Breast Implants

What are breast implants? Why do I need breast implants? How does breast implant surgery work? What are the risks associated with breast implants? What is silicone? How long have silicone breast implants been in use? Are breast implants regarded as lifetime devices? What are the main reasons for having my implants removed? Are breast implants subject to strain or rupture while traveling in aircraft? Is breast implant surgery painful? When can I return to work after implant surgery? Will my insurance pay for breast implantation? Who is not eligible for breast implants? What are breast implants? There are two basic types of implants: saline filled and silicone gel-filled breast implants. Both types have the same basic type of outer envelope made of a solid, rubber-like form of silicone called an elastomer. Saline filled implants These implants are made of an elastomer silicone envelope, which is surgically implanted under your tissues, and then filled with sterile saline, a salt-water solution, through a valve. Silicone gel-filled implants These implants are made of an elastomer envelope pre-filled (prior to surgery) with a clear, sticky, thick jellylike form of silicone that approximates the consistency of breast tissue. Silicone gel implants come in many sizes. The size used depends on the amount of augmentation desired or the size the reconstructed breast is to be. Presently, saline filled implants are available to all patients from only the Mentor Corporation and McGhan Medical. Silicone gel-filled breast implants are available to women through two FDA-approved studies, an adjunct study and an investigational device exemptions (IDE) study. http://www.fda.gov/cdrh/breastimplants/biavail.html Back to Top

Why do I need breast implants? The reasons for deciding to undergo a breast implant operation are as varied as the number of women who have the operation. The common thread amongst these women is a profound desire to improve their quality of life. In 1990 the American Society of Plastic and Reconstructive Surgeons (ASPRS) conducted a survey of women who had breast implants indicating that the overwhelming majority of women succeeded in improving the quality of their lives. The 592 women who completed the survey had had their implants for an average of eight years. 65% of the women who respond had implants for cosmetic enlargement and 35% for

reconstruction. 92.5% said they were satisfied with their implants 82% said they would do it again without a doubt 16% said they would probably do it again 2% said they would definitely not do it again Back to Top

How does breast implant surgery work? Augmentation Breast implant surgery for breast augmentation involves making a single incision in or near the breast and inserting the implant either between the breast and the chest muscle (subglandular placement) or behind the chest muscle (submuscular placement). Subgladular placement this placement may make surgery and recovery shorter, may be less painful, and may be easier to access for re-operation than the submuscular placement. However, this placement may result in more noticeable implants, more capsular contracture, and more difficult imaging of the breast with mammography. Submuscular placement This placement may make surgery last longer, may make recovery longer, may be more painful, and may make it more difficult to have some re-operation procedures than the subglandular placement. The possible benefits of this placement are that it may result in less noticeable implants, less capsular contracture, and easier imaging of the breast with mammography. Once you choose the placement of your breast implant, it is necessary for you to determine the location of the incision site. The location of the incision depends upon your body type and your personal preference. You can choose to have the incision, around your nipple (periareolar incision), underneath your breast (inframammary incision), or near your armpit (transaxillary incision). If the incision is made under the arm, the surgeon may use a probe fitted with a miniature camera, along with minimally invasive (very small) instruments, to create a "pocket" for the breast implant. Periareolar This incision is the most concealed, but is associated with a higher likelihood of inability to successfully breastfeed, as compared to the other incision sites. Inframammary This incision is less concealed than periareolar and associated with less difficulty than the periareolar incision site when breast-feeding. Axillary This incision is less concealed than periareolar and associated with less difficulty than the periareolar incision site when breastfeeding.

