DESCRIPTION
Surgeons have performed breast enhancement
through the use of breast implants since the late 1960's.
Since the initial concept and first prototype of implants,
much has changed. Breast implants have been made from
different materials but since the mid to late 1970's
manufacturers have concentrated on Saline and Silicone
Gel. Other substances and fillers have been proposed
and attempted but at the present time these two filler
materials are the mainstay of breast augmentation. In
1992 there was a great deal of controversy regarding
the use of silicone gel implants. Questions were raised
regarding their safety and the government placed a moratorium
on these types of implants. The government then required
the manufacturers to provide safety data. Many scientific
papers have been written since 1992 and most have failed
to place a direct causal relationship between the concerns
raised at the time and actual disease processes. At
the present time, silicone gel implants may be used
in certain situations with participation by the patient
in an adjunct study. The surgeon must be approved for
the use of silicone gel implants.
Breast size and shape seem to be directly associated
with our society's perception of feminine beauty. There
appears to be a predominance of breast enhancement in
the Western World in contrast to the Middle and Far
East regions of the world. Most women seeking breast
enlargement have suffered with small breasts for a number
of years prior to seeking out a solution through surgical
breast enlargement. Many have been affected by pregnancy
and breast-feeding.
A breast implant is comprised of an outer shell or envelope
of solid silicone that is then filled with saline (or
salt water) or silicone gel. The silicone gel implants
are pre-filled from the manufacturers and the saline
implants require filling at the time of surgery. Implants
are measured in cubic centimeters or cc. You will frequently
hear reference to a 330cc implant or other sizes. The
size of the implant does not always correlate to brassiere
cup size.
Breast implants are inserted through the inframammary
fold (underneath the breast fold), through the areola
or the axilla. They are then placed in front or behind
the pectoral muscle. The recommendations will vary from
patient to patient. All patients are unique and have
different requirements in order to achieve the optimal
aesthetic result. What is recommended for you may be
totally different than what is recommended for your
girlfriend. Remember all women were not created equal.
PROCEDURE
 |
|
|
|
Breast augmentations can be performed under local anesthesia
with intravenous sedation or general anesthesia. We
have found that our patients are most comfortable under
general anesthesia. The procedure is performed as an
outpatient, allowing you to go home afterwards. Depending
on your exact procedure, incisions will vary. At this
point dissection is undertaken with creation of a space
or "pocket that will accommodate the implant. This
pocket is created either underneath the glandular tissue
(sub-glandular or in front of the muscle) or underneath
the pectoral muscle (sub-pectoral). Having established
this pocket, the implant is then introduced. If the
implant is silicone gel, it will already be filled upon
insertion. Saline implants are inserted deflated and
subsequently filled through a sterile closed system
with saline. The incisions are closed, a surgical bra
is placed and you are taken to the recovery room. After
allowing time for recuperation, you will be discharged
to go home.
POST-OP RECOVERY
You will be allowed to go home after
your surgery. You will need to wear the surgical bra
for the first few days. We then suggest that you wear
a sports bra. Some custom surgical bras are available
from different manufacturers and our office will be
happy to assist you in this purchase.
You will experience pain in the first 24-48 hours and
a feeling of tightness. This is normal. Pain medication
will be provided for you and we suggest that all your
post-operative medications be purchased prior to surgery.
You should not be the person controlling the meds to
avoid self-medication. At home, it is suggested that
you rest. You will be asked to come to the office the
next day. At this point some bandages may be removed.
We will need to see you within another week for suture
removal. Most patients require 3-4 days recovery before
returning to work and/or driving their car unless your
work requires strenuous activity in which case you may
need7-10 days. Exercise may be continued after two weeks
for lower body and 4-6 weeks for upper body. Household
chores may be started within the second post-operative
week. Every patient is unique and will recuperate differently.
If you feel great, don't over do it.
Please note that all implants, but particularly if they
are placed in a subpectoral position, will tend to ride
high on the chest wall during the first 10-12 weeks
following your surgery. This is normal and occurs as
result of the implants being placed in a tight space
comprised of skin and muscle. As each week goes by,
the muscle and skin start to adjust and stretch allowing
the implants to assume a more natural position. Occasionally
this process is not completed and the implants remain
high on the chest wall requiring further surgical correction.
