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Breast Enlargement Surgery Breast Reduction Surgery |
BREAST ENLARGEMENT
Breast enlargement is usually done to balance a difference in breast size, to improve body contour or as a reconstructive technique following surgery. The best candidates for breast augmentation, known medically as augmentation mammaplasty, are women looking for improvement-not perfection-in the way they look.Breast augmentation, technically known as augmentation mammoplasty, is asurgical procedure to enhance the size and shape of a woman's breast fora number of reasons:
- To enhance the body contour of a woman who, for personal reasons, feelsher breast size is too small.
- To correct a reduction in breast volume after pregnancy.
- To balance a difference in breast size.
- As a reconstructive technique following breast surgery.
The best candidates for breast augmentation
Breast augmentation is usually done to
A breast implant is a silicone shell filled with either silicone gel ora salt-water solution known as saline.
In your initial consultation, your surgeon will evaluate your health andexplain which surgical techniques are most appropriate for you, based onthe condition of your breasts and skin tone. If your breasts are sagging,your doctor may also recommend a breast lift. Your surgeon will give you instructions to prepare for surgery, includingguidelines on eating and drinking, smoking, and taking or avoiding certainvitamins and medications. While making preparations, be sure to arrange for someone to drive you homeafter your surgery and to help you out for a few days, if needed.Your surgeon may prefer to perform the operation in an office facility,a freestanding surgery center, or a hospital outpatient facility. Occasionally,the surgery may be done as an inpatient in a hospital, in which case youcan plan on staying for a day or two.
Breast augmentation can be performed with a general anesthesia, so you'llsleep through the entire operation. Some surgeons may use a local anesthesia,combined with a sedative to make you drowsy, so you'll be relaxed but awake,and may feel some discomfort.
The method of inserting and positioning your implant will depend on youranatomy and your surgeon's recommendation. The incision can be made eitherin the crease where the breast meets the chest, around the areola (the darkskin surrounding the nipple), or in the armpit. Every effort will be madeto assure that the incision is placed so resulting scars will be as inconspicuousas possible.
Incisions are made to keep scars as Working through the incision, the surgeon will lift your breast tissue andskin to create a pocket, either directly behind the breast tissue or underneathyour chest wall muscle (the pectoral muscle). The implants are then centeredbeneath your nipples. The breast implant may be inserted directly under the You'll want to discuss the pros and cons of these alternatives with yourdoctor before surgery to make sure you fully understand the implicationsof the procedure he or she recommends for you. After surgery, breasts appear fuller and more
You're likely to feel tired and sore for a few days following your surgery,but you'll be up and around in 24 to 48 hours. Most of your discomfort canbe controlled by medication prescribed by your doctor. You should be able to return to work within a few days, depending on thelevel of activity required for your job. Routine mammograms should be continued after breast augmentation for womenwho are in the appropriate age group, although the mammographic technicianshould use a special technique to assure that you get a reliable reading,as discussed earlier. (see All surgery carries some uncertainty and risk.)
For many women, the result of breast augmentation can be satisfying, evenexhilarating, as they learn to appreciate their fuller appearance. Regular examination by your plastic surgeon and routine mammograms for thosein the appropriate age groups at prescribed intervals will help assure thatany complications, if they occur, can be detected early and treated. Your decision to have breast augmentation is a highly personal one thatnot everyone will understand. The important thing is how you feel aboutit. If you've met your goals, then your surgery is a success.
Breast reduction, technically known as reduction mammaplasty, is designed for such women. The procedure removes fat, glandular tissue, and skin from the breasts, making them smaller, lighter, and firmer. It can also reduce the size of the areola, the darker skin surrounding the nipple. The goal is to give the woman smaller, better-shaped breasts in proportion with the rest of her body.
If you're considering breast reduction, this will give you a basic understanding of the procedure- when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.
In most cases, breast reduction isn't performed until a woman's breasts are fully developed; however, it can be done earlier if large breasts are causing serious physical discomfort. The best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is not recommended for women who intend to breast-feed.
The procedure does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with slightly mismatched breasts or unevenly positioned nipples. Future breast-feeding may not be possible, since the surgery removes many of the milk ducts leading to the nipples.
