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Breast Implant (Augmentation) Pictutes Before and After
Breast Implant (Augmentation) Process
What is Breast Implant (Augmentation)?
A breast implant is a prosthesis used to enlarge the size of a woman's breasts (known as breast augmentation, breast enlargement, mammoplasty enlargement, augmentation mammoplasty or the common slang term boob job) for cosmetic reasons; to reconstruct the breast (e.g. after a mastectomy; or to correct genetic deformities), or as an aspect of male-to-female sex reassignment surgery.
Pectoral implants are a related device used in cosmetic and reconstructive procedures of the male chest wall.
According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure in the United States.
In 2007, 347,254 breast augmentation procedures were performed in the U.S according to statistics collected by the American Society of Plastic Surgery.
There are two primary types of breast implants:
- Saline-Filled
- Silicone-gel-filled implants
Saline implants have a silicone elastomer shell filled with sterile saline liquid.
Silicone gel implants have a silicone shell filled with a viscous silicone gel.
There have been several alternative types of breast implants that were developed, such as polypropylene string or soy oil, but these are no longer manufactured.
Breast Augmentation involves placing a saline or silicone gel filled
implant under or over the pectoral muscles to enahance the shape
and fullness of the breasts. At MDC, we offer patients a variety
of options for the placement of their implants as well as incision
location.
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General Recovery Information:
After Breast Implant (Augmentation) instructions?
After your breast augmentation, most patients take 1-2 weeks off of work and usually use pain medication to lessen the discomfort over the first few days. Exercise can resume after 3 weeks.
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How much does Breast Implant (Augmentation) cost?
The average cost of Breast Implant (Augmentation) is around $4999-$5995.
Having more than one surgery at a time can reduce the overall cost. Be sure to check with your doctor about the options available and the risks of combining more than one procedure.
We do offer financial services through Credit Care.
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Breast Augmentation History
Implants have been used since at least 1895 to augment the size or shape of women's breasts. The earliest known implant was attempted by Vincenz Czerny, using a woman's own adipose tissue (from a lipoma, a benign growth, on her back). Gersuny tried paraffin injections in 1889, with disastrous results. Subsequently, in the early to mid-1900s, a number of other substances were tried, including ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, polyvinyl alcohol-formaldehyde polymer sponge (Ivalon), Ivalon in a polyethylene sac, polyether foam sponge (Etheron), polyethylene tape (Polystan) or strips wound into a ball, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses. In recent history, various creams and medicaments have been used in attempts to increase bust size, and Berson in 1945 and Maliniac in 1950 performed a flap-based augmentation by rotating the patient's chest wall tissue into the breast to add volume. Various synthetics were used throughout the 1950s and 1960s, including silicone injections, which an estimated 50,000 women received. Development of silicone granulomas and hardening of the breasts were in some cases so severe that women needed to have mastectomies for treatment. Women sometimes seek medical treatment for complications up to 30 years after receiving this type of injection.
Breast Augmentation Indications
Breast implants are used primarily for:
- Primary reconstruction (to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality)
- Revision-reconstruction (revision surgery to correct or improve the result of an original breast reconstruction surgery)
- Primary augmentation (to increase breast size for cosmetic reasons)
- Revision-augmentation (revision surgery to correct or improve the result of an original breast augmentation surgery)
Breast Implant Patient characteristics
Patients seeking breast augmentation have been reported as being usually younger, healthier, from higher socio-economic status, and more often married with children than the population at large. Many of these patients have reported greater distress about their appearance in a variety of situations, and have endured teasing about their appearance.
Studies have identified a pattern (shared by many cosmetic surgery procedures) that suggest women who undergo breast implantation are slightly more likely to have undergone psychotherapy, have low levels of self-esteem, and have higher prevalences of depression, suicide attempts, and mental illness (including body dysmorphia) as compared to the general population.
Post-operative surveys on mental health and quality of life issues have reported improvement on a number of dimensions including: physical health, physical appearance, social life, self confidence, self esteem, and sexual function. Longer term follow-up suggests these improvements may be transitory, with the exception of body esteem related to sexual attractiveness. Most patients report being satisfied long-term with their implants even when they have required re-operation for complications or aesthetic reasons.
Mental health
A 2007 Swedish and US longitudinal study found that women who get cosmetic breast implants are nearly three times as likely to commit suicide as other women. No notable increase was seen in the first 10 years after surgery, but 10 to 19 years after, risk was 4.5 times higher, and six times higher after 20 years, compared with the expected suicide rate.
