Breast Implant Procedure
By inserting an implant behind each breast, Dr. Patterson is able to increase a woman's bust line by one or more bra cup sizes.
The method of inserting and positioning your breast implant will depend on your anatomy and Dr. Patterson's recommendations. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple) or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.
Working through the incision, Dr. Patterson will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.
Stitches are used to close the incisions, which may also be taped for greater support. A gauze bandage may be applied over your breasts to help with healing.
Length: The surgery usually takes one to two hours to complete.
Anesthesia: Breast implant surgery is performed under general anaesthetic, i.e. you will be unconscious during the procedure. The type of anaesthetic will depend on the anaesthetist, the surgeon and you. All anaesthetics carry a risk and you should discuss these risks with the anaesthetist.
In/Outpatient: The surgeon may prefer to perform the operation in his office facility, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.
Side Effects & Risks of Breast Implants
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several 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 operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. A small percentage of women develop an infection around an implant. This may 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 until the 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 some patients.
Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak.
CAPSULAR CONTRACTION: Capsular contraction is the most common side effect of breast implants. During surgery, a pocket is created for the implant that is somewhat larger than the implant itself. During healing, a fibrous membrane called a capsule forms around the device. Under ideal circumstances, the pocket maintains its original dimensions and the implant “rests” inside, remaining soft and natural. For reasons still largely unknown, however, the scar capsule shrinks or contracts in some women and squeezes the implant, resulting in various degrees of firmness. This contraction can occur soon after surgery or many years later and can appear in one or both breasts. Current theories suggest that a low-grade infection may “trigger” some contraction.
Capsular contraction is not a “health” risk, but it can detract from the quality of the result and cause discomfort, pain, or distortion of the breast contour. In cases of minor contraction, we usually will not suggest surgical correction. Cases of very firm contraction may require surgical intervention. Rarely, if the contraction occurs and cannot be eliminated, the occasional patient may choose to have the implants permanently removed.
Capsular contraction has markedly decreased since the strength of the outer shells has increased and the permeability (ability of fluids to migrate through the shell) has decreased. Capsular contraction rate have decreased from the 30-40% to the 5-10%* range with newer implants!
HEMATOMA: Some postoperative bleeding into the pocket containing the breast implant occurs in 2-3%* of women. If the bleeding has been minimal, the body will absorb it with time. Marked swelling, however, usually requires surgical removal of blood.
INFECTION: Postoperative infection is uncommon, but possible. We reduce this to a minimum by giving intravenous antibiotics during surgery and oral antibiotics after surgery. Most infections are mild and resolve without incident. If a serious infection should develop, the implant will probably need to be removed. It cannot be replaced for at least 2 months after healing.
LOSS OF SKIN OR NIPPLE SENSATION: Nerves that supply skin or nipple sensation may be cut or damaged while the pocket or space for the implant is being created. Although this does not happen routinely, it can happen no matter how carefully the surgery is performed. If sensory loss occurs, the nerves slowly recover within 1-2 years* in about 85% of cases.
EXPOSURE OR EXTRUSION OF IMPLANT: Thin skin, inadequate tissue coverage, capsule formation, infection or severe wrinkling may all contribute to the erosion of an implant through the skin or scar. Should this very rare complication occur, implant removal would probably be indicated (at least temporarily).
WRINKLING: With the use of textured implants, visible wrinkling under the skin has been more noticeable. Occasionally, the edge of the implant can be felt. These problems are usually mild and require no treatment. Experience has shown that the wrinkles usually improve with time.
ASYMMETRY: If your breasts had slightly different shapes before surgery, they may remain slightly different after surgery. Rarely, in spite of careful attention to detail, the dissection pockets may end up slightly different in shape or height. If this is not noted while you are in surgery, but poses a problem after healing, you may later need a small adjustment procedure.
SUBPECTORAL PLACEMENT OF THE IMPLANT (UNDER THE MUSCLE): If you and Dr. Patterson have decided to place the implants under the pectoralis muscle, a unique set of risks apply. During contraction of the muscle, the implants will temporarily be flattened and/or pulled upward. Occasionally, the implants may “ride” higher than their original position because of the muscular contraction. Implants were originally placed under the muscle to reduce the frequency of capsular contraction. The newer implants provoke capsular contraction at a much lower rate than older implants. Contraction appears to occur in less than 10%* of breast, whether the implants are placed below or above the muscle, though the rate of contraction may be slightly less if the subpectoral position is used. Implants are usually placed under the muscle in thin, small-breasted women to provide more “cover” over the implant. Placing the implants under the muscle may reduce visible wrinkling.
