inserting an implant behind each breast, surgeons are
able to increase a woman's bustline by one or more
bra cup sizes. If you're considering breast augmentation,
this will give you a basic understanding of the procedure
- when it can help, how it's performed, and what results
you can expect. It can't answer all of your questions,
since a lot depends on your individual circumstances.
Please ask Dr.
Monteiro about anything you don't understand in the information contained
you're considering breast
augmentation can enhance your appearance and your self-confidence,
but it won't necessarily change your looks to match your
ideal, or cause other people to treat you differently.
Before you decide to have surgery, think carefully about
your expectations and discuss them with your surgeon.
The best candidates for breast augmentation are women
who are looking for improvement, not perfection, in the
way they look. If you're physically healthy and realistic
in your expectations, you may be a good candidate.
augmentation, technically known as augmentation
mammoplasty, is a surgical procedure to enhance
the size and shape of a woman's breast for a
number of reasons:
enhance the body contour of a woman who, for
personal reasons, feels her breast size is
correct a reduction in breast volume after
balance a difference in breast size.
a reconstructive technique following breast
augmentation is usually done to balance a difference
in breast size, to improve body contour, or as a
reconstructive technique following surgery.
A breast implant is a silicone shell filled with either silicone gel or, typically
today, a salt-water solution known as saline.
Because of concerns that there is insufficient information demonstrating
the safety of silicone gel-filled breast implants, the Food & Drug
Administration (FDA) has determined that new gel-filled implants, at
the present time, should
be available only to women participating in approved studies. Some women requiring
replacement of the implants may also be eligible to participate in the study.
Saline-filled implants continue to be available to breast augmentation patients
on an unrestricted basis, pending further FDA review. You should ask your doctor
more about the specifics of the FDA decisions. (Above guidelines are current
as of July 1992.)
All surgery carries some uncertainty and risk
Breast augmentation is relatively straightforward. But as with any surgical
procedure, there are risks associated with surgery and specific complications
associated with breasst augmentation.
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
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
There is no evidence that breast implants will affect fertility, pregnancy,
or your ability to nurse. If, however, you have nursed a baby within the year
before augmentation, you may produce milk for a few days after surgery. This
may cause some discomfort, but can be treated with medication prescribed by
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. If a saline-filled implant breaks,
the implant will deflate in a few hours and the salt water will be harmlessly
absorbed by the body.
If a break occurs in a gel-filled implant, however, one of two things
may occur: If the shell breaks but the scar capsule around the implant
does not, you may
not detect any change. If the scar also breaks or tears, especially following
extreme pressure, silicone gel may move into surrounding tissue. The gel
may collect in the breast and cause a new scar to form around it,
or it may migrate
to another area of the body. There may be a change in the shape or firmness
of the breast. Both types of breaks may require a second operation and replacement
of the leaking implant. In some cases, it may not be possible to remove all
of the silicone gel in the breast tissue if a rupture should occur.
few women with breast implants have reported symptoms similar to
diseases of the immune system, such as scleroderma and other arthritis-like
These symptoms may include joint pain or swelling, fever, fatigue, or breast
pain. Research has found no clear link between silicone breast implants and
the symptoms of what doctors refer to as "connective-tissue disorders," but
the FDA has requested further study.
While there is no evidence that breast implants cause breast cancer, they may
change the way mammography is done to detect cancer. When you request a routine
mammogram, be sure to go to a radiology center where technicians are experienced
in the special techniques required to get a reliable x-ray of a breast with
an implant. Additional views will be required. Ultrasound examinations may
be of benefit in some women with implants to detect breast lumps or to evaluate
While the majority of women do not experience these complications, you should
discuss each of them with your physician to make sure you understand the risks
and consequences of breast augmentation.
Planning your surgery
In your initial consultation, Dr.
