Breast augmentation is a popular method of rejuvenating the breast following pregnancy, normal aging, weight loss, or simply to increase or balance your current breast size. The procedure involves inserting a prosthesis (implant) which is filled with either sterile saline (salt water) or silicone. All implants available in Canada have been proven safe and have been in use for many years. Never the less there are several issues which must be discussed when considering breast augmentation.
During your consultation we will discuss the issues of:
Location of implant placement (above or below the muscle);
Future breast surveillance ie mammograms;
Types of implants;
Size of implant;
Need for possible breast lift (mastopexy).
Breast augmentation can have a significant impact on your self esteem and confidence. As a woman herself, Dr Fortin can relate to the sensitive nature of this issue. She realizes that in contrast to the many ‘augmented’ images seen in magazines and on the internet most women are interested in a ‘natural’ improvement in their body. Her goal is to obtain a beautiful, natural result that will not garner attention as ‘fake’.
A good candidate for breast augmentation is a healthy woman in good physical shape; she may have small breasts relative to her frame; and be looking for a more ‘perky’ appearance. Women looking for the appearance achieved when wearing a ‘push-up bra’ or those moms looking to regain the fullness achieved when they were nursing or pre-children. Augmentation and/or mastopexy is often a key feature of the ‘mommy makeover’.
Recovery from breast augmentation is typically 1-2 weeks for pain and being able to return to work. Final result may take 1-3 months for implant settling and swelling to subside.
The two categories of implants available in Canada include saline and silicone implants. Both implants have a silicone shell (outer layer); the fill is the only difference. Both types of fill have been proven safe and have been used in Canada for many years.
Saline implants are filled with saline, or salt water. They tend to have a little more ‘rippling’ and palpability (meaning you can feel the edges) of the implant. This is especially notable in thin women with minimal breast tissue to camouflage the implant. It can be seen on the upper aspect of the breast as well as the lower outer area of the breast. Saline implants do have a slightly lower rate of capsular contracture than silicone implants. If these implant get a leak in them, they will deflate and this would likely lead you to exchange the implant for a new one. Always look into your manufacturer’s warranty details regarding financing for such complications.
Silicone implants are likely the most widely and thoroughly studied implantable device known to man. The 1990s had significant controversy regarding implants and as a result they have been improved and studied extensively. Most importantly, they have been proven safe. Once examined by the patient and compared to saline implants they are often chosen by augmentation candidates because of their softer and more natural feel.
Both saline and silicone implants can have a natural appearance. The key is in selecting the right size and projection for your body. You should spend a good amount of time in selecting the size that you think you will be happy with.
Implants also come in smooth or rough textures. The rough texturing is important when using shaped (tear-drop) implants to keep them in the correct position/orientation. However the texturing is also thought to help protect against capsular contracture.
Implants are a man-made device and as such are subject to mechanical failure. Usually a 2% rate of leakage is quoted but unless your implant actually deflates it does not require regular maintenance or replacement. Silicone implants that are suspected of leaking do not always require replacement. This can be discussed further should the need arise.
There are two manufacturers of breast implants in Canada, you may visit their websites at:
www.mentorwwllc.com/global-ca/ and www.allergan.ca/products/natrelle.htm.
These sites contain information pertinent to warranties and product information.
The two main incisions I recommend for breast augmentation are:
1) inframammary crease (the crease below the breast);
The incision in the natural crease beneath the breast is most often used as it is able to preserve the majority of the nerves (ie sensation) to the breast and nipple, and it is hidden in an inconspicuous location. It also facilitates any future revision surgery which can be more difficult to do through other locations.
2) peri-areolar (around the nipple);
The incision around the nipple has two disadvantages that are worth noting, firstly that you must cut through some of the breast tissue and ducts which may harbour bacteria, thereby increasing your risk of infection and or capsular contracture. Secondly cutting near the nipple can impact the sensation, contour, and potentially leave a prominent scar.
Other incisions are possible but I do not recommend them.
Placing the implant into the breast pocket can actually be done in one of two locations: either above or below the pectoralis muscle.
The breast that has very little tissue may benefit from placing the implant below the muscle for added layer of camouflage of the implant. The submuscular location has the added benefit of lowering the risk of capsular contracture around the implant because of the continual implant massage. The disadvantage of placing the implant below the muscle is that with muscle use (ie arm movement) the implant will be displaced (moved) down and outwards. This may be distressing to some women, particularly notable in the gym or with pushups etc. In breasts that are quite ptotic (droopy) a lift (mastopexy) may be required in addition to keep the breast tissue on top of the implant.
Placing the implant in the subglandular position (above the muscle) is a very natural plane as it is actually directly behind the breast tissue and does not disturb the muscle. It is a much less painful procedure than going behind the muscle and can be a very good option for women with adequate breast tissue to camouflage the implant and with good skin quality that will avoid stretching out once the implant is placed.
Infection is a rare but feared complication whenever a medical device is placed into a patient (ie hip replacement, heart valves etc). This applies to breast implants as well, because these devices are ‘not alive’ the bacteria are able to latch onto the implants and effectively stay away from the antibiotics that we would usually give to treat the infection. In this ‘safe zone’ the blood supply can’t deliver the antibiotics to effectively treat the infection. In the worst case scenarios implants must be removed to get rid of the infection. They usually wouldn’t be replaced until >3 months afterwards. Again it is important to know your implant warranty with regards to added costs if this were to happen. The original implant cannot be re-used.
It is important to contact our office immediately if there is any concern of infection, this may include increasing pain, redness, fever or pus.
Any surgery is associated with scars; breast implants create round scars and as a result if these scars tighten with time they can create a very hard, round and sometimes even painful implant. It is said everyone has a capsule, that is just the normal scar. It would be graded initially as grade 1, however, as it gets tighter and harder it can progress to Grade 3 or 4 which is painful and would likely require a surgical revision. Revision cannot guarantee that the contracture won’t recur but it is our best treatment option, besides removing the implant permanently. Other factors that may play a role in developing capsular contracture include infection, smooth implant texture, silicone implants. Breast implant massage is advised and will be demonstrated to you in clinic.
After placement of breast implants it is still advisable to have regular mammograms. You must advise the technician that you have breast implants as they employ special displacement techniques to get the best view of the breast tissue during the test. Breast implants have not been associated with increased rates of breast cancer nor later detection. Self breast examination is the best way of continued surveillance.
Several factors are considered when advising you in selecting your breast implant size. Your chest width, breast tissue volume and your desires are all considered. After your consultation you will have a ‘ball-park’ of what size is appropriate and we encourage you to think about the size carefully before making your final selection.
Mastopexy is the term for breast lift. Various degrees of ‘lifting’ may be required depending on how droopy or ptotic the breast has become. The aim of the surgery is to reshape the breast and make it more perky while at the same time lifting the nipple to a central position. The extent of lift is proportional to the length of scar that will result after the surgery. For example, a very small lift will require only a small amount of scar, the minimal would be around the nipple-areola. Most lifts require the lollipop scar (around the nipple and down the centre of the breast). Extensive lifts require a full anchor scar (around the nipple, down the centre and along the crease beneath the breast). Size discrepancies can be addressed by removing a proportional amount of breast tissue or adding an implant at the time of surgery.
On some occasions mastopexy can be combined with breast augmentation to obtain an optimal result in breast rejuvenation. This option must be discussed in detail and in some cases may be done in a staged fashion.