The breast implant surgery itself may be done either under local or general anesthesia in the hospital, a surgical center, or in the physicians office. The procedure is usually done as one-day outpatient surgery; however, for some women an overnight stay is recommended. The procedure takes two hours or more, depending on whether the implant goes above or beneath the muscle. First, the surgeon creates a pocket-a space between the tissues-to accommodate the implant. After inserting the implant, he or she closes the pocket and sutures the tissues in place. Then either a surgical bra or bandage is placed over the incision. Post surgical swelling is to be expected, as is some pain and discomfort. Most women return to work and resume non-strenuous activities, such as driving, about a week to ten days after surgery. Reconstruction The following description applies to reconstruction following mastectomy, but similar considerations apply to reconstruction following breast trauma or for reconstruction for congenital defects. The procedure for breast implant reconstructive surgery differs from that of augmentation surgery. Following your mastectomy you have a choice, you can choose to have immediate reconstruction or delayed reconstruction. Immediate reconstruction occasionally involves placement of a breast implant directly after your mastectomy; however, it usually involves placement of a tissue expander that will eventually be replaced by an implant. Immediate reconstruction There are two potential advantages to immediate reconstruction: your breast reconstruction starts at the time of your mastectomy, and there may be cost savings in combining the mastectomy procedure with the first stage of reconstruction. There are, however, some disadvantages. There may be a higher risk of complications such as deflation with immediate reconstruction, and your initial operative time and recuperative time may be longer. Delayed reconstruction The advantage to delayed reconstruction is that you can delay your reconstruction decision and surgery until other treatments; such as radiation therapy and chemotherapy are completed. Delayed reconstruction may be advisable if your surgeon anticipates healing problems with your mastectomy, or if you simply need more time to consider your options. Tissue expander During a mastectomy, the surgeon often removes skin as well as breast tissue, leaving the chest tissues flat and tight. To create a space for the breast implant, a tissue expander is placed under the remaining chest tissues. The tissue expander, like an implant, has a rubber silicone outer shell. Generally, the tissue expander is surgically inserted through a small incision in the mastectomy scar. Over the course of several months, the surgeon adds small amounts of saline through a special tube. The expander gradually inflates, gently expanding the skin and muscle by stimulating the growth of healthy new tissue, much as a baby gradually expands a mother's stomach. This procedure creates a more natural appearance and may reduce the risk of capsular contracture. When sufficient tissue has been created, the temporary expander is surgically removed and a more permanent implant is inserted. The surgery to replace the

tissue expander with a breast implant is usually done under general anesthesia in an operating room. It may require a brief hospital stay or be done on an outpatient basis. Tissue-Transfer Surgeries Breast reconstruction may be achieved without any implants at all by surgically moving a section of skin, fat and muscle from one area of your body to another. The section of tissue may be taken from such areas as your abdomen, upper back, upper hip, or buttocks. The tissue flap may be left attached to the blood supply and moved to the breast area through a tunnel under the skin (a pedicled flap), or it may be removed completely and reattached to the breast area by microsurgical techniques (a free flap). Operating time is generally longer with free flaps, because of the microsurgical requirements. Flap surgery has both advantages and disadvantages. Flap surgery creates breasts with a more natural shape and feel, and allows reconstruction in women who have so little skin or such tight, irradiated skin that reconstruction would otherwise be impossible or unsatisfactory. However, flap surgery requires a hospital stay of several days and generally a longer recovery time than implant reconstruction. Flap surgery also creates scars at the site where the flap was taken and possibly on the reconstructed breast. Flap surgery is a major operation, and it is more extensive than your mastectomy operation. It requires good general health and strong emotional motivation. If you are very overweight, have uncontrolled cancer, or have other severe medical problems, this surgery may be too risky for you. Also, if you are very thin, you may not have enough tissue in your abdomen or back to create a breast mound with this method. The two most common types of tissue flaps are the TRAM (transverse rectus abdominus musculocutaneous flap, from the abdomen) and the Latissimus dorsi flap (which uses tissue from the upper back). TRAM flap In this procedure, the surgeon creates a flap using skin, fat, and one or both of the rectus abdominis (abdomen) muscles. This pair of muscles extends the length of the front of the stomach and flexes the spinal column, tenses the stomach and intestine walls, and helps press the contents of the stomach and intestines. There are two types of TRAM flap procedures, pedicle and free flap. In the pedicle TRAM flap procedure, the flap remains attached to the original blood supply and is tunneled through the abdomen up to the breast area. In the free-flap procedure, the tissue is detached from the abdominal blood supply and reconnected to the blood vessels in the armpit using microvascular surgery. The pedicle TRAM flap procedure typically takes three to six hours of surgery under general anesthesia; a free TRAM flap procedure generally takes longer. Typically, the hospital stay is two to five days. You can generally resume normal activity after six to eight weeks. You may have temporary or permanent muscle weakness in the abdominal area. If you are considering a pregnancy after your reconstruction, you should discuss this with your surgeon.

