Reasons and Procedure

Everything you want to know about Breast Implants

Women have been augmenting their breasts for approximately 100 years. In the 1940s, Japanese prostitutes injected their breasts with sponges, paraffin, and non-grade medical silicone to attract American servicemen.

One million cosmetic procedures occurred during 1998. Approximately 950,000 of these surgeries were performed on women. Of these procedures, 132,000 involved breast augmentation. The amount of breast augmentations conducted in the United States is surpassed by only one procedure - liposuction. A record breaking 150,000 surgeries of the latter took place in 1998. The incidence of breast augmentation has risen nearly fourfold since 1992. Presently two million or eight percent of women in the United States have breast implants. The majority of breast implant recipients are white women (95%), followed by African-American women (4%). The remaining one-percent of women that have breast implants are Asian (0.5%) and other non-specified races (0.5%).

Surgery for Medical Reasons
The reasons for surgery are about as varied as the women that seek them. Approximately 20 - 33% of breast implant surgeries are performed for medical or reconstructive reasons. Such medical conditions include mastectomy, congenital maladies such as asymmetry (one breast being significantly larger than the other), "snoopy" deformity (involving a breast and nipple which resemble the side profile of the infamous Peanuts character, for whom it is named), and tubular breast deformity (lack of adequate skin at the inferior portion of the breast). Another reason why women decide to get breast implants is to repair a problem with an existing implant. Her implants may have ruptured, have fused together (symmastia), excessive scarring may occurred (capsular contracture), or her implants may have "bottomed out" (a condition where the patient's implants have disproportionately settled at the bottom half of her breast).

"Standard of Beauty"
Augmentation that is unrelated to a medical condition represents the remaining percentage of breast implant surgeries (about 67 - 80%). Women seeking breast implants in this situation, may attempt to counteract the inevitable sagging of breasts due to pregnancy, breastfeeding, aging, genetics, or loss of skin elasticity. Other women have implants because they small have breasts. This perception of course varies according to the ideals of the time period. For example, during the 1890s, a woman was considered desirable if her bosom was large and waist small. During the "roaring" twenties, however, this concept changed - smaller breasts, which better accommodated the flapper dresses of the era, were deemed beautiful.

Never Satisfied
A condition known as body dysmorphic disorder (BDD), a mental illness characterized by an incessant preoccupation with a slight or non-existent defect may spur the rest to remedy "flabby" or "sagging" breasts. It has been estimated that half of the clients of plastic surgeons are afflicted with this debilitating disease. Often, the surgery is not considered successful by the BDD patient, contending that the surgeon worsened the appearance of the "defect" and undergoes revision after revision. In severe cases of BDD the patient may commit suicide. (more on BDD)

Availibility of Silicone Gel-Filled Implants
Since 1992, the FDA has banned silicone gel-filled breast implants. Saline implants are widely available, however, for both reconstructive and augmentation purposes. Silicone Breast implants are available only to women that qualify for them and are willing to be part of the Adjunct Study, which is currently underway to investigate whether women who have silicone breast implants are at a higher risk for developing connective-tissue and systemic auto-immune diseases. The prerequisites for obtaining silicone breast implants are as follows:

Women that participate in this study do not stand to gain financially - participants are volunteers, there is no compensation or partial funding for the implants.

Alternative Medicine
Other methods have been cleverly advertised as being the natural and safe alternative to breast implants. It is therefore necessary to dispel such myths. Some creams and lotions actually do increase the volume of breast tissue, by causing the breast tissue to swell, but the effects are hardly noticeable if one were to put on a bikini. Pills have also been also been strongly advocated by manufacturers. And, some may actually be worth investing in, however, they fail to adequately inform the consumer that the mechanism by which they act (increasing the level of circulating hormones), can actually do more harm than having breast implants. In fact, they may cause breast cancer. Displacing one's own fat from the thigh to the breast was also championed as being the safest option. This procedure is only effective in small areas such as the face. Amounts large enough to augment breasts can cause excessive scarring and the formation of calcium deposits that can easily be mistaken for cancer on a mammogram.

$$
Augmentation mammoplasty can cost anywhere from four to ten thousand dollars. This price includes the surgeon's fee, implant, anesthesia, and operating room costs. Breast augmentation surgery lasts between ninety minutes and two hours. Local or general anesthesia can be utilized. Patients typically chose an implant the size of 300cc-600cc (small C - mid D), or between approximately one to two pints of fluid.

Decisions, Decisions
A patient may chose between teardrop implants (anatomical breast implants) or round implants. An advantage of a teardrop implant is that a natural look is achieved faster than the round implant. However, the former types of implants have a higher rate of deflation and fold failure. Round implants, with time, create fullness in the upper and lower regions of the breasts.

There are four main incisions that can be made to insert a breast implant. A surgeon can place the implant through the belly button. Although this option eliminates scarring of the breasts, it is impossible to be sure of proper placement. A second tactic involves making an incision in the armpit. Again, there would not be any scarring of the breast, but may contribute to a higher risk of permanent loss of feeling in the nipples. A third strategy requires the surgeon to place the implant via the fold under the breast. A disadvantage to this protocol is that a scar is often apparent when one wears a bikini or is in a supine position. The last option calls for an incision to be made in the areola, the darkest region of the breast. The advantage of this choice is that although a scar is left, it is camouflaged because of the natural color change from the areola to the breast. The disadvantage to this option is that it may affect a woman's ability to breastfeed in the future.

Another important decision the patient must make is where the implant will be placed. There exists two locations: over the muscle or under the muscle. The over the muscle option is less natural looking. Having the breast implant positioned under the muscle safeguards against sagging, hides edges, and looks more natural. The initial disadvantage is that the implant will ride high until the pectoralis muscle accommodates to it.

The implant is placed into the breast empty and filled with a filling device. If a woman prefers, she can have the surgeon install a pre-filled (PIP) implant. The incisions required to place it in her breast will inevitably be large and so will the resulting scar.

RISKS
Normal scarring should be expected. Usually, with any silicone prosthesis, a capsule forms around it. However, in some instances a mild form of capusular contraction ensues. This condition is categorized by rippling that can be felt under the skin. If it is serious, the capsule contracts, making the breast hard. A surgeon will have to retrieve the implant, a procedure known as a capsulectomy. There is no manner in which to predict who will excessively scar. Other risks not exclusive to this to this type of surgery include infection, excessive bleeding, problems associated with anesthesia, rupturing of the implant, and leakage. There have been a total of 120,000 reports of silicone implants rupturing, 50,000 reports associated with saline implants. (morbidity)

References:
1. FRONTLINE/WGBH Educational Foundation/www.wgbh.org
2. www.middletoncosmetic.com
3. www.webplastics.com
4. www.drgiunta.com
5. www.alpenglowplasticsurg.com

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