicians who would recommend a “correction” that consists of a big implant just behind the breast tissue. In general, this will lead to even more thinning out and settling of the breast and set up a vicious cycle.
The natural architecture of the breast must be respected. Before you seek consultation, learn about the architecture of your own breast. You can stand in front of a mirror and if you gently support the breast with the opposite hand, you can see where the natural base of the breast lies. Unless there is an abnormality in your fundamental anatomy, make sure that the surgeon designs an operative plan that respects this natural architecture. Big implants that creep beyond the natural borders of the breast often lead to very strange long-term results, especially in thin women.
Always consider the effects of lifestyle and activity patterns in your choice of surgery. Patients with breast implants can participate in a full range of sports, although one might want to exercise caution if you engage in a sport that involves frequent blows to the chest, such as skydiving or kick boxing. Factors which will definitely influence the early weeks after your surgery include: responsibilities for small children, the need to lift heavy objects at work, and your ability to modify your sports and workout pattern for at least several weeks. These issues should be discussed in detail with your surgeon and his team prior to the operation.
Implants can deflate, and scar tissue can form around them. These, in my opinion, are the truly important long-term issues with regard to breast implants.

With saline implants, as with any implanted medical device, there is the possibility that the device will break. If this happens, salt water that was in the implant is naturally absorbed by the body. It will, however, require a surgery to replace the device. Most of the studies from the manufacturers indicate a deflation rate between three and five percent in the first ten years after surgery. Anyone who tells you that their patients never experience implant deflation is simply not being truthful. In general, patients who experience a deflation tell me that they do not regret their original decision to proceed with breast augmentation surgery even with the need for additional surgery to replace the device.

As with any implanted medical device, scar tissue forms around breast implants. Up to a point this is desirable, in that it helps to maintain the implant in proper position, almost like an internal brassiere. If there is too much scar tissue, however, this can actually make the implant feel firm and distort the shape of the breast. This is known as capsular contracture. In some patients it is necessary to perform surgery to release this scar tissue.
Please do this surgery for you and you alone. This operation will not salvage a bad relationship. It would also be unwise to undergo this surgery simply at the request of a boyfriend or spouse. Remember that it is you, not he, who will experience the surgery, the recovery, and the long-term results.
Big implants in petite people look silly and get worse over time. I am sure there are many surgeons who will dispute me on this point, but my opinion is based upon long-term experience and patients who have been referred to me because they are dissatisfied with surgical results. The more an implant overwhelms the breast, the more the resultant creation will take on the characteristics of the implant and not natural breast tissue. Very large implants will thin out the remaining breast tissue that you have. The result can be a thin covering of skin over an unattractive wrinkled looking implant. Forgive me for describing things in this manner, but it really is the truth. In today’s competitive environment there are individuals who will simply put in whatever size implant the patient requests, even if this is not in the patient’s best interest, so it is definitely a case of buyer beware.
Please do your homework before you select your surgeon. This is an important decision and you shouldn’t rush into it. If you can’t find someone who you think is compatible with your goals and expectations, it is better to continue your search until you have found a doctor who can work well with you than to rush into an operation that you may regret. Please visit the web page Ten Questions You Should Ask Your Doctor Before You Undergo Breast Augmentation Surgery for some suggestions in preparing for your consultation.

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