Latissimus dorsi flap In this procedure, the surgeon moves a section of tissue from your back to your chest to reconstruct the breast. The surgeon creates a flap from your skin, fat, and the latissimus dorsi muscle - the broad, flat, triangular-shaped back muscle that moves the arm, draws the shoulder back and down, and helps draw the body up when climbing. The flap is then tunneled inside the body from the back to the front of the chest. The skin and muscle remain partly attached to the blood and nerve supply. The tissue flap is then set into the mastectomy site and sutured in place. The Latissimus Dorsi flap is usually thinner and smaller than the TRAM flap, and therefore this procedure may be more appropriate for reconstructing a smaller breast. The Latissimus Dorsi flap procedure typically takes two to four hours of surgery under general anesthesia. Generally, the hospital stay is two to three days. You can resume daily activity after two to three weeks. You may have some temporary or permanent muscle weakness and difficulty with movement in your back and shoulder. You will have a scar on your back, which can usually be hidden in the bra line. You may also have additional scars on your reconstructed breast. Back to Top

What are the risks associated with breast implants? Capsular Contracture During capsular contracture, the scar tissue or capsule that normally forms around the implant tightens and squeezes. Capsular contracture is generally more common following infection, hematoma, and seroma. It is also more common amongst women who have chosen to have subglandular placement. Symptoms range from firmness and mild discomfort, to pain, distortion, palpability of the implant, and/or displacement of the implant. Additional surgery is needed in cases where pain and /or firmness is severe. This surgery ranges from removal of the implant capsule tissue to removal and possible replacement of the implant itself. In some cases, capsular contracture may happen again after these additional surgeries. Breast Feeding As far as the ability to successfully breast feed after receiving breast implants, one study reported that 64% of women with implants with were unable to breast feed compared to 7% without implants. It is thought that the periareolar incision site may significantly reduce the ability to successfully breast feed. Additional Surgeries There is a high likelihood that women who have received breast implant surgery will need to have additional surgery at some point to replace or remove their implants. Problems such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the implants. Most women choose to have their

implants replaced. For those who do not, cosmetically unacceptable dimpling and/or puckering of the breast may result. Dissatisfaction with Cosmetic Results Dissatisfying results such as wrinkling, asymmetrical implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, hypertrophic (irregular, raised scar) scarring, and/or sloshing may occur. Careful surgical planning and technique minimize, but do not always prevent results such as these. Pain Pain of varying intensity and duration may occur and persist following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain associated with nerve entrapment or interference with muscle motion. You should tell your doctor about severe pain. Infection As with any surgery, infection can occur during or after the breast implant operation. Infections with an implant present are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the implant may have to be removed. In this event you can choose to have another implant surgery once your infection has been eliminated. Interference with mammography Breast implants may delay or hinder the early detection of breast cancer either by hiding suspicious wounds, injuries, or tumors or by making it more difficult to include them in the mammogram image. Implants increase the difficulty of both taking and reading mammograms. Mammography requires breast compression that could contribute to implant rupture. For these reasons you may wish to undergo a preoperative mammogram and another mammogram six months to one year after implantation to establish a baseline. It is essential that you tell your mammography technologist that you have an implant before the procedure. The technologist can use special techniques to minimize the possibility of rupture and to get the best possible views of your breast tissue. These special techniques require more x-ray views, therefore exposing you to more radiation. The benefit of the mammogram in finding cancer outweighs the risk of the additional x-rays. Toxic Shock Syndrome In rare instances, Toxic Shock Syndrome has been noted in women after breast implant surgery. Toxic Shock Syndrome is a life-threatening condition. Symptoms include sudden fever, vomiting, diarrhea, fainting, dizziness, and/or sunburn-like rash. In this event, you should see a doctor immediately for diagnosis and treatment. Hematoma/Seroma A hematoma is a collection of blood inside a body cavity. A seroma is a collection of the watery portion of the blood (in this case, around the implant or around the incision). Postoperative hematoma and seroma may contribute to infection and/or capsular contracture. Swelling, pain, and bruising may result. If a hematoma

