Breast implants, breast augmentation, and breast enlargement surgery are incredibly popular. Last year, over 300,000 women had their breasts enlarged to complement their figure or to fill redundant skin after having had children. Over the decades, augmentation procedures have been refined, many different types of implants have been developed, and both the operations and implants themselves are safer than ever.
Understandably, though, many patients express concern about implants affecting the ability to breastfeed, restrictions around physical activity or changes in sensitivity after having breast augmentation surgery. Here’s the good news: there is no known difficulty associated with breastfeeding after having implants, nipple sensitivity is usually not affected, and breast implants themselves do not restrict physical activity after complete healing.
Here at the Santa Fe Plastic Surgery Center, we’ve performed over 2,000 breast augmentations and reconstructions—and with very good results. We’ve considered all the options, opinions and arguments, studied copious amounts of literature and directly experienced outcomes from various techniques, firsthand. Here are some of the critical pieces of information a patient should consider:
- Any consultation with a plastic surgeon about breast augmentation should include a fundamental discussion about the variety of breast implant options, their particular advantages, disadvantages and appropriateness for the patient. Implants provide size enlargement, particularly forward projection and a fullness in the upper portion of the breast, and elevated position of the nipple. A normal female breast does not necessarily have this profile. In fact, the majority of female breasts have some laxity and very little fullness in the upper part of the breast, particularly if the breasts are large or if the woman has had children. But today’s culture does not find this particularly desirable, so when we place implants, we are creating a fullness in the upper part of the breast.
- Implants themselves do not create cleavage. Cleavage is created by clothing. Medium to large breasts without garments don’t typically touch—that’s just anatomy.
- If the nipple is above where the breast meets the chest wall, when we place the implant, the nipple elevates somewhat and upper fullness is created. If the nipple falls below the point where the breast meets the chest wall, the implant creates fullness in the upper part of the breast, but the nipple position may remain low. In this event, we could perform a mastopexy, a procedure that relocates the nipple to the desired position.
CHOOSING YOUR IMPLANTS
Size can be determined by the desires of the patient, within reason. Smaller implants typically provide a more natural looking result. The size of an implant is somewhat limited by the available skin on the chest wall. A patient who has breastfed children will often have much more skin and so a larger implant is more desirable. Individuals who desire extremely large breasts in proportion to their body size may require a number of implant surgeries, each of which can incrementally increase the implant sizes.
Here at the Santa Fe Plastic Surgery Center we encourage people to have moderate-size implants. Why? Because there is a more natural look to a smaller augmentation. Once you get to a certain size it becomes very obvious that the breast has been augmented, which can appear unnatural. It’s also interesting to note that we perform a lot of operations each year to make breasts smaller, and some of these breast reductions end up being the size to which that other patients would desire. Women who want very large breasts may experience shoulder, neck, and back pain. Also, the larger the implants, the more they stretch the skin. Heavier implants may also present other issues, such as loss of sensation, sagging of the breast, and stretching of the tissue.
From years of experience with breast augmentation, we understand the effects different-sized implants will have with various body types. We therefore take exact measurements of the breast, and provide the patient with feedback tailored to their exact situation. We also avoid speaking in terms of cup size—it’s too variable. What we suggest is: Look at the different implants, hold them, put them in your clothes. It’s helpful in selecting the most appropriate size implant for you.
Lastly, patients should never be pressured. Through an informative and dynamic discussion we review what the patient is trying to accomplish and make suggestions, but always allow the patient to make the decision about volume for themselves.
TYPES OF IMPLANT & PROFILES
There are two main categories of implants: gel-filled implants and saline- (salt-water) filled implants. In 1992 the U.S. Food and Drug Administration took the gel implants off the market when there was an accusation that they caused collagen vascular disease. That accusation turned out to be false and resulted in a huge scare for women, as well as being a great disservice to doctors, manufactures, and patients alike. In 2010, about half of the augmentations we performed were silicon-gel-filled and half the implants were saline-filled. Today, with all of the improvements to implant materials and design, about 90% of our patients are choosing gel-filled implants.
Silicon-Gel-Filled Implants: Gel implants look and feel more natural. When they’re in place, you’re less able to detect the edge of the implant, and there’s less rippling or visible unevenness in the skin. We strongly recommend that thin patients, and those with very minimal breast tissue, seriously consider gel implants. When you touch implants in a thin chest with little breast tissue, there’s very little breast tissue overlying the implant, which makes touch and texture more of an issue. If you have moderate-sized breast tissue to start with, you’ll feel natural breast tissue above the implant, so the implant is less noticeable; a saline- or gel-filled implant performs relatively well. A patient has to make a decision whether they are comfortable with a gel-filled implant in their body. It’s a very personal decision.
Saline-Filled Implants: Some patients feel more comfortable with saline-filled breast implants. Should they ever rupture, saline is harmlessly absorbed by the body. Saline-filled breast implants are essentially round in profile, and are slightly heavier than natural breast tissue.
