By most estimates almost 2 million women in this country have had an augmentation mammoplasty. Breast augmentation has been one of the most gratifying cosmetic operations from the standpoint of both the patient and the surgeon, and until recent controversies over the safety of silicone implants, it was the most common cosmetic surgical operation carried out in the United States. Although every operation involves some risks, breast augmentation is generally not considered to be high risk.

While breast augmentation will enlarge the breasts, it will not alter basic asymmetries in breast shape or form. Major variations may be improved, but will not be corrected. Slight differences in the size or shape of the two breasts are considered normal, and should not be a cause for concern. Long experience with this operation has demonstrated highly satisfactory results for the majority of patients who are considered suitable candidates for the surgery.

Modern silicone prostheses have been in use for thirty years. Both silicone gel and saline filled implants have been available. There have been innumerable media reports, and even some medical reports of patients with implants developing a neurological disease or connective tissue problems, suggesting that there might be a connection between the two; however, we know of no true scientific data to support this causal relationship. Extensive studies have been carried out, and there has, so far, been no evidence that the implants or silicone have any relationship to breast cancer, or systemic illnesses in patients. At the present time, in the United States, surgeons and patients are restricted to the use of saline filled implants for primary augmentations. Many recent studies have confirmed the safety of silicone breast implants. Specifically, patients with breast implants have no higher incidence of auto immune or connective tissue disease such as rheumatoid arthritis, scleraderma or lupus, in comparison with the general population.

Breast implants are available in a round or teardrop shape, with a smooth or textured surface. The procedure may be performed using intravenous sedation with local anesthesia, or with general anesthesia. The incision may be placed in one of three locations: Under the breast in the inframammary crease, under the areola (the pigmented skin around the nipple), or in the axilla (armpit). The implant is placed under the breast tissue and on top of or under the pectoralis muscle. You and your surgeon will make the final decision regarding which approach, or which placement to use.

After the procedure, you will be advised regarding wound care, bra selection, and follow-up. You may be asked to take it easy and remain quiet the night of surgery as bleeding around the implant can occasionally occur. It usually takes about 2-4 weeks for swelling and discoloration to subside, and for you to return to a normal activity level.

Postoperative bleeding is one possible complication. If this occurs, it will usually be within the first couple of days, and may require another operation to remove a collection of blood (hematoma). Infection is very uncommon, but should it occur adjacent to the implant, it might be necessary to remove the implant to resolve the infection. A fairly common problem that can occur with breast implants is related to the natural tissue capsule that forms around the implant within the body. Even though a capsule forms most of the time, only occasionally does it thicken or contract causing unnatural firmness and/or shape to the breast. In severe cases, it can also cause pain or discomfort and can lead to the formation of fine calcium deposits. In early cases, capsule formation can be corrected by gentle external massage, but in more severe cases, further surgery is required. This condition is called capsular contracture. In the past, surgeons often recommended firm compression to treat capsular contractures, a maneuver called closed capsulotomy. This is no longer recommended in most situations, because of the risk of breaking the outer shell of the implant. After augmentation mammoplasty, many patients have breast fed without difficulty, and occasionally, stretch marks can develop.

Breast implants have never been shown to cause any form of cancer in women. Implants do make mammography somewhat more difficult to interpret. This was true more pertinently with silicone gel filled implants. If you are having a mammogram, advise your radiographer about your implants so that the mammogram technique can be modified to include the extra views recommended.

Recently, some health insurance providers are excluding coverage for breast disease if a patient has had breast implants. There is no medical substantiation for this at the present time. In spite of the potential problems, most women who have had this surgery are very happy with the results. They report feeling better about themselves, and having improved self-esteem.