occurs, it will usually be soon after surgery. However, a hematoma may also occur at any time after injury to the breast. While the body absorbs small hematomas and seromas, larger ones will require the placement of surgical drains for proper healing. A small scar may result from surgical draining. Implant deflation/rupture can occur from surgical draining if damage to the implant occurs during the draining procedure. Alteration of Nipple and Breast Sensation The feeling in your nipple and breast may change following breast implant surgery. Your feeling can range from intense sensitivity to no feeling at all. These changes may be temporary or permanent. They may affect your ability to nurse a baby as well as your sexual response. Extrusion Extrusion (when the breast implant comes through the skin) may result from unstable or compromised tissue covering and/or interruption of wound healing. Calcium Deposits in the Tissue Around the Implant Deposits of calcium may be seen on mammograms and can be mistaken for cancer. In this event, it may be necessary to undergo additional surgery such as biopsy and/or removal of the implant to distinguish the calcium deposits from cancer. Necrosis Necrosis, the formation of dead tissue around the implant, may prevent wound healing and require surgical correction and/or implant removal. Permanent scar deformity may occur following necrosis. Factors associated with increased necrosis include infection, use of steroids in the surgical pocket, smoking, chemotherapy/radiation, and excessive heat or cold therapy. If you are a smoker, it is recommended that you do not smoke during the few months preceding and following your surgery. Breast Tissue Atrophy/Chest Wall Deformity The pressure of the breast implant may cause the breast tissue to thin and shrink. This can occur while implants are still in place or following implant removal without replacement. In addition to these complications, there have been concerns associating breast implantation with certain systemic diseases: Connective Tissue Disease A recent study conducted by the FDA indicates that women whose implants have ruptured and have extracapsular silicone gel (silicone outside the fibrous scar around the implant) were 2.8 times more likely than women whose breast implants havent ruptured to report that they had the soft tissue syndrome, fibromyalgia. Fibromyalgia is a syndrome characterized by widespread pain, fatigue, and sleep disturbance. The study did not show cause and effect, but a statistical association between extracapsular silicone and fibromyalgia. The study also indicated that patients with extracapsular silicone gel are not more likely than other women to have "other connective tissue disease" such as dermatomyositis, polymositis, and mixed connective tissue disease.

CancerPublished studies indicate that breast cancer is no more common in women with implants than those without implants. Second Generation Effects There have been concerns raised regarding potential damaging effects on children born of mothers with implants. A review of published literature on this issue suggests that the information is insufficient to draw definitive conclusions. Back to Top

FAQs What is Silicone? Silicone is a synthetic plastic, or polymer, that was first developed in the 1930s. It contains silicon, a naturally abundant material, combined with carbon, hydrogen, and oxygen that have been polymerized, a process in which simple molecules are combined to form more complex molecules. Silicone can be processed into three forms: a fluid, a gel, and a solid, rubber-like compound known as an elastomer. Silicone has been used in all its different forms, for medical purposes such as pacemakers, hypodermic needles, penile implants, eye lenses, and lubrication. How long have silicone breast implants been in use? Silicone breast implants became available in the early 1960s. They were vastly superior to the previous breast implants, which were made of polyurethane foam, paraffin, steel, and grafts of human tissue. The first silicone implants were firm and therefore required several large surgical incisions, leading to prominent scars. Over time the procedure has improved drastically leading to improved feel, more natural look, and much smaller incisions during surgery. Are breast implants regarded as lifetime devices? Breast implants are not regarded as lifetime devices. It is likely that you will undergo implant removal at some point over the course of your life. At this point you have the option of replacing your implant or removing your implant altogether. What are the main reasons for having my implants removed? The FDA recommends that you do not have your implants removed if you are having no physical problems. The following are the main physical problems that necessitate removal: a rupturing or leaking of your implant leading to deflation, silicone gel escaping from the implant envelope and scar capsule that is detectable in your breast or elsewhere in your body, or having a spherical capsular contraction that is hard, painful, and deforms the breast. Are breast implants subject to strain or rupture while traveling in aircraft? No, breast implants are not subject to strain or rupture while traveling in aircraft. Is breast implant surgery painful?

