Breast augmentation is the most common cosmetic surgical procedure performed in the U.S. The procedure involves a plastic surgeon enhancing the size and shape of a woman's breast by means of a prosthetic device called a breast implant. Breast augmentation, depending upon the reasons for getting the procedure done, is often referred to as breast enlargement, breast enhancement, augmentation mammoplasty, breast reconstruction, or perhaps by the slang term, boob job. Women get breast augmentation for a variety of reasons, each personal to themselves. The result is a more shaplier figure which helps them achieve the lifestyle they desire.
Breast Augmentation Cosmetic Surgery
What Happens During a Breast Augmentation Procedure?
Where is the surgery performed?
Breast augmentation is most frequently performed on an outpatient basis in a hospital operating room, surgery center or surgical suite in a surgeon's office. You and your plastic surgeon may have decided on an app
roach to your surgery that may require an overnight stay at the hospital.How long does the procedure take?
On average, the surgery lasts one to two hours.
What anesthesia will be used?
General anesthesia is commonly used, but local anesthesia also is an option. Your doctor can discuss with you the most appropriate choice of anesthesia for you.
What are the differences between incision site options?
With incision sites, the goal is always to choose the option that will result in the least obvious scar. There are three common incision sites used for breast augmentation: under the arm (transaxillary), around the nipple (periareolar), or within the breast fold (inframammary). If the incision is made under the arm, the surgeon may use a probe fitted with a miniature camera, along with minimally invasive (very small) instruments, to create a pocket for the breast implant.
Incision options:
Periareolar
This incision is the most concealed, but is associated with a higher likelihood of inability to successfully breast feed, as compared to the other incision sites.
Inframammary
This incision is less concealed than the periareolar and associated with less difficulty than the periareolar incision site when breast-feeding.
Transaxillary
This incision is less concealed than the periareolar and associated with less difficulty than the periareolar incision site when breast feeding.
Umbilical/endoscopic
This incision site has not been studied and is not recommended.
Where are implants placed in the breasts?
Here again, you have options. Breast implants may be placed sub-glandular, which is between the chest muscle and the breast tissue, or sub-muscular, which is below the chest muscle.
Sub-glandular Breast Implant Placement
Sub-glandular placement may make your surgery and recovery time shorter. It may be less painful and it may make the implant easier to access if re-operation is necessary. This placement also may make it easier to see and feel your implants through your skin after your surgery. Capsular contracture is more likely with sub-glandular placement, and imaging of the breast with mammography may be more difficult.
Sub-muscular Breast Implant Placement
The sub-muscular placement may make surgery last longer, may make recovery longer, may be more painful, and may make it more difficult to have some re-operation procedures than the sub-glandular placement. The possible benefits of this placement are that it may result in less palpable implants, less capsular contracture, and easier imaging of the breast with mammography.
The standard implant in the United States has been saline-filled, ever since the FDA moratorium on silicone gel filled breast implants in 1992. Yet, silicone breast implants have not ceased to exist due to the popularity of the more natural feel offered by this type of implant.
Silicone gel-filled breast implants were first introduced in 1962. In 1976, the Medical Device Amendments were enacted, giving the FDA authority to regulate medical devices such as breast implants. In 1988, the FDA announced that all breast implants would be labeled as class III devices, meaning they are to be considered as medical breakthrough, new technology devices, and devices with poorly established or questionable safety and effectiveness. In addition, the FDA called for implant manufacturers to submit PMAs in which data showing the safety and effectiveness of these devices would have to be approved before the device could be placed on the market. Breast implants were now under careful scrutiny of the FDA.
[http://www.fda.gov/cdrh/breastimplants/indexbip.html]
In early 1992, the FDA placed a moratorium on silicone gel breast implants provided to the mainstream market for cosmetic purposes after many women who had received implants complained of pain and illness as a result of the implants leaking. The FDA concluded there was "inadequate information to demonstrate that breast implants were safe and effective." Access to silicone gel-filled breast implants continued to be allowed under controlled clinical studies for reconstruction after mastectomy, correction of congenital deformities, or replacement of ruptured silicone gel-filled implants due to medical or surgical reasons. Implant manufacturers were required to collect clinical trial data and were allowed distribution of the implants to a limited number of augmentation patients for these studies.