Monteiro will evaluate your health and explain which surgical
techniques are most appropriate for you, based on the condition of your breasts
and skin tone. If your breasts are sagging, your doctor may also recommend
a breast lift. Be sure to discuss your expectations frankly. The doctor will
be equally frank with you, describing your alternatives and the risks and
limitations of each. You may want to ask for a copy of the manufacturer's
insert that comes
with the implant he will use - just so you are fully informed about it. And,
be sure to let Dr.
Monteiro if you smoke, and if you're taking any medications,
vitamins, or other drugs.
Dr. Monteiro will the type of anesthesia
to be used, the type of facility where the surgery will be performed,
and the costs involved. Because most insurance companies do not consider
breast augmentation to be medically necessary, carriers generally do
not cover the cost of this procedure.
for your surgery
Monteiro will give you instructions to prepare for surgery, including
guidelines on eating and drinking, smoking, and taking or avoiding
certain vitamins and medications. While making preparations, be sure
to arrange for someone to drive you home after your surgery and to
assist you for a few days, if needed.
Dr. Monteiro may prefer to perform the operation
in an office facility, a freestanding surgery center, or in 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.
Types of anesthesia
Breast augmentation can be performed with a general anesthesia, so you'll sleep
through the entire operation. Some surgeons may use a local anesthesia, combined
with a sedative to make you drowsy, so you'll be relaxed but awake, and may
feel some discomfort.
Where your surgery
will be performed
Monteiro may prefer to perform the operation in an office facility,
a freestanding surgery center, 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.
The method of inserting and positioning your implant will depend on your anatomy
and Dr. Monteiro's recommendation.
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.
are made to keep scars as inconspicuous as
possible, in the breast crease, around the
nipple, or in the armpit. Breast tissue and
skin is lifted
to create a pocket for each implant.
Working through the incision, the surgeon 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
Some surgeons believe that putting the implants behind your chest muscle may
reduce the potential for capsular contracture. Drainage tubes may be used for
several days following the surgery. This placement may also interfere less with
breast examination by mammogram than if the implant is placed directly behind
the breast tissue. Placement behind the muscle however, may be more painful for
a few days after surgery than placement directly under the breast tissue.
breast implant may be inserted directly under the breast tissue
the chest wall muscle.
Results after properly-performed breast augmentation: Various
possible incision sites are indicated in white for
implant-insertion at left.
Dr.Monteiro will discuss these insert options whith you for your particular needs
and desires and he will facilitate the best result for you.
You'll want to discuss the pros and cons of these alternatives with your Dr.
Monteiro before surgery to make sure you fully understand the implications
of the procedure he recommends for you. The surgery usually takes one to two
hours to complete. 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.
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 the 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 Dr. Monteiro. You may also
experience a burning sensation in your nipples for about two weeks, but this
will subside as bruising fades. Your stitches will come out in a week to 10
days, but the swelling in your breasts may take three to five weeks to disappear.
back to normal
be able to return to work within a few days, depending on the level
of activity required for your job. Follow Dr.
Monteiro's advice on when to begin exercises and normal activities.
Your breasts will probably be sensitive to direct stimulation for two
to three weeks, so you should avoid much physical contact. After that,
breast contact is fine once your breasts are no longer sore, usually
three to four weeks after surgery. Your scars will be firm and pink
for at least six weeks. Then they may remain the same size for several
months, or even appear to widen. After several months, your scars will
begin to fade, although they will never disappear completely.
Routine mammograms should be continued after breast augmentation for women who
are in the appropriate age group, although the mammographic technician should
use a special technique to assure that you get a reliable reading, as discussed
For many women, the result of breast augmentation can be satisfying, even exhilarating,
as they learn to appreciate their fuller appearance. Regular examination by Dr.
Monteiro and routine mammograms for those in the appropriate age groups
at prescribed intervals will help assure that any complications, if they occur,
can be detected early and treated.
Your decision to have breast augmentation is a highly personal one that not
everyone will understand. The important thing is how you feel about it. If
you've met your goals, then your surgery is a success.