The same study found that women with breast implants also had a tripled risk of death from alcohol and drug use. Seven studies have been made connecting breast implants to a higher rate of suicide.
Researchers believe that breast implants themselves did not directly cause the higher suicide rate amongst the women who had them. The hypothesis from research is that women with an inclination towards psychopathology (psychological problems) are more likely to get breast implants in the first place.
For example, in one Danish study (Jacobsen, 2004), eight percent of women who underwent cosmetic breast augmentation were found to have a history of psychiatric hospitalisation before surgery.
Procedure
The surgical procedure for breast augmentation takes approximately one to two hours. Variations in the procedure include the incision type, implant material, and implant pocket placement.
Incision types
Breast implants for augmentation may be placed via various types of incisions:
Inframammary - an incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible scars in smaller breasts which don't drape over the IMF. In addition, the scar may heal thicker.
Periareolar - an incision is placed along the areolar border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola's circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5 cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment. There is a higher incidence of capsular contracture with this technique.
Transaxillary - an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast and is more likely to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary-placed implants may require inframammary or periareolar incisions (but not always). Transaxillary procedures can be performed with or without an endoscope.
Transumbilical (TUBA)- a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. In that regard it is pertinent that a published medical journal report analyzed a consecutive series of more than 1300 TUBA cases done by a single surgeon over a 15 year span, with no instance of incorrect implant placement. Transumbilical procedures are performed bluntly, with or without an endoscope (tiny lighted video camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell if attempting insertion through the small 2 cm incision in the navel, and as those implants are pre-filled they cannot be passed through that incision.
Transabdominoplasty (TABA) - procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.
Types of implants
Saline implants
Saline filled breast implantsSaline-filled breast implants were first manufactured in France in 1964, introduced by Arion with the goal of being surgically placed via smaller incisions. Current saline devices are manufactured with thicker, room temperature vulcanized (RTV) shells than earlier generations of devices. These shells are made of a silicone elastomer and the implants are filled with salt water (saline) after the implant is placed in the body. Since the implants are empty when they are surgically inserted, the scar is smaller than is necessary for silicone gel breast implants (which are filled with silicone before the surgery is performed). A single manufacturer (Poly Implant Prosthesis, France) produced a model of pre-filled saline implants which has been reported to have higher failure rates in vivo.
Saline-filled implants were most common implant used in the United States during the 1990s due to restrictions that existed on silicone implants, but were rarely used in other countries. Good to excellent results may be obtained, but as compared to silicone gel implants, saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and to be noticeable to the eye or the touch. Particularly for women with very little breast tissue, or for post-mastectomy breast reconstruction, silicone gel implants are considered as superior. In patients with more breast tissue in whom submuscular implant placement is used, saline implants can look very similar to silicone gel.
Silicone gel implants
Silicone gel-filled breast implantsThomas Cronin and Frank Gerow, two Houston, Texas, plastic surgeons, developed the first silicone breast prosthesis with the Dow Corning Corporation in 1961. The first woman was implanted in 1962. Silicone implants are generally described in terms of five generations which segregate common characteristics of manufacturing techniques.
First generation
Original Cronin-Gerow Implant from 1963. Note Dacron patch and anatomic "tear drop" shape.The Cronin-Gerow implants were made of a tear drop shaped silicone rubber envelope (or sac), filled with a thick, viscous silicone gel with a Dacron patch (to reduce rotation of the implant)on the posterior shell.
Second generation
In response to surgeons' requests for softer and more lifelike implants, breast implants were redesigned in the 1970s with thinner, less cohesive gel and thinner shells. These implants had a greater tendency to rupture or "gel bleed" silicone through an intact implant shell, and complications such as capsular contracture were quite common. It was predominantly implants of this generation that were involved in the American class action-lawsuits against Dow-Corning and other manufacturers in the early 1990s.
Another development in the 1970s was a polyurethane foam coating on the implant shell which was very effective in diminishing capsular contracture by causing an inflammatory reaction that discouraged formation of fibrous tissue around the capsule. These implants were later briefly discontinued due to concern of potential carcinogenic breakdown products from the polyurethane. A review of the risk for cancer from TDA by the FDA later concluded that the risk was so small so as not to justify recommending explantation of the devices from individual patients. Polyurethane implants are still used in Europe and South America, but no manufacturer has sought FDA approval for sale in the United States. Second-generation implants also saw the introduction of various "double lumen" designs. These implants were essentially a silicone implant inside a saline implant. The double lumen was an attempt to provide the cosmetic benefits of gel in the inside lumen, while the outside lumen contained saline and its volume could be adjusted after placement. The failure rate of these implants is higher than for single lumen implants due to their more complex design. The contemporary versions of these devices ("Becker Implants") are used primarily for breast reconstruction.