[http://www.fda.gov/cdrh/breastimplants/indexbip.html]
In mid-1992, the FDA approved Mentor Corporation's adjunct study protocol for silicone gel-filled breast implants for reconstruction and revision patients. That same year, silicone and breast implant manufacturer, Dow Corning, announced that it would no longer make five implant grades of silicone, but that it would continue to manufacture 45 other medical grades of silicone materials. Just three years later, in 1995, Dow Corning Corp., once the major manufacturer of silicone breast and other implants, faced 19,000 lawsuits, pushing it into bankruptcy.
[http://www.fda.gov/cdrh/breastimplants/indexbip.html]
In 1997, the Department of Health and Human Services began one of the most extensive research studies in medical history by appointing the Institute of Medicine of the National Academy of Science (IOM) to examine potential complications during or after surgery.
After reviewing years of evidence and research concerning silicone gel-filled breast implants, the IOM found that "Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants." Most studies have failed to find a link between silicone breast implants and disease.
[http://www.fda.gov/cdrh/breastimplants/indexbip.html]
In 1998, the FDA approved Inamed Corporation's adjunct study protocol for silicone gel-filled breast implants for reconstruction and revision patients only and also approved, later that same year, the corporation's IDE study for silicone gel-filled breast implants for a limited number of augmentation, reconstruction, and revision patients.
[http://www.fda.gov/cdrh/breastimplants/indexbip.html]
Also in 1998, Mentor Corporation and its subsidiary, Mentor Texas, signed a consent decree of permanent injunction, promising to manufacture its breast implants in compliance with the Quality System Regulation which helps to assure that medical devices are consistently high in quality and are safe and effective. The FDA permitted Mentor Corporation to continue marketing its breast implants because the deficiencies in Mentor Corporation's manufacturing process were not shown to result in a significantly increased risk to women who received this company's breast implants. [http://www.fda.gov/cdrh/breastimplants/indexbip.html]
In 1999, the IOM released a comprehensive report on both saline-filled and silicone gel-filled breast implants entitled Safety of Silicone Breast Implants. The determination was that there was insufficient evidence to establish that either or both types of breast implants cause systemic health effects and that there was no new health or safety issues associated with the use of both types of implants. The IOM concluded that local complications are "the primary safety issue with silicone breast implants", making a clear distinction between local complications and systemic health concerns. Bothersome results such as rupture, pain, capsular contracture, disfigurement, and infection, were stated to be possible local complications that could require medical intervention or repeat surgeries. [http://www.fda.gov/cdrh/breastimplants/indexbip.html]
The IOM report can be read online at http://books.nap.edu/catalog/9602.html. A consumer booklet on the IOM study, Information for Women about the Safety of Silicone Breast Implants, can be read at http://books.nap.edu/catalog/9618.html.
In 2000, the FDA granted approval of Mentor Corporation's and Inamed Corporation's saline-filled breast implant PMAs, showing data on the types and rates of local complications experienced by patients. [The 3-year complication rates are summarized in a FED press release available at http://www.fda.gov/bbs/topics/NEWS/NEW00727.html] “Despite complications experienced by some women, the majority of those women still in the Inamed Corporation and Mentor Corporation studies after three years reported being satisfied with their implants.”
[http://www.fda.gov/cdrh/breastimplants/indexbip.html] Both PMAs were approved for breast augmentation to females of at least 18 years of age and for breast reconstruction.
[The approval letter, the labeling at the time of approval, and the Summary of Safety and Effectiveness (SSED) are available at http://www.fda.gov/cdrh/pdf/p990075.html for Mentor Corporation and at http://www.fda.gov/cdrh/pdf/p990074.html for Inamed Corporation.
