Breast size procedures

Breast size procedures are performed to increase or decrease the size of thebreast. The two types of breast size procedures are breast augmentation, or implants, and breast reduction. With the earliest experiments in breast size procedures documented in the 1890s by a doctor in Vienna who attempted breastenlargement with paraffin injections, further research along with the public's interest subsided until the introduction of liquid silicone in the 1950s and 1960s. As research continues, from implanting polyvinyl sponges in dogs in1952 to test their validity for use as prostheses in humans, to the search for the "perfect" and safer implant filler today, the demand for breast size procedures remains constant.

Augmentation

Breast augmentation is a surgical procedure used for enlarging the breast, tobalance a difference in size, to adjust a reduction in breast volume following pregnancy or weight loss, and as a reconstructive technique following breast cancer surgery. The classic technique for breast augmentation was developed in the early 1960s, at the same time a Texas plastic surgeon along with DowCorning Company created the first silicone gel prosthesis. Breast-shaped sacks made of a silicone outer shell and filled with silicone gel or saline (salt water), called implants, are placed under the breast through a small incision. Reports indicate that by 1997, 1.5 to 1.8 million American women had received silicone breast implants, with 70 percent undergoing breast augmentationfor cosmetic reasons, and 30 percent for postmastectomy reconstruction. Sometimes a woman having a breast reconstruction after a mastectomy will need theopposite breast enlarged to make the breasts more symmetrical. Breasts thatare very unequal in size due to trauma or congenital deformity may also be corrected with an enlargement procedure.

A cosmetic breast enlargement is usually an outpatient procedure. It may be done under local, regional, or general anesthesia, depending on patient and physician preference. The incision is made in the armpit (or axilla), under thebreast (submammary fold incision), or around the areola (the dark area around the nipple) as a periareolar incision, or a transareolar incision (across the nipple). These techniques create the most inconspicuous scars. The implantis placed between the breast gland and underlying chest muscle, or under thechest muscle. The operation takes approximately one to two hours. The cost of a cosmetic procedure is rarely covered by insurance. However, if enlargement is part of breast reconstruction after a mastectomy, health plans may pay for some or all of it. The surgeon's fee ranges from $2,700 to $4,200, and up.The procedure may also be called augmentation mammoplasty.

Following breast augmentation, it is recommended that a medical support bra be worn for a month to keep the implants in place. Daily dressing changes forseven to ten days are required, with the stitches normally removed at this time. Restrictions after the procedure include: minimum movement of the arms during the first two weeks; driving and carrying of heavy weights until the third postoperative week; and any type of sports activity or sunbathing for at least one month.

Breast enlargement may result in decreased sensation in the breast, or interference with breast-feeding. Implants can also make it more difficult to readand interpret mammograms, possibly delaying breast cancer detection. Those with implants require special imaging procedures for an effective mammogram. Also, the implant itself can rupture and leak, or become displaced. A thick scar that normally forms around the implant, called a capsule, can become very hard. This is called capsular contracture and may result in pain or an alteredappearance of the breast. The older the implant, the greater the chances that these problems will occur.

There has been publicity about possible health risks from breast implants. Most concerns have focused on silicone gel-filled implants and the correlationof silicone gel bleeding and the precipitation of autoimmune diseases. As of1992, the Food and Drug Administration (FDA) restricted the use of this type of implant, and ordered further studies. In 1999, a study by the Institute of Medicine (IOM) reported to Congress that there was "no definitive evidence linking (silicone) breast implants to cancer, immunological diseases, neurological problems, or other systemic diseases." Today only saline-filled implants are used for cosmetic breast surgery. Although recent studies have shown no evidence of long-term health risks from silicone implants, research onthe possible links between these implants and autoimmune or connective tissue diseases is continuing.

Reduction

Breast reduction is a surgical procedure performed in order to decrease the size of the breasts. Women with very large breasts (macromastia or mammary hyperplasia) seek breast reduction for relief of pain in the back, shoulder, andneck. They may also feel uncomfortable about their breast size and have difficulty finding clothing that will fit properly. Additionally, breast reduction may be needed after reconstructive surgery following the surgical removal of cancerous breast tissue (mastectomy), to make the breasts more symmetrical.

Men who have enlarged breasts (gynecomastia) may also be candidates for breast reduction. However, excessive alcohol intake, smoking marijuana, or using anabolic steroids may cause gynecomastia, and surgery is not recommended for men who continue to use these products.

Breast reduction may also be called reduction mammoplasty. It is most often done in the hospital, under general anesthesia. However, studies have suggested that an outpatient procedure, using a local anesthetic and mild sedation may be appropriate for some patients. The operation takes approximately two tofour hours. Those who undergo breast reduction can expect one of three typesof incisions to be used: the inverted T incision, which is most widely used;the L incision; and the periareolar incision. While the type of incision mayvary by surgeon, the goal of the procedure remains the same: the areola and nipple are dissected and elevated to their new position, excess tissue, fat, and skin are removed, and the breast is mounted and sutured in place. The mostcommonly made incision (the inverted T incision) encircles the areola and extends downward and around the underside of the breast. This produces the least conspicuous scar. In certain cases, liposuction (fat suctioning) is used toremove extra fat from the armpit area.

Follow-up care for a breast reduction includes wearing a support bra during the first postoperative month, and external stitches removed between the tenthand fourteenth day. A hospital stay of up to three days may be needed for recovery.

If considered medically necessary, breast reduction is covered by some insurance plans. However, a specified amount of breast tissue may need to be removed in order to qualify for coverage. Surgeon's fees range from $4,800-$6,500 and up.

While not a procedure that dramatically changes the size of the breast, mastopexy is commonly used to elevate the fallen breast by removing excess skin and molding the breast to its original position. Designed for those whose skinis too limp to hold the breasts in place without support, mastopexy has a faster healing time than breast reduction due to the changes being more superficial.

Before surgery to reduce or increase breast size is performed, the woman should have a clear understanding of what her new breasts will look like. She andher physician should agree about the desired final result. Many surgeons find it helpful to have the patient review before and after pictures, to clarifyexpectations.

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