Surgical
Procedures
Breast Implant Surgery
Augmentation Mammoplasty/Breast
Enlargement
Concept -
Augmentation mammoplasty or breast enlargement, is a
surgical procedure to enhance the size and shape of
a woman's breast. Augmentation mammoplasty consists
of placing an implant, usually a silicone shell filled
with either saline or silicone gel, immediately behind
the breast or pectoralis major muscle. This procedure
has been done since the early 1950s. At the time of
consultation, realistic goals are assessed as to the
size of the implant required for the desired result
and also whether some form of ptosis procedure (lifting
the drooping breast) will be necessary for the
optimal result.
Augmentation mammoplasty may be performed through several
different incisions. The classic procedure utilizes
an inframammary incision on the underside of the breast..
A peri-areolar incision (incision around the areola-skin
interface) is an alternative to the inframammary
scar. Dr. Dabb prefers the transaxillary(armpit)
incision with saline implants. This allows for a hidden
incision in the axilla, leaving no tell-tail incision
on the breast itself.
Most
implants today that are used for augmentation mammoplasty
are saline filled implants. Most saline implants will
be placed in a submuscular position. By placing the
implant behind the pectoralis muscle, the implant is
better hidden. When they saline implants placed on top
of the muscle, it may be easily palpated and a certain
amount of rippling may be noticed at the border the
implant.
In certain patients, gel implants may be utilized instead
of saline. Gel implants may be preferable to saline
implants when the clinical situation requires that the
implant be placed on top of the pectoralis muscle. Gel
implants are still under FDA restrictions and may be
only utilized by surgeons who are participating in the
prospective studies governed by the FDA. Dr. Dabb is
a member of this study group that is evaluating the
long-term effects of gel implants. Gel implants may
only be utilized at this time for post-mastectomy reconstruction,
replacement of previously placed gel implants, and when
used in association with ptosis (lifting) procedures.
All studies to date by established research facilities
(Harvard University, Mayo Clinic, The National Institute
of Science) show basically no relationship of gel
silicone to any systemic disease (collagen diseases
such as lupus, arthritis, scleroderma), as suggested
by the numerous litigations that took place during the
Dow-Corning product liability settlement. Only practices
participating in the FDA protocol are able to provide
gel implants at this time.
At
the time of consultation, the size of the implant is
determined. Careful measurements of the breast are made,
along with evaluation of the chest wall, especially
the pectoralis major muscle. Care is made to choose
an implant that properly fits in anatomic pocket behind
the muscle.
This sometimes is in conflict with the patient's initial
desires, especially if the patient desires to be dramatically
larger.
If there is uncertainty as to the size of the desired
implant by the patient or surgeon, an adjustable implant
may be used. This implant is designed with a filling
port that may be left underneath the skin. Saline may
be injected into this port to enlarge, or withdrawn
from this port to diminish the size of the implant.
This system is especially valuable for patients who
have significant breast asymmetry, allowing the surgeon
to alter the size of one implant in reference to the
other.
Surgery
- The procedure is performed as an outpatient, under
general anesthesia or I.V. sedation. The implant is
placed with endoscopic assistance. This allows for maximal
visualization of the pocket from behind the muscle,
allowing for less postoperative complications, such
as bleeding, and creating an exact anatomic dissection.
Endoscopic placement causes minimal disruption of the
pectoralis major muscle; the patient may return to normal
activity immediately after the procedure without any
restrictions or fear of disrupting the muscle. Dr. Dabb
has performed endoscopic augments for over 10 years.
Recovery
- After the surgery, the patient is placed in a brassiere
and a strap across the top of the breast. The patient
is allowed to shower 48 hours after the surgery. The
patient is kept on antibiotics for approximately five
days. There are no immediate postoperative restrictions.
A pain pump mixed with local anesthetic and an antibiotic
is utilized, minimizing the immediate post operative
discomfort.
Return to Work
- 48 hours
Full Activity
- 7 to 10 days
Complications
- bleeding, infection (with associated loss of implant),
loss of sensation of breast skin or nipple, asymmetry,
traumatic rupture of the implant, leakage of the implant,
capsular contracture (scar tissue forming around
the implant), palpability of the implant, and visual
rippling of the edge of the implant will be discussed.
It will also be noted, that the implant manufacturer
warranties the implant for a certain period of time.
Implant manufacturers are presently McGhan,
Mentor; their websites are very instructive.
Examples
Augmentation Mammoplasty
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Augmentation Mammoplasty
II
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