The pain associated with breast implant surgery depends upon which specific surgery you choose to undertake, whether you choose submuscular or subgladular placement, and your individual reaction to the surgery. In general, post surgical swelling is to be expected, as is some pain and discomfort. When can I return to work after implant surgery? Most women return to work and resume non-strenuous activities, such as driving, about a week to ten days after surgery. Will my insurance pay for breast implantation? Most insurance does cover your first breast reconstruction operation. Insurance coverage for re-operation procedures or additional doctors visits following reconstruction may not be covered, depending upon your policy. Insurance does not cover breast augmentation and may not cover re-operation and additional doctors visits following augmentation. Who is not eligible for breast implants? Women who have existing malignant or pre-malignant cancer of the breast without adequate treatment and women with active infection anywhere in the body are not eligible for breast implants. Breast implants are also contraindicated for pregnant or nursing women seeking augmentation.

Advantages & Disadvantages of Cohesive Gel Breast Implants

(Gummy Bear Breast Implants) Cohesive (left) vs. standard gel - note how the cohesive does not collapse or fold. Information & Photos courtesy of Dr. Teitelbaum of Santa Monica, CA Though they have been used for ten years in Europe, the data from the US clinical trials has not matured to the point that we can argue any of these advantages conclusively. These are what is hoped will be proven to be the advantages, but the reader should realize that these are all unproven. Shape - It does seem that these implants do maintain their shape, thereby making them able to impart their shape upon the breast. Non-form stable fillers, such as saline or standard silicone gel, are subject to the forces of gravity and of the breast, so that they assume the shape that the forces of the breast and the forces of gravity dictate. These implants have a distinct shape, and they will impart it upon the visible shape of the breast. Folds and Rippling - Since the fill does not shift from one area of the shell to the

other, shell collapse and folds do not seem to occur, even in long term follow up. Won't Leak - There are two components to this issue. One is whether the shell might break, and the other is whether the gel will leak out if the shell does break. The shell is certainly physically susceptible to breakage, but since most ruptures are believed to occur along shell folds (they result in weakening of the shell, much like a folded newspaper left in a drawer will crack along its folds), it is expected that shell failures will occur less frequently. In the largest series in the world, there has supposedly been only one shell failure in several thousand implants done in Sweden. If the shell is peeled off the implant, the cohesive gel filler will maintain its shape. I have one that I did this to several years ago, and it looks just the same as the day I did it. But, that doesn't mean that in the warmth of the body, and with the forces that act upon the implant, that the situation wouldn't be different. Another issue is diffusion; though there is a layer of the implant shell that decreases silicone diffusion, some microscopic diffusion of silicone will always occur through the shell.

MRI of a cohesive implant shows anatomic shape, free from folds that are not just visible and palpable, but worse, can be the site of shell failure.

Capsular Contracture - The European experience has been that firm scar tissue seems to occur less often with these implants (capsular contracture.) It is not clear if this will be maintained over time, or what the cause is. Some speculate that it is related to there being less diffusion of silicone than with non-cohesive fillers, while others believe it is due to the increased firmness of the implant, which inhibits the body from contracting around it. More time and study will be necessary before we know the answer to this issue. Purported Disadvantages of Cohesive Silicone Gel Breast Implants Shape - It is listed here for the same reason that it is listed as an advantage. Since it will impart its shape upon the breast, the patient and surgeon had better be sure that they are choosing an implant shape that they want the breast to have. While implant selection certainly matters with old style silicone gel and saline implants, since their shape so so affected by gravity and forces of the breast, there is a great margin for error. This is not a problem per se, but rather, this is an issue in which one must be aware of. For instance, women preferring "Baywatch"-grapefruit looking breasts may find the teardrop shape of this implant will not meet their expectations. I think this problem becomes significant only in "disproportionate" augmentations, situations in which the implant size chosen exceeds what is optimum for a patient's soft tissues. Feel - These implants do feel a little bit firmer than old style silicone gel implants (though if the old ones get a capsular contracture, they will feel firmer. Some believe that the cohesives are less likely to get such a contracture, but that is not yet