Some patients may experience a permanent loss of feeling in their nipples or breasts. Rarely, the nipple and areola may lose their blood supply and the tissue will die. (The nipple and areola can usually be rebuilt, however, using skin grafts from elsewhere on the body.)
Heavy breasts can lead to physical
The surgeon will examine and measure your breasts, and will probably photograph them for reference during surgery and afterwards. (The photographs may also be used in the processing of your insurance coverage.) He or she will discuss the variables that may affect the procedure-such as your age, the size and shape of your breasts, and the condition of your skin. You should also discuss where the nipple and areola will be positioned; they'll be moved higher during the procedure, and should be approximately even with the crease beneath your breasts.
Your surgeon should describe the procedure in detail, explaining its risks and limitations and making sure you understand the scarring that will result. The surgeon should also explain the anesthesia he or she will use, the facility where the surgery will be performed, and the costs. (Some insurance companies will pay for breast reduction if it's medically necessary; however, they may require that a certain amount of breast tissue be removed. Check your policy, and have your surgeon write a "predetermination letter" if required.)
Breast reduction doesn't usually require a blood transfusion. However, if a large amount of breast tissue will be removed, your physician may advise you to have a unit of blood drawn ahead of time. That way, if a transfusion should be needed, your own blood can be used.
While you're making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.Breast reduction is generally done in a hospital, as an inpatient procedure. The surgery itself usually takes two to four hours, but may take longer in some cases. You can expect to remain in the hospital two to three days.
Incisions outline the area of skin, breast
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. (This will result in a loss of sensation in the nipple and areolar tissue.)
Skin formerly located above the nipple is
Stitches are usually located around
the areola, in a vertical line extending
downward, and along the lower crease
of the breast. In some cases, techniques
can be used that eliminate the vertical
part of the scar. And occasionally, when
only fat needs to be removed, liposuction
alone can be used to reduce breast size,
leaving minimal scars.
After surgery, you'll be wrapped in an elastic bandage or a surgicalbra over gauze dressings. A small tube may be placed in each breast todrain off blood and fluids for the first day or two. You may feel some pain for the first couple of days-especially whenyou move around or cough-and some discomfort for a week or more. Your surgeonwill prescribe medication to lessen the pain. The bandages will be removed a day or two after surgery, though you'llcontinue wearing the surgical bra around the clock for several weeks, untilthe swelling and bruising subside. Your stitches will be removed in oneto three weeks. If your breast skin is very dry following surgery, you can apply a moisturizerseveral times a day, but be sure to keep the suture area dry.
Your first menstruation following surgery may cause your breasts toswell and hurt. You may also experience random, shooting pains for a fewmonths. You can expect some loss of feeling in your nipples and breastskin, caused by the swelling after surgery. This usually fades over thenext six weeks or so. In some patients, however, it may last a year ormore, and occasionally it may be permanent.
Although you may be up and about in a day or two, your breasts may stillache occasionally for a couple of weeks. You should avoid lifting or pushinganything heavy for three or four weeks. Your surgeon will give you detailed instructions for resuming your normalactivities. Most women can return to work (if it's not too strenuous) andsocial activities in about two weeks. But you'll have much less staminafor several weeks, and should limit your exercises to stretching, bending,and swimming until your energy level returns. You'll also need a good athleticbra for support.
You may be instructed to avoid sex for a week or more, since sexualarousal can cause your incisions to swell, and to avoid anything but gentlecontact with your breasts for about six weeks.
A small amount of fluid draining from your surgical wound, or some crusting,is normal. If you have any unusual symptoms, such as bleeding or severepain, don't hesitate to call your doctor.
Although much of the swelling and bruising will disappear in the firstfew weeks, it may be six months to a year before your breasts settle intotheir new shape. Even then, their shape may fluctuate in response to yourhormonal shifts, weight changes, and pregnancy. Your surgeon will make every effort to make your scars as inconspicuousas possible. Still, it's important to remember that breast reduction scarsare extensive and permanent. They often remain lumpy and red for months,then gradually become less obvious, sometimes eventually fading to thinwhite lines. Fortunately, the scars can usually be placed so that you canwear even low-cut tops. Of all plastic surgery procedures, breast reduction results in the quickestbody-image changes. You'll be rid of the physical discomfort of large breasts,your body will look better proportioned, and clothes will fit you better. However, as much as you may have desired these changes, you'll needtime to adjust to your new image-as will your family and friends. Be patientwith yourself, and with them. Keep in mind why you had this surgery, andchances are that, like most women, you'll be pleased with the results.