DEFLATION: The newer stronger implant shells almost never break or rupture. In the event that rupture does occur, the breast will probably not decrease in size as the silicone will almost always stay in the same area within the “capsule.” Your body will not absorb the silicone. The shape or feel of the breast may change (usually feel softer).
LOSS OF SKIN, BREAST TISSUE, OR NIPPLE: This is an extremely rare complication of breast enlargement. When it occurs, it is usually the result of an infection that has gotten out of control and results in the death of the involved tissue. This very rare complication will usually involve only small areas that will eventually heal with good wound care. Secondary surgery is a remote possibility.
INTERFERENCE WITH BREAST FEEDING: Many women with breast implants have nursed their babies successfully. Nevertheless, any breast surgery can theoretically interfere with your ability to breast feed.
CALCIUM DEPOSITS: Some patients will develop a thin layer of calcium within the scar capsule surrounding the implant. This usually occurs several or more years after the implant has been inserted. In these patients, the added density of the scar may reduce the delectability of lesions close to the scar on mammograms. Lesions may still be visible and detectable when specialized techniques are used.
BREAST CANCER: There is no evidence linking implants and breast cancer. The only clinical studies available show that the prevalence of breast cancer in women with implants is the same or even slightly lower than that in women without implants! Furthermore, two studies have shown, to date, that the stage of breast cancer detection in women with implants appears to be identical to that found in the overall population.
INTERFERENCE WITH MAMMOGRAPHY: You should tell the technician that you have implants. Special techniques will be used and extra views may be needed in order to see as much of the breast tissue as possible. Even under the most ideal circumstances, some breast tissue will remain unseen, and a suspicious lesion may be missed.
The breast is compressed during mammography; therefore it is possible, but rare for an implant to rupture.
SYNMASTIA (LOSS OF CLEAVAGE): This is a very unusual problem that can develop after normal augmentation either above or below the muscle. The skin over the lower sternum (breastbone) pulls away from the bone, and normal cleavage is reduced or eliminated. In its more serious form, the pockets on either side merge to form a single pocket. In its more minor form, the pockets remain separate, but the skin tents upward. Reduced fibrous or elastic “strength” in the subcutaneous tissues may contribute, but this is difficult to predict. If the problem develops, correction will require secondary surgery.
IMMUNE DISORDERS: Some women have claimed that silicone gel prostheses have contributed to, or stimulated connective tissue disorders such as systemic lupus, erythematosis, scleroderma, rheumatoid arthritis etc. Other complaints involving the nervous system, skin and immune systems have been reported. Reports claiming a casual relationship between silicone gel and such symptoms have been published in the medical literature and widely reported in the press. To the present time, no such relationship has been established scientifically. Gel implants are not available for routine use because of the concerns of the Food and Drug Agency. The saline (salt water) used to fill saline implants is harmless and is excreted in the urine should the implant leak or rupture.
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 can be controlled by medication prescribed by your doctor.
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 your surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.
You should be able to return to work within a few days*, depending on the level of activity required for your job.
Q. How long will my implants last?
A. *Breast implants may have a limited life span and may have to be removed and/or replaced. They will age and may wear out and rupture as a result of an injury such as a fall or knock. An implant may last for only a very short time or for many years. Recent studies indicate that the risk of experiencing problems with the breast implant is much greater 8 to 10 years after the surgery. The implants can, however, last for up to 20 years without incident. Breast implants should not be considered lifetime devices.
Q. Should I have regular mammograms?
A. If you are over 50 years of age, it is recommended that you have a mammogram every two years for the early detection of breast cancer. If you have breast implants this procedure is safe if performed by a trained technician. In theory, the pressure applied by a mammography machine could damage the implant causing rupture or gel diffusion. However the risk of this is considered very small.
Q. Should I have my implants removed or replaced?
A. Your decision to leave your implants in place or to have them removed or replaced is a personal one. Only you, in consultation with your doctor or surgeon can make it, but you should weigh up all the benefits and risks. Doctors generally only recommend removal of implants if you are experiencing specific problems such as extreme capsular contracture, constant pain, infection that will not clear up, or rupture. Other factors to consider are how you feel about your implants, your health, your body image and your concerns about the long-term health effects of keeping your implants in.
Q. Is it safe for me to breast-feed?
A. Current information indicates that women with breast implants are able to breast-feed. However there have not been many studies conducted on the effects of silicone on breast fed babies. There is no evidence that silicone from breast implants is present in breast milk, or whether if swallowed, silicone is absorbed by babies or passes through them. There is also no evidence that if silicone is absorbed it will cause illness in the child.