known.) How significant this is in a given patient depends upon how much breast tissue they have relative to how large an implant will be chosen, and how firm or loose their tissue feels. A rare patient will complain about the firmness, but for most patients, particularly those getting implants that are not oversized, this is not an issue. Cost - These implants do cost significantly more than saline, and several hundred dollars more per pair than old style silicone gel implants. However, if part of the study, patients will be reimbursed most of the implant cost over a period of ten years. Incision Size - Since these implants are not deformable, they cannot be squeezed through little incisions. Depending upon the size of the implant, incision length must be between 4.5-5.5 cm. It also can make insertion from around the areola difficult (I usually use the underneath incision with the cohesive implants.) Armpit incision is possible, but exceedingly difficult. Rotation - These implants only come in anatomical shapes, meaning that they project more on the bottom than they do on the top. One of the risks of such a design is that if the implant rotates in the body, it will create a distortion. Care is taken during pocket dissection and insertion in order to minimize this. It is a very rare, but very possible complication. The only way to fix it if it occurs is to remove them and replace them with a round implant. Rotation is at greater risk when the tissue is loose, for instance in a revision when a patient wants to go smaller. Gel Fracture - Since the gel is almost a solid, it can actually crack. I have only seen this happen from excessive manipulation of the implant outside of the body, but it can theoretically occur in the body. No one knows if this can actually occur, or what the consequences would be if it were to occur. My speculation is that it would not be noticed, but the answer to this is not yet known.

Advantages of Breast Augmentation

Breast augmentation can enhance appearance and boost self-confidence, but it won't necessarily change one's looks to match an "ideal" image. Before a woman decides to have surgery, she should think carefully about her expectations as well as possible outcomes, and discuss them with her surgeon. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If a woman is physically healthy and realistic in her expectations, she may be a good candidate for this surgery. It is important to discuss your individual expectations regarding the change you seek in the shape and size of your breast with your doctor who will be able to consider the optimal surgical approach to satisfy your desired outcome. Breast augmentation may be a good option for you if you have at least one the following conditions or traits:

You consider your breasts to be too small or under-developed You believe your figure is out of proportion due to small breasts and in turn, make your hips appear wider You feel you have limited choices of flattering clothing or swim wear styles due to small breasts

You are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss, or with aging You are unhappy with the upper part of the breast appearing "empty" Your breasts have asymmetry or vary in size or shape from one another You currently have breast implants, and are experiencing problems with them One or both breasts failed to develop normally, or have an unnatural, elongated shape

Breast Augmentation in Phoenix, Scottsdale and surrounding Arizona areas

Do you feel your breasts are too small, uneven, or do not have the shape you desire? If so, you may have considered breast augmentation. If your breasts never developed, if they shrank as a result of weight loss or pregnancy, or if your breasts just do not have the size or shape you desire--you may benefit from breast augmentation. Beyond improving your appearance, many women report additional benefits in terms of improved self-esteem and social or professional opportunities. If you would like to talk about the potential benefits of breast augmentation in a personal consultation, we invite you to contact Phoenix, Arizona plastic surgeon Bryan W. Gawley, M.D. today. Appearance Benefits of Breast Augmentation The primary benefit of breast augmentation is an improved appearance of your breasts. Although most people think of breast augmentation as "breast enlargement," the appearance benefits can go far beyond merely making breasts larger. Breast enlargement can improve:

Breasts that are too small Breasts that are uneven Breasts that lack fullness Poor cleavage Lack of projection Imbalanced appearance or lack of proportion And many other issues related to the shape or size of your breasts. Breast augmentation by Dr. Gawley can give you a wide range of results, from subtle and natural to dramatic and flashy. Additional Benefits of Breast Augmentation As a result of breast augmentation, many women experience additional benefits that come from an improved appearance. These benefits can include:

Improved self esteem Improved job opportunities Improved social opportunities Ability to wear new or different clothes Feeling more youthful These are just a few examples of some of the emotional benefits that women experience following breast augmentation. According to recently published surveys, about nine out of ten women had improved self esteem after breast procedures like breast augmentation. The benefits you might see depend on your personal situation and will be discussed during yourconsultation with Dr. Gawley.