COMPLICATIONS OF BREAST AUGMENTATION
Although complications are not frequent and percentages
will vary, you need to be aware that the following complications
may occur:
INFECTION, HEMATOMA, CONTOUR DEFORMITIES, IMPLANT REJECTION,
IMPLANT DEFLATION, IMPLANT RIPPLING (may feel and see
implant "ripples" underneath skin), NIPPLE
AND SKIN SENSORY CHANGES (either increased or decreased),
CAPSULARCONTRACTURE, REMOTE POSSIBILITY OF LACTATION,
KELOID OR HYPERTROPHIC SCARS, DIFFICULTY IN MAMMOGRAPHY
Some of these complications if severe enough, may delay
recovery time, require further surgery for correction
at additional costs and may involve other specialists
within the medical field. Please be aware that smokers,
diabetics and overweight individuals have a higher incidence
of complications when compared to those who don’t
smoke, have diabetes and/or are overweight. You should
also note that patients undergoing combined procedures
(i.e. breast augmentation and tummy tuck) also have
a higher complication rate than those undergoing a single
procedure.
WHAT & WHAT NOT TO EXPECT
These procedures are considered
body contouring and enhancing in nature. They are
not meant as a substitute for normal breast tissue.
We have found that one of the key factors in achieving
patient satisfaction is patient expectation. No guarantee
implied or in writing is given regarding the eventual
bra cup size that you will wear. A suggestion is made
by Dr. Perez-Gurri based on his professional experience
as to the size of implant. Remember that many things
are taken into consideration but the one limiting
factor is the skin and availability of good tissue
coverage for the implant.
There seems to be an inverse
relationship with expectation and satisfaction. That
is, the higher the expectation, the lower the satisfaction.
Body image is unique and what the patient frequently
sees may not be what is seen by
the surgeon. Therefore, it is important that you become
keenly aware of your expectations for the procedure,
know its limitations and fully discuss any concerns
that you may have regarding the procedure with Dr.
Perez-Gurri. We encourage questions and have allowed
ample time to answer them personally or with our literature
and videotapes.
OTHER QUESTIONS
What if I get pregnant?
Your breasts will grow under hormonal influence
just as they would without implants. Following your
pregnancy there is involution or "shrinking"
of your breast tissue but this will not affect the
implant. However, if you are left with excess skin,
the breast may sag.
Can I breast feed?
Maybe yes and maybe no. You need to fully understand
that some women cannot breast feed regardless of implants.
If you are able to breast feed there is no scientific
data that implants are harmful to the baby.
Will
I be able to feel the implants?
More than likely. Saline implants seem to have a higher
incidence of implant wrinkling or rippling which makes
the implants more palpable underneath the skin and
in some cases the patient may see the ripples on the
skin. This happens more frequently in thin patients
and with the use of bigger implants.
Can breast implants cause cancer?
Scientific studies have not proven a causal
relationship between breast implants and breast cancer.
Will I need to change my implants?
Manufacturers suggest that breast implants should
be changed after ten years. However, every case is
different and patients need to be evaluated on an
individual basis. You should know that further surgery
would be required in the future either because of
complications or normal wear and tear. This means
that you will undergo added expenses in the future.
Are my results permanent? Although
we cannot state that they are, we know of many cases
that were performed years ago, that have remained
shapely and full.
Will my stretch marks go away?
No. There are no permanent cures for stretch marks.
Different creams and remedies exist that temporarily
hydrate the skin making the stretch marks less visible
but they do not remove stretch marks. Lasers have
been utilized to treat stretch marks but are only
effective in reducing the color intensity of red/bluish
ones. By stretching the skin as a result of the implants,
the stretch marks may become less visible.
What happens if my implants "leak"?
If you have saline implants, the salt water will be
absorbed by the body, processed and eliminated in
the urine. Your breast will go flat within hours and
you will require further surgery to replace your old,
deflated implant. Do not worry; it is not an emergency.
If you have silicone gel implants, a leak is not readily
apparent from loss of breast volume and other diagnostic
tests will be required.
The above information has been compiled as a benefit
to you. We hope that this document has served to better
inform you on the proposed procedure. We encourage
dialogue. Dr. Perez-Gurri and his staff at Imagos
Institute of Plastic Surgery, Inc welcome your questions.
It is our sincerest wish that your surgical
experience at IMAGOS INSTITUTE OF PLASTIC SURGERY,
INC. be a pleasant and informative one. We recognize
that all patients will experience pre-operative anxiety
and fear of elective surgical procedures is normal.
Our trained professional staff and doctors are here
to serve your needs and answer your questions.
|