With smaller, better proportioned breasts,
balance a difference in breast size, to
improve body contour, or as a reconstructive
technique following surgery.
Types of implants
Because of concerns that there is insufficient information demonstratingthe safety of silicone gel-filled breast implants, the Food & Drug Administration(FDA) has determined that new gel-filled implants, at the present time,should be available only to women participating in approved studies. Somewomen requiring replacement of the implants may also be eligible to participate in the study.
Saline-filled implants continue to be available to breast augmentation patientson an unrestricted basis.
All surgery carries some uncertainty and risk
Breast augmentation is relatively straightforward. But as with any operation,there are risks associated with surgery and specific complications associatedwith this procedure.
The most common problem, capsular contracture, occurs if the scar or capsulearound the implant begins to tighten. This squeezing of the soft implantcan cause the breast to feel hard. Capsular contracture can be treated inseveral ways, and sometimes requires either removal or "scoring"of the scar tissue, or perhaps removal or replacement of the implant.
As with any surgical procedure, excessive bleeding following the operationmay cause some swelling and pain. If excessive bleeding continues, anotheroperation may be needed to control the bleeding and remove the accumulatedblood.
A small percentage of women develop an infection around an implant. Thismay occur at any time, but is most often seen within a week after surgery.In some cases, the implant may need to be removed for several months untilthe infection clears. A new implant can then be inserted.
Some women report that their nipples become oversensitive, undersensitive,or even numb. You may also notice small patches of numbness near your incisions.These symptoms usually disappear within time, but may be permanent in somepatients.
There is no evidence that breast implants will affect fertility, pregnancy,or your ability to nurse. If, however, you have nursed a baby within theyear before augmentation, you may produce milk for a few days after surgery.This may cause some discomfort, but can be treated with medication prescribedby your doctor.
Occasionally, breast implants may break or leak. Rupture can occur as aresult of injury or even from the normal compression and movement of yourbreast and implant, causing the man-made shell to leak. If a saline-filledimplant breaks, the implant will deflate in a few hours and the salt waterwill be harmlessly absorbed by the body.
If a break occurs in a gel-filled implant, however, one of two things mayoccur. If the shell breaks but the scar capsule around the implant doesnot, you may not detect any change. If the scar also breaks or tears, especiallyfollowing extreme pressure, silicone gel may move into surrounding tissue.The gel may collect in the breast and cause a new scar to form around it,or it may migrate to another area of the body. There may be a change inthe shape or firmness of the breast. Both types of breaks may require asecond operation and replacement of the leaking implant. In some cases,it may not be possible to remove all of the silicone gel in the breast tissueif a rupture should occur.
A few women with breast implants have reported symptoms similar to diseasesof the immune system, such as scleroderma and other arthritis-like conditions.These symptoms may include joint pain or swelling, fever, fatigue, or breastpain. Research has found no clear link between silicone breast implantsand the symptoms of what doctors refer to as "connective-tissue disorders,"but the FDA has requested further study.
While there is no evidence that breast implants cause breast cancer, theymay change the way mammography is done to detect cancer. When you requesta routine mammogram, be sure to go to a radiology center where techniciansare experienced in the special techniques required to get a reliable x-rayof a breast with an implant. Additional views will be required. Ultrasoundexaminations may be of benefit in some women with implants to detect breastlumps or to evaluate the implant.
While the majority of women do not experience these complications, you shoulddiscuss each of them with your physician to make sure you understand therisks and consequences of breast augmentation.
Planning the surgery
Be sure to discuss your expectations frankly with your surgeon. He or sheshould be equally frank with you, describing your alternatives and the risksand limitations of each. You may want to ask your surgeon for a copy ofthe manufacturer's insert that comes with the implant he or she will use-- just so you are fully informed about it. And, be sure to tell your surgeonif you smoke, and if you're taking any medications, vitamins, or other drugs.