Form Stable Implants (Gummy Bear Implants): These “fourth generation” implants contain a gummier, cohesive gel filler that holds a teardrop profile and does not become spherical over time. These implants look and feel more natural, and have fewer complications than standard implants. Learn More >
New Round Gel Implants: These silicone implants are just entering the U.S. market and are fuller and rounder than any implants manufactured before.
CONSIDERATIONS + RISKS
In order to approach these procedures in a balanced way, it’s important to discuss the motivations behind them. Cosmetic surgery is in the realm of cultural pressures, and people are often making these decisions based on an idea of a cultural norm. The kind of profile our culture seems to favor is an augmented breast (round, full, nipples out). A natural breast is not as round as an augmented breast, especially when it gets to be a certain size. A natural female breast has some sagging.
Timing is important. When a woman has implants, the skin stretches. If she later has a baby, her breasts will enlarge, and the tissues will stretch even more. Afterwards they may require other operations to reduce the skin or increase the size of the implants.
If the person is younger than 18, we won’t perform an augmentation. We feel that the patient needs to be an adult with enough life experience to make these kinds of decisions for themselves. The FDA does not approve gel-filled implants for patients under 22, and in some cases, implant warranties are voided when placed in a patient who is too young.
Breast implants are manmade devices and typically will not last a lifetime. Patients should understand that breast implants are not considered permanent. Most patients will require an operation in the future. The most common problems associated with breast implants are tissue hardening (capsular constriction) over time, leaking or ruptured implants and implant displacement. Please review our article: Addressing Problems With Breast Implants.
Gel-filled implants typically cost more than saline-filled implants. Implants made by all of the major brands cost about the same. Lesser-known brands might be cheaper, but we only use the major brands because of their warranty and established track record. The total cost for Breast Augmentation, operating room and anesthesia averages between $4,900—6,500, depending on the type of implant. The type of surgical procedure necessary is different for each patient, therefore costs vary.
Breast augmentation is performed in the office surgical suite while the patient is asleep under general anesthesia. A typical operation takes about an hour. The patient has long-lasting pain medication placed into the operative site to decrease immediate post-operative discomfort. Also, oral medications are given to reduce the discomfort over the first week. Most patients take medication for three to four days after their procedure.
There is a lot of discussion in the media about incisions. At the Santa Fe Plastic Surgery Center, we prefer a more practical incision, such as low on the breast (as opposed to under the nipple, under the arm or through the navel). The more exotic types of incisions have limitations. Visibility is not as good, which makes it harder for the surgeon to do his or her job. The surgeon wants to create the optimum placement and shape and cause the least amount of damage to healthy tissues. So better visibility and control make a difference.
As mentioned above, implants are not permanent and will require secondary operations. Incisions from under the arm, the navel or nipple are not as reusable. That’s ultimately more scarring for all our efforts to make the incision more concealed, and that doesn’t make much sense.
A small, incision low on the breast is just better. They are very safe, and the surgeon can see the tissues extremely well. They offer more ease and control in placement and shaping. These “infra-mammary” incisions are also very reusable. The scars tend to be flat and tend to fade over time.
Some surgeons use only a local anesthetic for breast-augmentation procedures. We find that problematic on a number of levels. Injections are given between the ribs, which run the risk of collapsing a lung. We don’t like that. If the patient begins to experience discomfort during the procedure, you only have a couple of choices. One is to compromise your result and end the procedure more quickly. Nobody would be happy with that. The second is to administer even more anesthetic in a situation where you don’t have control of the patient’s airway. That’s really not safe. By giving them more medication you may lose that airway. In our opinion, a local anesthetic saves money but adds risk to the procedure. And while “twilight anesthesia” may sound nice, it may not be safer. And we like to do things the safest way possible.
We use general anesthesia for breast implants because we believe it’s the safest way to do the procedure. The patient is put completely under with the help of a licensed expert in anesthesia. The airway is completely controlled with a breathing tube. This gives us the time and the safety to do the operation completely and correctly. It’s a relatively short anesthesia (about an hour), so we think it’s very safe.
You will need a lot of rest in order to recover. Expect discomfort, additional swelling and a sensitivity in your breasts. Avoid strenuous activity, including housework, for at least two weeks. Take medication and pain reliever as prescribed by your surgeon. For more details on recovering from breast augmentation surgery click here.
Whenever a foreign body, like a breast implant, is placed in the body, the body automatically develops a protective capsule around that body. This capsule can harden over time, and this is the number one reason why women get their implants changed. It’s not due to rupture, infection or bleeding but to a hardening of the naturally formed capsule around the implant over time. To reduce this effect you need to regularly move the implant around to keep the body’s tissues soft and pliable. At the same time, you can perform self exams to detect any changes in the breast. If you discover changes, you should come in for an examination.
When you put gel in your body, you have to make sure that it is staying put and not moving to other parts of the body. The FDA recommends MRI scans three years after the gel implants are placed as an additional monitoring precaution.
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