BREAST SURGERY   (enlargement, reduction and breast lift)

Breast enlargement

The surgery consists of lifting the breast tissue and placing an envelope containing a soft, natural-feeling implant material underneath.

Although several implants are available at the present time, the implant which is used most often for enlargement purposes, is made of a silicone shell, and filled with a saline solution. Under certain conditions, silicone gel implants can be used, but these are mostly used for revision surgery. There are a variety of implant designs, all of which have advantages and disadvantages. You will need to discuss with the surgeon the choice of implant, reasons for the selection, and review the size changes that are possible with the procedure.  

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.  

How is the procedure conducted? 

Several different methods are used for placement of the implants. An incision can be made in the crease of the lower part of the breast, along the lower half of the dark skin around the nipple or in the armpit. All of these methods are designed to result in minimal scarring so that the incisions are not easily detected. After the incision is made, the implant is carefully inserted either under the breast tissue or beneath the chest muscle. The implants are then adjusted to ideal size and symmetry before the incision is sutured closed.   

Risks

Breast enlargement is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

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 blood.

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 patients.

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. 

Breast Reduction

Sometimes large, heavy breasts can be painful due to excessive weight and often cause problems such as back pain and soreness in the shoulders from bra straps which cut into the skin. Breast reduction surgery involves removal of excess breast tissue in combination with reshaping of the breast. The incisions are similar to those used for more extensive breast lifts.

A surgical dressing is usually placed to protect the incisions. Some swelling, bruising and minor discomfort may be experienced for several days after the surgery. Discomfort can be easily controlled with pain medication.  

Breast Lift

The best candidates for mastopexy are healthy women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts. 

Many women seek breast lift (also called mastopexy ) because pregnancy and nursing have left them with stretched skin and less volume in their breasts. However, if you're planning to have more children, it may be a good idea to postpone your breast lift. While there are no special risks that affect future pregnancies (for example, mastopexy usually doesn't interfere with breast-feeding), pregnancy is likely to stretch your breasts again and offset the results of the procedure.

Surgery consists of removing excess skin from around the areola and from the bottom of the breast and rearranging the skin of the breast to tighten the skin envelope. In doing so, the position of the nipple and areola can be elevated to a more natural position.

The surgery is designed to minimize scarring. Some patients who seek breast enlargement actually will need a breast lift for the most desirable result. 

Risks

A breast lift is not a simple operation, but it's normally safe when performed by a qualified plastic surgeon. Nevertheless, as with any surgery, there is always a possibility of complications or a reaction to the anesthesia. Bleeding and infection following a breast lift are uncommon, but they can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery.

Mastopexy does leave noticeable, permanent scars, although they'll be covered by your bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.