What is it? There are many reasons that a woman may desire a change in her breast shape and size. She may wish to restore the breasts she had before having children, to correcting a deformity, or to have a more proportional body frame. Many times, this desired change can be accomplished with the placement of breast implants with or without a breast lift. Breast Implants come in two general categories: saline and silicone. All implants come in a variety of shapes, sizes, and textures, and are carefully chosen depending on the patient’s desires. Saline implants are made of a flexible silicone shell (the same as for silicone implants) which is then filled with sterile saline to its desired size once placed in the body. Advantages of saline implants include: the ability to make a smaller incision on the skin, as well as easier detection when there is a rupture. In the event of a rupture, the saline will leak out and be absorbed by the body, and the implant will collapse. Disadvantages include the fact that they have a less natural feel than silicone implants and tend to show more rippling, especially when a patient has minimal breast tissue to camouflage it. Silicone implants generally have a more natural look and feel, especially in those patients with thin breast tissue. However, they do require a slightly larger incision for placement. Additionally, imaging is generally required to detect rupture since the silicone tends to keep its shape and is not absorbed by the body. The silicone used in modern implants stays together in a fairly solid shape, and does not leak into the breast like some of the older silicone implants you may have heard of. Both saline and silicone implants have been shown to be equally safe for placement by the FDA. The implants themselves can be placed above or below the pectoralis muscle. However, in most situations, they are placed under the muscle due to the fact that studies have shown a reduced risk for capsular contracture in this position. The increased tissue over the implant tends to camouflage it more effectively as well. If you desire breast implants in Houston or breast augmentation in Houston, Lift Plastic Surgery is your best option.
What happens during surgery?
During surgery, a small incision is made in the crease under the breast or along the areola (the colored part of the nipple). The breast tissue and pectoralis muscle (usually) is then lifted off of the ribs to create a pocket for the implant to sit. The pocket is irrigated and the implants are placed. We sit you up to make sure that everything looks symmetric and the size is appropriate. The incisions are closed with dissolving sutures and covered with tape and skin glue and you are then placed in a soft surgical bra. You are able to go home the same day.
What will my recovery be like? Postoperatively, you will have some discomfort, particularly from the pectoralis muscle being stretched. This feels almost like muscle soreness after a workout, but it is usually not significantly painful. You will be able to shower the day after surgery. You must wear a soft supportive bra with no underwire at all times other than showering for the first month. After four weeks, you can change to a normal bra as long as your incisions are well healed. No vigorous exercise or activity is allowed for the first 4-6 weeks after surgery and you should limit lifting your arms above your head. Expect that your breasts will be swollen, and this will gradually decrease over the next few months. Immediately after surgery your breast implants will generally appear “high and tight”. This is because the tissues, especially the pectoralis muscle, needs to stretch to accommodate the new implant. Eventually the shape will round out and the implants will drop and settle, but this process generally tends to take 1-3 months.
What are the risks? It is possible to have some changes in sensation of the breast or nipple after surgery, but is rarely permanent. Usually full sensation returns after several months. In general, placement of implants should not affect the ability to lactate or breast feed. Any time a foreign object is placed in the body it is always possible for infection to develop or for the body to react to the implant and reject it. However, the vast majority of breast augmentations go extremely well without any issues and with high patient satisfaction. There is a reason why it is one of the most popular cosmetic procedures performed!
Implant rupture is possible even without trauma to the chest. Rupture rates vary depending on type and specifics of the implant used, but can be up to 15% at 10 years. With saline implants, rupture is easier to detect because the implant deflates. Silicone ruptures are usually “silent” because the patient has no symptoms and usually require imaging to detect. Because of this, it is recommended that women with silicone breast implants undergo regular surveillance with MRI 3 years after implant placement, and then every 2 years after that. Otherwise, women with breast implants should undergo regular breast surveillance and mammograms as recommended by their primary care physician. If rupture occurs, it is generally possible to remove the implant and replace it with a new one.
Another complication that can occur after implant placement is something called “capsular contracture”. This can happen for various reasons, as well as on a spectrum of severity. Essentially, it means that the body forms scar tissue around the implant, which can make the breast feel hard, can make it look misshapen, or sometimes even cause pain. As mentioned above, there is a decreased risk if the implants are placed under the muscle. Fixing capsular contracture usually requires another operation where the scar tissue is either released or removed and new implants are replaced. Sometimes women will also choose to just remove the implants, and undergo a breast lift instead. Women should expect that throughout their lifetime their implants will have to be exchanged at some point for various reasons. Usually this comes sometime after the 10-year mark.
What is ALCL? You may have heard recently about a rare cancer associated with breast implants. According to the research so far, ALCL (anaplastic large cell lymphoma) has been found in only 100-250 cases out of the millions of women receiving implants worldwide. Therefore, we know that the incidence is very low. When it has occurred, it was most often found in women with late onset persistent seromas (fluid collections) around their implants. This has generally presented as swelling or pain noticed years after implant placement. ALCL is not a breast cancer. It is a type of lymphoma which is a cancer of the immune cells usually found elsewhere in the body, and is extremely rare in the breast. Diagnosis is made by testing the fluid around the implant as well as the implant capsule (layer of scar tissue that forms around every breast implant). If ALCL is found, removal of the implants and the entire capsule is recommended. Most patient have an excellent prognosis without further treatment, but further research is ongoing.