Who is a Good Candidate for Breast Implants?

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For the past decade, breast enlargement (augmentation mammoplasty) has been the  most common surgical cosmetic operation performed in the United States—over 285,000 women requested this operation in 2014, up 183 percent from 1997 [American Society for Aesthetic Plastic Surgeons Data].  Since 2004, breast enlargement has been the most common operation performed at Minneapolis Plastic Surgery, Ltd.; every year several hundred patients undergo this one-hour outpatient operation in our AAAASF-accredited office surgical facility.  Superior anesthesia care (TIVA), advanced surgical techniques, the care of my fantastic nursing and office staff, and over 28 years of experience allow my breast implant patients to return to everyday activities within 24 hours, and strenuous activities within several weeks.

But how do you know if this operation is for you?

Some women who choose breast enlargement do so to restore breast volume lost as a result of pregnancy, breastfeeding, weight loss, or aging.  Others request this outpatient operation to improve symmetry in breasts that have never matched in size, and many women simply seek the improvement in self-image or clothing fit that fuller breast size gives them.  For some women, breast lift surgery with or without implants may give a superior result.  Examination and measurements will immediately tell us if breast lifting is necessary, or if excellent results can be obtained with breast implants alone.

Your pregnancy, breastfeeding, and mammographic history are important, as is physical examination of your breasts, nipple-areola position, measurements, and skin and muscle tone. Mild to moderate ptosis (breast droop or sagging of the skin caused by loss of breast volume after pregnancy or breastfeeding, and normal to slightly low nipple-areola position) can usually be corrected with implants alone (standard breast augmentation).  If the ptosis is more severe, or if nipple position is below the inframammary crease, a breast lift (mastopexy) procedure will likely be necessary. After examination, I can determine the exact type of breast lift that is recommended and explain the additional incisions and resultant permanent scars that are involved.  Breast lift surgery (with or without breast implants) requires additional operating time, incisions, and cost, but can correct more severe drooping or sagging of the breast skin, as well as raise nipple position.  This is done without removal of the nipple-areola complex (though there is a scar around the areola to reposition it higher on the chest), which can preserve both sensation and ability to breast feed in about 85% of patients undergoing breast lift surgery.

Other conditions such as nipple inversion, tuberous breasts, significant asymmetry, Poland's syndrome, or problems from prior surgery, can also be corrected or improved.

Whatever the reason for requesting information about breast augmentation, you must understand that this operation is appropriate for you if and only if:
• You have realistic expectations regarding potential risks vs. benefits.
• Your breast development is complete (for younger women).
• You have decided to undergo this operation to feel better about yourself, not to live up to the expectations of anyone else.
• You are not pregnant or breastfeeding.

Basic Facts

• Breast implants do not increase the risk of developing breast cancer.
• Mammography and breast self-examination can be performed on augmented breasts.
• Skillfully augmented breasts both look and feel normal in the majority of women.
• Breast implants do not harden, nor do they automatically need replacement after ten years.
• Nipple sensation and the ability to breast-feed are preserved in most patients.
• Breast implants (both silicone gel and saline) do not cause or increase the risk of developing arthritis, lupus, scleroderma, or connective tissue diseases.
• Saline implant leakage and deflation is uncommon and can be dealt with when it does occur.
• Silicone gel implants are FDA-approved for use in first-time cosmetic breast enlargement patients.  They are “cohesive” and cannot leak or deflate.

Many women wonder if they should wait until their family is complete before undergoing breast augmentation.  Certainly, pregnancy and breast-feeding change the breast skin, shape, and size; these are common reasons many women choose to have this surgery.  Should a woman who has never had a child (and plans to in the future), or a woman who wishes to have more children later, undergo augmentation mammoplasty?
    
Since breast implants are in most cases placed beneath the chest (pectoralis major) muscle, and in all cases beneath the breast itself, the presence of implants does not interfere with the function of the breasts.  Whatever breast tissue a woman has prior to breast enlargement surgery will swell and respond to the normal hormonal changes of pregnancy and later breast-feeding.  The degree of enlargement, skin stretch and later droop or sagging is as individual as each woman.  A patient who had breast augmentation prior to pregnancy may choose to undergo a breast lift when her family is complete, just as the woman without breast implants.  Others may simply choose a slightly larger implant to further fill the stretched skin brassiere.  Or, you can indeed wait until your family is complete, and then undergo augmentation to obtain desired breast size, or augmentation plus mastopexy if a lift is needed in addition to restoring volume. 

What you need to know is that it is safe and appropriate to choose either way, whichever is best for you.
Breast augmentation does not generally affect the ability to breast feed.  One study shows that about 54% of women without implants reported problems nursing.  93% of breast augmentation patients had their children before undergoing the procedure, so nursing was not an issue. Of the 7% who had children and nursed them after augmentation, 50% reported problems, essentially the same number as those without implants.

Activity Restrictions and Time Off Work

Virtually every patient can resume normal everyday activities within 24 hours after surgery, including showering, doing one’s hair or applying cosmetics, dressing, eating normal meals, and moving about the house. You should avoid stretching or repetitive activities that might raise your pulse or blood pressure, which can increase the risk of bleeding and re-operation.  Our superior anesthesia protocols (TIVA), as well as careful, minimal-trauma surgery may allow most patients to feel well enough to go out for pizza on the way home from surgery, or to go dancing the next day.  But really, this makes no sense, since every patient having an operation must heal tissues and seal blood vessels.  The less strenuous activity you engage in, the less likelihood of bleeding, bruising, discomfort, capsular contracture, or re-operation.  Taking things easy, even if you feel great, is an investment in your final cosmetic result!

If you work outside the home and do not lift, strain, or elevate your pulse or blood pressure, you may return to work in 2-3 days, but many patients feel most comfortable taking a week off, even with “light duty” jobs. You may find that you have less endurance with full or extended hours at work—don’t push yourself; you (and your boss, if you’re not the boss herself) will appreciate this for the first week or two.

You should avoid exercising, lifting, or strenuous activity for a full two weeks following surgery, to limit the possibility of bleeding.  If you have bleeding, re operation is necessary to remove the blood, cauterize or suture the source, and resuture the incision.  Most patients prefer to reduce activities rather than risk re operation and the higher rate of capsular contracture that may result if this occurs.  You should avoid anything that might increase your blood pressure or cause your pulse to elevate.  This generally means no exercise or other strenuous activity for the first two weeks.  Jogging, horseback riding, weightlifting (bench press, military press, curls, etc.), yoga, or any activities that bounce the breasts or stretch the chest muscles should be avoided for a full month.

Return to more physical work based on the activity levels required at your job, and resume exercise or strenuous activity gradually, no sooner than the two weeks discussed above.   Vigorous sexual activity should be avoided for four weeks to decrease the risk of bleeding, re operation, and/or capsular contracture. Your bleeding risk is actually highest 10 to 27 days AFTER surgery, as pain and soreness resolve, and activities naturally increase.

So if fuller or restored breast volume is something you have considered, call an ABPS-certified plastic surgeon for an appointment. We would be happy to continue the discussion! Dr. Tholen
 
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Minneapolis Plastic Surgeon