($4,500 to $8,500)
In 2008, about 350,000 women in the United States had breast augmentation, 57,000 had breast reconstruction, 106,000 underwent breast reduction, and 14,000 had their implants removed. Those are interesting numbers. Since the advent of breast implants in 1962 it is estimated that over 2 million women have had breast augmentation (Source: American Society of Plastic Surgeons, www. plasticsurgery. org).
Breast augmentation is typically performed to enlarge small breasts, underdeveloped breasts, or breasts that have decreased in size after a woman has had children or lost weight. It is accomplished by surgically inserting an implant behind each breast. The implant is soft and pliable, and it resembles a plastic bag filled with water. An incision is made either under the breast, around the areola (the colored skin surrounding the nipple), or in the armpit. A pocket is created for the implant either behind the breast tissue or behind the muscle between the breast and the chest wall.
Textured-surface breast implants are made with the same silicone material used for the shell of other types of breast implants, but a special manufacturing process creates a textured surface. Some studies have suggested that this surface texture may help reduce the incidence of capsular contracture—tightening of the scar tissue that forms naturally around the implant—which can make the breast feel heavy and hard.
The controversy surrounding implants over the past several years has to do with health risks associated with the contents of silicone gel-filled implants leaking into the body and causing autoimmune disorders. Large-scale epidemiological studies conducted independently by leading research institutions have provided some reassuring data. One large-scale study of this kind conducted by the Mayo Clinic and published in the June 16, 1994, issue of the New England Journal of Medicine found no connection between silicone breast implants and connective tissue diseases such as rheumatoid arthritis and lupus. Similar conclusions were reached in an extensive study reviewed in the November 2001 issue of Arthritis and Rheumatism (pages 2477-2484).
A press release from the National Cancer Institute (http://newscenter. cancer. gov/pressre- leases/siliconebreast. html) on Monday, October 2, 2000, stated that “In one of the largest studies on the long-term health effects of silicone breast implants, researchers from the National Cancer Institute (NCI) in Bethesda, Md., found no association between breast
implants and the subsequent risk of breast cancer_____ Of the implant patients in the study,
49.7 percent received silicone gel implants, 34.1 percent double lumen implants, 12.2 percent saline-filled implants, 0.1 percent other types of implants, and 3.8 percent unspecified
types of implants____ The participants had cosmetic surgery during a time (between 1962
and 1988) when a great number of changes were taking place in the manufacturing of breast implants such as the shell thickness, the type of shell coating, and the gel composition. However, the researchers found there was no altered breast cancer risk associated with any of the types of implants.”
Due to the controversy regarding implants, in 1994 a new version was launched for clinical trials. Called the TrilucentTM implant, it was filled with a soybean oil derivative that developers hoped would allow for better results and less risk. Despite the natural sound of the soybean material, this implant has since been withdrawn from the market and it has been recommended that all women who received the Trilucent implant have it removed. It turns out that the breakdown of the soybean oil filler resulted in substances that had a toxic effect on the body. (Sources: FDA Center for Devices and Radiological Health, www. fda. gov/cdrh/breastimplants/indexbip. html; and British Journal of Plastic Surgery, December 2001, pages 684-686.)
There are a wide variety of options when it comes to implants. These now include round or anatomical pre-filled saltwater implants, adjustable implants (that are filled with salt water at the time they are placed in the body), and double-lumen or “stacked” implants (this implant has two layers, an inner sac filled with silicone gel and an outer sac filled with salt water). Each has its own set of positives and negatives, so the choice depends on what you and your surgeon prefer.
A review published in the Aesthetic Surgery Journal (July 2000, pages 281-290) concluded that “the round and anatomical saline implants have similar teardrop shapes and essentially the same proportions relative to height and volume when the patient is in an upright position, but that round implants behave more like a natural breast when the patient is lying down. When both the upright and the recumbent implant shape is considered, the round implant is the more [natural in appearance].”
Another review in the same issue of the Aesthetic Surgery Journal (pages 332-334) stated that “Adjustable breast implants allow women to adjust their breast size up or down within a certain time period following breast augmentation surgery. They also give surgeons the ability to improve breast shape and symmetry, and may be useful in treating capsular contracture (breast firmness), the most common problem associated with breast implants. The technique involves overfilling the implant to stretch the breast tissues, then removing some of the saline solution to obtain the final result.” Stacked implants were also discussed in this issue (pages 296-300): “The stacked implant has two compartments, each able to be filled to a different volume, so that greater fullness can be achieved at the base of the breast with a gradual slope in the breast’s upper portion.” This can also be helpful when breast reconstruction is done, allowing the operated breast to be filled to match the other side more precisely.
Although having large, full breasts can be a tempting possibility, be sure your physician is sensitive to your body type and will veto your preconceived notion of what a desirable body looks like if it is not appropriate for your size and shape. It is best to have breasts that look like they are a part of you, not two huge lumps pointing straight out and up from your chest.
Be sure the physician you see is familiar with the differences between saline, silicone gel, and textured-surface implants. Also, your physician should be aware of the need for strict postoperative treatment and should explain it to you at length. For example, it is essential that there be no movement of the hands or arms above the waist for several days after surgery. Also, the breasts must be bound for from several days to three weeks after surgery. All this ensures healing and minimizes the chances of the implant becoming encapsulated.
There are significant risks with breast augmentation surgery, and they can include any and all of the following.
Capsular contracture, the most common problem associated with breast implants, occurs when the body rejects the implant or when scar tissue builds up and pushes against the implant, causing a hardening of the area. The result of this encapsulation around the implant can produce hard breast tissue. It is not a health concern, but depending on the extent of the encapsulation it can be extremely painful and can also make mammography screening more difficult. The likelihood of capsular contracture is fairly high, occurring in more than 54% of breast implants.
Deflation, rupture, and leakage are highly probable. It is very important to understand that breast implants are not lifetime devices and cannot be expected to last forever. Some implants deflate or rupture in the first few months after being implanted and some deflate after several years; others are intact ten or more years after the surgery, though the incidence of rupture is less likely with saltwater-filled implants than with silicone gel-filled implants.
Other physical complications can include pain, infection, swelling, and changes in the physical sensation of the breast and nipple.
Cosmetically undesirable side effects can include wrinkling or puckering of the skin around the implant, asymmetry, implant shifting, thickened or noticeable scarring, and an obvious movement of the sac’s content. Also, the breast tissue can shrink around the implant.
Again, perhaps the most serious associated problem is that breast implants can interfere with mammography.
breast lift (mastopexy) ($з,000 to $5,ooo)
Frequently, a woman elects this surgery after losing a considerable amount of weight or when she has lost volume and tone in her breasts after having children. The plastic surgeon relocates the nipple and areola (the pink skin surrounding the nipple) to a higher position, repositions the breast tissue to a higher level, removes excess skin from the lower portion of the breast, and then reshapes the remaining breast skin. Scars occur around the areola, and extend vertically down the breast and horizontally along the crease underneath the breast. Variations on this technique, in some cases, may result in less noticeable scarring.