Updated clinical data from Mentor Corporation's (http://www.mentorcorp.com) and Inamed Corporation's (http://www.allergan.com) ongoing postapproval studies for these PMAs are available in the patient labeling on FDA's website at http://www.fda.gov/cdrh/breastimplants, as well as on the websites for both companies.]
The manufacturers continued to improve their gel-filled products, developing a more cohesive gel implant, and continued with their studies. In November of 2006, the FDA approved the new and improved [[silicone]] gel-filled breast implants produced by the two manufacturers, [[Mentor Corporation]] and [[Allergan]], both for breast reconstruction and for cosmetic breast augmentation. Cosmetic use of the implants was restricted to women aged 22 and older. The approval was given with a number of conditions including a requirement to complete 10-year studies on women who have already received the implants and a 10 year study on the safety of the devices in 40,000 women. The post-approval studies will be closely monitored by the [[FDA]].]].<ref> {{cite web | url= http://www.fda.gov/bbs/topics/NEWS/2006/NEW01512.html |title=FDA Approves Silicone Gel-Filled Breast Implants | accessdate=2008-07-01 |publisher=FDA }} </ref> The FDA warned that the implants are not without risk and that women receiving implants should have regular MRI exams to watch for any signs of rupture or leakage. It was also mandated that patients be given brochures explaining the risks.
[http://www.fda.gov/cdrh/breastimplants/indexbip.html]
Currently, as of November 2006, the FDA has approved four breast implants for marketing in the U.S.:
- Allergan and Mentor Corporation’s saline-filled breast implants approved for breast augmentation in women 18 years or older and for breast reconstruction in women of any age.
- Allergan and Mentor Corporation’s silicone gel-filled breast implants approved for breast augmentation in women 22 years or older and for breast reconstruction in women of any age.
“All breast implants other than these four approved devices are considered investigational devices, including the more-cohesive (“gummy bear”) implants. For a woman to receive an investigational breast implant in the U.S., she must enroll in a clinical study.”
[http://www.fda.gov/cdrh/breastimplants/qa2006.html]
The FDA states its basis for the decision to approve silicone gel-filled breast implants made by Allergan and Mentor to be that the scientific information in the PMAs demonstrated that “there is a reasonable assurance that Allergan (formerly Inamed) and Mentor’s silicone gel-filled breast implants are safe and effective and that there is adequate information about these products to enable women to make informed decisions about whether to get them.”
Further questions about breast implants can be answered from the U.S. Food and Drug Administration’s website http://www.fda.gov/cdrh/breastimplants/qa2006.html.
All About Breast Implants
Sizes, Texture and Styles Explained
What is a Breast Implant?A breast implant has an exterior sac or implant shell made of silicone, a rubber-like substance. The implant is filled with one of two substances: silicone gel or saline. The implant is surgically implanted under your chest wall.
How do silicone and saline compare?
Silicone gel breast implants hold together uniformly while retaining the natural give that resembles breast tissue. Saline breast implants are filled with a saltwater solution similar to the fluid that makes up most of the human body and offer a slightly firmer feel.
Breast Implant Profiles
Breast implants come in High Profile, Moderate Plus Profile, and Moderate Profile - each offering a different level of projection (profile) for each woman's preference and body type. Mentor Corporation's High Profile Breast Implant offers greater projection, particularly designed for women with a narrower chest wall.
Choosing the right size breast implant is generally the most important decision a woman and her surgeon will make. Your plastic surgeon will evaluate your existing breast tissue to determine if you have enough tissue to accommodate the desired size of breast implant. Being realistic and following your doctor's recommendations is very essential for the best result possible.
What are the possible physical repercussions of implants that are "too big" for me?
With breast implants that are too large for the amount of breast tissue you have, the implants' edges may be visible through your skin after your operation or the implant may be more easily felt. You may also increase the risk of having surgical complications. Also, breast implants that are excessive in size may increase the effects of gravity on your body, which may cause your breasts to prematurely droop or sag.