Your surgeon should also explain the type of anesthesia to be used, thetype of facility where the surgery will be performed, and the costs involved.Because most insurance companies do not consider breast augmentation tobe medically necessary, carriers generally do not cover the cost of thisprocedure.
Preparing for the surgery
Types of anesthesia
The surgery
inconspicuous as possible, in the breast
crease, around the nipple, or in the armpit.
Breast tissue and skin is lifted to create a
pocket for each implant.
Some surgeons believe that putting the implants behind your chest musclemay reduce the potential for capsular contracture. Drainage tubes may beused for several days following the surgery. This placement may also interfereless with breast examination by mammogram than if the implant is placeddirectly behind the breast tissue. Placement behind the muscle however,may be more painful for a few days after surgery than placement directlyunder the breast tissue.
breast tissue or beneath the chest wall muscle.
The surgery usually takes one to two hours to complete. Stitches are usedto close the incisions, which may also be taped for greater support. A gauzebandage may be applied over your breasts to help with healing.
natural in tone and contour. Scars will fade
with time.After surgery
Within several days, the gauze dressings, if you have them, will be removed,and you may be given a surgical bra. You should wear it as directed by yoursurgeon. You may also experience a burning sensation in your nipples forabout two weeks, but this will subside as bruising fades.
Your stitches will come out in a week to 10 days, but the swelling in yourbreasts may take three to five weeks to disappear.
Getting back to normal
Follow your surgeon's advice on when to begin exercises and normal activities.Your breasts will probably be sensitive to direct stimulation for two tothree weeks, so you should avoid much physical contact. After that, breastcontact is fine once your breasts are no longer sore, usually three to fourweeks after surgery.
Your scars will be firm and pink for at least six weeks. Then they may remainthe same size for several months, or even appear to widen. After severalmonths, your scars will begin to fade, although they will never disappearcompletely.The new look
BREAST REDUCTION
If you're a woman with very large, drooping breasts, you may suffer from back and neck pain, skin irritation and even breathing problems and skeletal deformities. Along with this physical discomfort, some women also feel somewhat self-conscious about living with a top-heavy body. Breast reduction, medically known as reduction mammaplasty, can make your breasts smaller, lighter, firmer and in better proportion with the rest of your body.
Women with very large, pendulous breasts may experience a variety of medical problems caused by the excessive weight-from back and neck pain and skin irritation to skeletal deformities and breathing problems. Bra straps may leave indentations in their shoulders. And unusually large breasts can make a woman-or a teenage girl-feel extremely self-conscious.
Best Candidates for Breast Reduction
Breast reduction is usually performed for physical relief rather than simply cosmetic improvement. Most women who have the surgery are troubled by very large, sagging breasts that restrict their activities and cause them physical discomfort.All surgery carries some uncertainty and risk
Breast reduction is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications, including bleeding, infection, or reaction to the anesthesia. Some patients develop small sores around their nipples after surgery; these can be treated with antibiotic creams. You can reduce your risks by closely following your physician's advice both before and after surgery.
Planning the surgery
In your initial consultation, it's important to discuss your expectations frankly with your surgeon, and to listen to his or her opinion. Every patient-and every physician, as well-has a different view of what is a desirable size and shape for breasts.
discomfort, a variety of medical
problems, shoulder indentations
due to tight bra straps, and
extreme self-consciousness. Preparing for surgery
Your surgeon may require you to have a mammogram (breast x-ray) before surgery. You'll also get specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Some surgeons suggest that their patients diet before the operation.The Surgery
Breast reduction is nearly always performed under general anesthesia. You'll be asleep through the entire operation.
Techniques for breast reduction vary, but the most common procedure involves an anchor-shaped incision that circles the areola, extends downward, and follows the natural curve of the crease beneath the breast. The surgeon removes excess glandular tissue, fat, and skin, and moves the nipple and areola into their new position. He or she then brings the skin from both sides of the breast down and around the areola, shaping the new contour of the breast. Liposuction may be used to remove excess fat from the armpit area.
tissue, and fat to be removed and the new
position for the nipple.
brought down and together to reshape the
breast. Sutures close the incisions, giving
the breast it's new contour.
After Surgery
Getting back to normal
The New look
you'll feel more comfortable and your clothes
will fit better.
