Breast Augmentation ( Breast Implants )
Breast enlargement (breast augmentation, breast implants) answers the
woman’s desire for fuller, larger breasts that may better balance her proportions
and harmony with the rest of her body contour. The natural loss of breast
volume occurring after a pregnancy and breast feeding is reversible with
augmentation surgery thus restoring a younger appearance. This leads
to a great deal of satisfaction and increase in self-confidence for many
women – no wonder that breast enlargement surgery is one of the most commonly
performed aesthetic cosmetic procedures in the United States. In the
United States the great majority of breast implants performed between 1992
and 2006 have have been saline (salt water) implants due to FDA restriction
on silicone gel implants, whereas in the rest of the world the improved
cohesive silicone gel implants have been vastly more popular as they tend
to provide more natural feel of the breasts following augmentation.
The improved silicone gel implants with cohesive gel and a sturdier shell
have finally been released for wide use in the United States in November
2006 as the prior questions and problems had been resolved. While
it is anticipated that many women will now choose to have silicone gels,
some will still prefer saline implants as there are many factors to consider
in the saline versus silicone gel decision. In a recent definitive
study, breast implants (saline and silicone) have been shown not to
have any connection to breast cancer. In fact, patients with implants have
a lower rate of breast cancer than the general female population owing to
more frequent breast self-exams and regular mammograms that women with implants
tend to undergo.
Pre-operative Consultation
A consultation and a pre-operative visit are usually required prior to
breast augmentation, and patients are strongly encouraged to become very
active participants in the informed decision process. During your
consultation Dr. Zemplenyi will examine you, address your cosmetic concerns
and will advise you whether breast augmentation surgery alone or breast
lift (mastopexy) may be the right solution for you. We suggest that
you bring a sports bra of the desired cup size to the initial consultation
to help you to decide on the implant size. Dr. Zemplenyi and our staff
wish you to understand your choices, realistic goals, expectations, and
risks of breast augmentation surgery so that you are empowered to make an
informed decision about a procedure that best fits your needs. You will
also be provided detailed literature about breast surgery that
you will need to read at your leisure and confirm your understanding with
your signature. A baseline mammogram will be obtained prior to surgery.
Dr. Zemplenyi and his experienced staff will discuss with you the choices
that exist in breast augmentation: 1. Selection of implant type (saline
versus silicone gel). 2. Implant size and shape (profile). 3. Placement
of the implant above or under the Pectoralis muscle, and 4. Site of the
skin incision. Neither saline nor silicone gel implants are life time
devices, and both are likely to have to be replaced in ten to fifteen years
following implantation. Silicone implants may have a longer life span and
feel more natural but they are more expensive to implant, and they need
a more extensive periodic MRI follow-up to check for silent rupture of the
implant. Silicone gel implants are easiest to insert through an incision
in the crease under the breast (infra-mammary) but peri-areolar (through
the nipple) and axillary (through the armpit) are possible. Saline
implants iinserted through smaller skin incision and can be inserted
through the belly-button (TUBA) in addition to the insertion sites above.
Both saline and silicone gel implants are commonly inserted into a pocket
developed under the muscle (sub-pectoral, sub-muscular, under the muscle)
as this placement provides greater thickness of tissue for coverage of the
implant. Sub-pectoral (sub-muscular) placement reduces the incidence of
implant rippling and possibly the incidence of significant post-operative
firmness (capsular contracture). Placement above the Pectoralis muscle (sub-glandular)
or an intermediate depth placement (sub-fascial) may be recommended in selected
patients, especially if the amount of breast tissue to cover the implant
is adequate. Dr. Zemplenyi is familiar and well-trained in all of the approaches
and placements, and he will provide his recommendations while always respecting
your desires. While Dr. Zemplenyi and his staff may provide guidance
in the selection of implant size and will discuss disadvantages of large
implants (over 400cc), it will be you, the patient, who ultimately decides
the size of the breast implant.
Surgery & Anesthesia
Our goal is to perform all breast surgeries without any patient recollection
of the procedure and with the least amount of discomfort, nausea or other
anesthetic side-effects. Patient's comfort and safety are paramount
and complete monitoring is performed for all patients undergoing any anesthetic.
Since all levels of anesthesia are available in our Medicare-certified surgical
center we are able to tailor the technique to patient's needs, desires and
wishes. Breast augmentation is commonly performed under general
anesthesia but may be done in the twilight sleep (sedation anesthesia).
On the morning of surgery, Dr. Zemplenyi will review the surgical plan
with you and will carefully place marks on your chest to delineate the extent
of the pocket and other intra-operative considerations. When you are
asleep, a pocket under or above the Pectoralis muscle will be developed
through the previously chosen incision site. Once the pocket is dry and
irrigated with an antibiotic solution the implant of your choice will be
inserted and the procedure will be repeated on the other side. Following
closure of the incisions you will be placed in supportive bra or dressing.
Following the completion of the surgery, the patients are quite comfortable
and ready for discharge home usually within one hour accompanied by a responsible
adult.
After Your Breast Surgery
A sports bra commonly supports the breasts for several days following
surgery. Moderate pain, that is somewhat worse if the implants are
sub-muscular (under the muscle) is relieved with prescribed narcotic medications.
Patients are encouraged to walk around the evening of surgery. Following
the initial several days most ladies resort to Tylenol or anti-inflammatory
medications such as Ibuprofen. Sutures are removed in about one week.
You will be seen several times in the post-operative period to help answer
any questions and take care of all of your concerns. Patients return
to work in about one week and resume exercise in three to four weeks.
The final cosmetic result is not achieved for several months until the pocket
around the implants matures and residual swelling and changes resolve.
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