Medical & Trade Publications

October 2006

by Amy M. Ortega, M.D.
Medical / Plastic Surgery

Breast Augmentation Answers: Part 1

Breast augmentation has become one of the most commonly requested procedures in the United States. Although the procedure may seem fairly simple, there are acually many variables to consider when planning the surgery.

Breast augmentation tends to look very natural, unless the patient chooses an extremely large implant.

Keep in mind that just because your client may know someone who has had breast augmentation, it does not necessarily mean that those same choices may be right for her. It is important for you to advise your clients to carefully consider these choices and review the options with their doctors. Here are some frequently asked questions that your client should get answers for.

The consultant

Q: How should I prepare for my consultation?

A: Do some research online or read books that describe the procedure so that you can understand the basic procedure, the anatomy involved, as well as the options. These options include different types of implants, implant placement with regards to the pectoralis muscle, and incision types.

Mammograms

Q: I'm in my 30s now. Do I need a mammogram?

A: If you are older than 35, have a personal or family history of breast cancer, or have had trouble with breast masses in the past, you should have a mammogram performed within the year, and if possible, bring the report to your appointment with your doctor. It is important to have a baseline study of the breast prior to any surgical event.

As with any cosmetic surgery, you also should be in a generally healthy state and a calm state of mind so that you can carefully consider your options and go through your surgery and recovery with as little additional stress as possible.

The procedure

Q: How is the breast augmentation procedure performed?

A: The procedure takes one hour or less to perform. It is performed in an outpatient surgical setting—patients go home the same day.

It is often performed under general anesthesia, although some physicians will perform the procedure under a heavy sedation or twilight anesthesia.

Size

Q: How do I know what size implant to choose?

A: Cup sizes vary with the brand of the bra. For example, in some brands a patient may be a large B cup, where in other brands she may be a small to medium C cup. Therefore, when discussing breast augmentations, doctors generally do not speak in terms of "cup size."

It is much more helpful to describe to the surgeon what you want, and perhaps look at some before and after pictures that may match your goals. During the consultation, I have my patients "try on" implants in a bra. I find that this is the single, most-helpful exercise in determining the patient's size choice.

Natural look

Q: I do not want my implants to look fake. How can I avoid this?

A: Most patients requesting breast augmentation are very concerned about the final appearance being natural-looking and the implants being proportionate to the size of their figure.

Almost everyone has seen another breast implant result that they did not like. As a result, the patient mistakenly assumes that all augmentations will look that way. Actually, breast augmentation tends to look very natural, unless the patient chooses an extremely large implant. Or, if the patient develops a hard scar around the implant, a capsular contracture, this can distort the shape of the implant, pushing it upward and causing it to appear and feel hard.

Danger

Q: Are breast implants dangerous? Are silicone gel implants more dangerous compared to saline implants?

A: At one time it was suspected that silicone gel breast implants contributed to the development of certain connective tissue diseases in women. This has been studied extensively and is not found to be true. In fact, the FDA even put out a notice stating that there is no relationship between the presence of silicone gel implants causing connective tissue disease.

That having been said, silicone implants and saline implants have the same risks, which generally have more to do with the presence of an implant rather than the substance in the implant.

A breast implant, within three to five days of its placement, will be encased in a scar capsule. This is the body's way to "wall off" a foreign substance. In most patients the scar capsule does not cause any problems; however, in some patients, the scar capsule can contract upon itself, forming what is called a capsular contracture.

This can cause the breast to appear and feel hard, and to appear distorted should the scarring become severe enough. Therefore, capsular contracture is a risk to be considered with implants.

Another risk is implant rupture or deflation. This can happen either because of manufacturer defect, wear and tear of the implant, or trauma. Should a saline implant rupture, the saline solutions is reabsorbed by the body and the implant will immediately lose its volume. Should a silicone gel implant rupture, the gel remains encased within the scar capsule around the implant.

The FDA is still studying whether the presence of this gel within the capsule is dangerous at all. Although at this time, with the data that is currently available, the conclusion would most likely be that the presence of the gel within the capsule is not dangerous. Therefore, saline implants and silicone gel implants both pose the risk of capsular contracture and implant rupture or deflation.

Although these instances have been extensively studied, and there are specific percentages of these instances occurring in each implant, and within types of implants and brands, in my experience I have not seen either of these occurring noticeably in one type of implant than another. Therefore, the type of implant chosen would then be more related to the patient's preference.

At the present time, the FDA does not permit the use of silicone gel implants on first-time augmentations. The FDA does permit the use of silicone gel implants in reconstructive patients, and those include patients who are getting a breast lift. To qualify for this, the patient must agree to be enrolled in a research study which requires a complete follow-up period of five years to collect data that is then submitted to the implant manufacturer.

With regard to a patient's personal preference, some patients may choose silicone gel implants because they tend to feel softer and, therefore, are more natural. I do think this is the case; however, saline implants are also a very good product. They provide an augmentation. They both look very natural after the augmentation is performed.

Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. Her office is located in Atlanta, GA. To reach her, call (404) 751-2500. For more information ABOUT DR. ORTEGA, visit her website, www.ASAbeautiful.com.