Third & Fourth generation
Third & fourth generation implants, from the mid 1980s, represented sequential advances in manufacturing principles with elastomer-coated shells to decrease gel bleed, and are filled with thicker, more cohesive gel. The increased cohesion of the gel filler reduced potential leakage of the gel compared to earlier devices and the more substantial shell improved durability as compared to 2nd generation implants. A variety of both round and tapered anatomic shapes are available from different implants in this group. The anatomic or shaped implants are uniformly impregnated with a textured surface to reduce rotation, while round devices are available in both smooth or textured surfaces.
Fifth generation
Evaluation of "gummy bear" or solid, high-cohesive, form-stable implants is in preliminary stages in the United States but these implants have been widely used since the mid 1990s in other countries. The semi-solid gel in these type of implants largely eliminates the possibility of silicone migration. Studies of these devices have shown significant potential improvements in safety and efficacy over the older implants with low rates of capsular contracture and rupture.
Polypropylene breast implants
Polypropylene breast implants, also known as string breast implants, are a form of breast implant using polypropylene developed by Dr. Gerald W. Johnson. Due to a number of medical complications, the device has been banned in the European Union and United States. They work by absorbing fluid and expanding inside the body, resulting in extreme breast sizes.
They are rarely seen outside of the adult entertainment industry.
US FDA Approval
Silicone gel-filled breast implants were first introduced in the United States 1962 by Cronin and Gerow. As a response to reports of implant failure and allegations of resultant complications and illness, in 1988 the USFDA announced that all breast implants would be subsequently relabeled as class III medical devices, and called for data from manufacturers showing the safety and effectiveness of these devices. In 1992, the FDA placed a moratorium on silicone gel breast implants for cosmetic purposes. The FDA concluded there was "inadequate information to demonstrate that breast implants were safe and effective." Access to silicone gel-filled breast implants continued to be allowed under controlled clinical studies for reconstruction after mastectomy, correction of congenital deformities, or replacement of ruptured silicone gel-filled implants due to medical or surgical reasons. Implant manufacturers were required to collect clinical trial data and were allowed distribution of the implants to a limited number of augmentation patients for these studies. In mid-1992, the FDA approved adjunct study protocol for silicone gel-filled breast implants for reconstruction and revision patients. That same year, silicone and breast implant manufacturer, Dow Corning, announced that it would no longer make five implant grades of silicone, but that it would continue to manufacture 45 other medical grades of silicone materials. Just three years later, in 1995, Dow Corning Corp., once the major manufacturer of silicone breast and other implants, faced 19,000 lawsuits, pushing it into bankruptcy.
In 1997, the Department of Health and Human Services (HHS) began one of the most extensive research studies in medical history by appointing the Institute of Medicine of the National Academy of Science (IOM) to examine potential complications during or after surgery. After reviewing years of evidence and research concerning silicone gel-filled breast implants, the IOM found that "Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants." Most individual studies and all systemic review studies have also subsequently failed to find a link between silicone breast implants and disease.
In 1998, the FDA approved adjunct study protocols for silicone gel-filled breast implants for reconstruction and revision patients only and also approved, later that same year, the corporation's IDE study for silicone gel-filled breast implants for a limited number of augmentation, reconstruction, and revision patients.
In 1999, the IOM released a comprehensive report on both saline-filled and silicone gel-filled breast implants entitled Safety of Silicone Breast Implants. The determination was that there was insufficient evidence to establish that either or both types of breast implants cause systemic health effects and that there was no new health or safety issues associated with the use of both types of implants. The IOM concluded that local complications are "the primary safety issue with silicone breast implants", making a clear distinction between local complications and systemic health concerns. Bothersome results such as rupture, pain, capsular contracture, disfigurement, and infection, were stated to be possible local complications that could require medical intervention or repeat surgeries.
In 2000, the FDA granted approval of saline-filled breast implant PMAs, showing data on the types and rates of local complications experienced by patients. "Despite complications experienced by some women, the majority of those women still in the Inamed Corporation and Mentor Corporation studies after three years reported being satisfied with their implants." Both PMAs were approved for breast augmentation to females of at least 18 years of age and for breast reconstruction.