Smooth and Textured Breast Implant Surfaces
Breast implant shells come in either a smooth or textured surface. And here is the difference. As a natural reaction to any device placed in the body, scar tissue will form around the breast implant surface, creating a capsule.
In some women, the capsule can tighten and squeeze the implant. This occurrence is called capsular contracture. Textured breast implants were designed to reduce the chance of capsular contracture. Some information in the literature on small numbers of patients suggests that surface texturing reduces the chance of severe capsular contracture, but clinical information from studies of a large number of women with breast implants shows no difference in the likelihood of developing capsular contracture with textured implants compared to smooth-surfaced implants. Saline Breast Implants
- Filled with a saltwater solution similar to the fluid that makes up most of the human body
- Slightly firmer feel
- Flexible fill volume implants allow the surgeon to adjust the volume during the procedure
- Smaller incision size with various options for incision placement.
Silicone Gel Breast Implants
- Holds together uniformly while retaining the natural give that resembles breast tissue
- Slightly more natural, soft feel
- Set fill volume
- Slightly larger incision size with various options for incision placement
Silicone Breast Implants Get FDA Approval
MemoryGel Breast Implants by Mentor FDA Approved
3D Body Model
Breast Augmentation Before and After Pictures
Viewing photos of breast augmentation surgeries is an excellent way to ensure you make the right decision for yourself. The LoveYourLook.com website offers an extensive photo gallery of before and after pictures of breast augmentation. You can see pictures of different types, sizes, and shapes of implants on a variety of body frames. Use this valuable resource to help you select the right type of breast implant for your breast augmentation. Breast Augmentation Plastic Surgeons
How do I Find the Best Breast Augmentation Plastic Surgeon for Me?
Like your dentist or family physician this may likely be a long-term relationship, so choose your doctor carefully. Equally important as a physician's surgical skills is his or her communication style. You also will be interacting with your plastic surgeon's office staff, so you should consider how well they communicate with you, and how well they answer your questions and concerns about cosmetic surgery. Be sure to clearly state your expectations and goals of the surgery, and don't be embarassed to ask questions. Your plastic surgeon should be happy to discuss with you any concerns or questions that you may have.
A word about ABMS board certification.
The American Board of Medical Specialties (ABMS), a not-for-profit organization, assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians. ABMS, recognized as the "gold standard" in physician certification, believes higher standards for physicians means better care for patients. Board certification by an ABMS member board provides assurance of a physician's expertise in a particular specialty and/or subspecialty of practice.
Online doctor find directories are very helpful in finding a doctor in your area. The online directory of plastic surgeons at LoveYourLook.com is very useful as you can view photos of plastic surgeons in your area, read their online profiles, and even view videos of the doctors talking about their experience. It also contains before and after pictures of the breast augmentation surgeries the doctors have done. These tools are great for helping you find the best plastic surgeon in your area for your breast augmentation surgery.
Additional methods for finding the best plastic surgeon for you.
- Ask friends or family who have had breast augmentation surgery about their doctor - if they would recommend him or her and why
- Obtain a list through professional organizations, such as the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS)
- Obtain a list from your local medical society.
Breast Augmentation Cost and Financing
Estimate the price of your plastic surgery
For 2004, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery each cite an average figure near $3,400 for just the surgeon's fees for breast surgery with breast implants. However a surgeon's cost for breast augmentation may vary based on his or her experience.
It is likely that the actual cost of the entire breast augmentation surgical procedure will be more than the estimated $3,400 figure.
Additional breast augmentation fees may include:
- Hospital or surgical facility fees
- Anesthesia fees for surgery
- Prescriptions for medication
- Post-surgery garments
- Medical tests, and other miscellaneous costs
LoveYourLook.com
by Mentor Corporation
find the right surgeon for you so that you achieve the most beautiful outcome.
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