The manufacturers continued to improve their gel-filled products, developing more cohesive gel implant, and continued with their studies. In November 2006, the FDA approved the new and improved silicone gel-filled breast implants produced by the two manufacturers for breast reconstruction and for cosmetic breast augmentation. The approval was given with a number of conditions including a requirement to complete 10-year studies on women who have already received the implants and a 10 year study on the safety of the devices in 40,000 women. The post-approval studies will be closely monitored by the FDA. The FDA warned that the implants are not without risk and that women receiving implants should be suggested to have periodic MRI exams to watch for any signs of rupture or leakage. It was also mandated that patients be given brochures explaining the risks.
Currently the FDA has approved silicone gel-filled breast implants and over a million women around the world have already received these implants.
Implant pocket placement
Diagrams of cross sections of breast implants, subglandular (left) and submuscular (right)The placement of implants is described in relation to the pectoralis major muscle.
Subglandular- implant between the breast tissue and the pectoralis muscle. This position closely resembles the plane of normal breast tissue and is felt by many to achieve the most aesthetic results. The subglandular position in patients with thin soft-tissue coverage is most likely to show ripples or wrinkles of the underlying implant. Capsular contracture rates are also slightly higher with this approach, and placement of implants in this pocket might be inappropriate in women who are at risk for capsule formation (smokers, multiple breast surgeries).
Subfascial - the implant is placed in the subglandular position, but underneath the fascia of the pectoralis muscle. The benefits of this technique are debated, but proponents believe the (sometimes thick) fascial sheet of tissue may help with coverage and sustaining positioning of the implant. Implants that undergo capsular contraction are unlikely to displace upward or toward the underarm.
Subpectoral ("dual plane") - the implant is placed underneath the pectoralis major muscle after releasing the inferior muscular attachments. As a result, the implant is partially beneath the pectoralis in the upper pole, while the lower half of the implant is in the subglandular plane. This is the most common technique in North America and achieves maximal upper implant coverage while allowing expansion of the lower pole. Animation or movement of the implants in the subpectoral plane can be excessive to some patients.
A new technique for lowering the breast fold was developed to help round and enhance cleavage of the inner lower portion of the breast. This has proven to be especially helpful for women with wide cleavage, a high breast fold (constriction of the lower portion of the breast), lateral flare of the breasts and when oversized implants are planned to help prevent "bottoming out." In this technique a muscular sling of pectoralis major is developed to help protect the implant from drifting too low in the breast fold.
Submuscular - the implant is placed below the pectoralis without release of the inferior origin of the muscle. Total muscular coverage may be achieved by releasing the lateral chest wall muscles (serratus and/or pectoralis minor) and sewn to the pectoralis major. This technique is most commonly used for maximal coverage of implants used in breast reconstruction.
Recovery
Depending on the level of activity required, patients are generally able to resume normal activity in approximately one week's time. Women who have their implants placed underneath the muscle (submuscular placement) will generally have a longer recovery time and experience slightly more pain due to the muscle being cut during surgery. Exercise and strenuous physical activity will often need to be avoided for up to six weeks.
During initial recovery arm movement is encouraged to help lessen the discomfort. Pain catheters have been shown to be safe and effective. Scars from a breast augmentation surgery will last six weeks or longer and usually begin to fade several months after surgery.
Repair or revision surgery
Regardless of the type of implant, it is likely that women with implants will need to have one or more additional surgeries (re-operations) over the course of their lives. Breast implants do not last forever. According to studies conducted by implant companies for the U.S. FDA, they sometimes only last a few years. Most common indications for re-operations have included major or minor complications, capsular contracture treatment, and replacement of ruptured/deflated implants. Re-operation rates are predictably more frequent in breast reconstruction cases due to the dramatic changes in the soft-tissue envelope and anatomical breast borders after mastectomy, particularly when patients have received adjuvant XRT. Breast cancer patients also frequently undergo staged procedures for reconstruction of the nipple-areola complex (NAC) and symmetry procedures on the opposite breast.
It appears that re-operation rates in cosmetic cases can be improved by more carefully matching individual patients' soft-tissue characteristics to the type and size of implants used. Using appropriate device selection and proper technique, re-operation rates at up to seven years followup have been reported as low as 3%, as compared with the 20 percent re-operation rate at 3 years in the most recent Food and Drug Administration study.
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