Breast augmentation is not right for every woman, but if you feel your breasts are too small, are not the right shape, or don't give you the look you desire, it might be right for you. Please call or email us today to schedule a consultation with Phoenix, Arizona plastic surgeon Dr. Gawley.

The Advantages of Breast Augmentation

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There are a number of reasons to consider having a breast augmentation. For some women breast augmentation means improved self confidence and self esteem. Yet for others it is a way to reclaim their feeling of femininity. Whether you want to fill out your blouse better, restore your breast to pre-pregnancy fullness or you have had a mastectomy or injury that has caused you to loose one or both of your breasts, breast augmentation can help you feel content with who you are as a woman again. Beyond the bathing suit or the perfect little black dress, breast augmentation can help provide balance to your body making it more proportional. Not all of us are born with the ideal body to the perfect proportions, if the area that is off balance for you are your breasts and you are tired of dealing with the imbalance it is time for a consultation. Why should you go for a consultation even if you aren't sure that you want the surgery done? Simple, the doctor will sit and talk with you and get a better understanding of who you are and what it is you want to change and why. This isn't like going to the hair stylist and changing your hair style or color. This is about you being more comfortable and more confident with who you are and happy with what you see in the mirror. Talking with the doctor during your consultation will also help you understand the limitations of breast augmentation surgery. There are some things that this surgery just can't do for you. Talking with your doctor will help you not only see what augmentation can do for you, but if it can't meet your expectations the doctor will be able to go over your options with you.

It is important right now for you to answer one question. Are you doing this for you? The bottom line is that you need to consider what is going to make you happy when you look in the mirror or try on that new top. You shouldn't have this surgery done to please what someone else thinks you should look like. There are other requirements for having breast augmentation surgery. All surgery, regardless of the type is not an option for everyone. This is equally as true here. You need to be healthy and have realistic expectations of what augmentation can do for you. You also need to be an adult. It is important that before having breast augmentation that your breasts are fully developed. When preparing for your consultation, you need to be honest with yourself and your doctor if this procedure is going to help you. This is no time to sugar coat anything or be timid and shy. Explain to your doctor exactly why you are looking into have this procedure and what your expectations are (in regards to end results). At your consultation you need to be ready to discuss with your doctor when you want to have the surgery. You need to fully disclose any and medical conditions you have and are being treated for. Make sure if you are taking medications you bring a list of them with you. This list needs to include any holistic and natural supplements that you are taking. Be prepared to tell of any other surgeries you have had and if you have any family history of breast cancer as well as any results from any mammograms or breast related surgeries you have had. Then with all issues, facts and options out in the open, you and your based doctor will be able to make an informed and intelligent decision about your plans for breast augmentation. If you are considering Manhattan breast augmentation, please feel free to visit our website and request a free, no obligation consultation with Dr. Richard Swift. Article Source: http://EzineArticles.com/?expert=Andrew_W_John

Breast Augmentation (Breast Enlargement) This page gives a detailed discussion of breast enlargement.

Richard V. Dowden, M.D., C.M., F.A.C.S. Certified by the American Board of Plastic Surgery Cosmetic and Plastic Surgery, Inc. 6770 Mayfield Road, Suite 410 (Mayfield Heights) Cleveland, Ohio 44124 (440) 449-7470

Breast Augmentation (Breast Enlargement) Contents:

General Information Advantages Disadvantages Frequently Asked Questions (loads another page) Photos RE: inserting implants via the navel. (loads another page) To Home page.

General information about breast enlargement: Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:

To balance a difference in breast size To correct a reduction in breast volume after pregnancy or weight loss To enhance the body contour of a woman who feels her breast size is too small. To enlarge and help lift a breast that is excessively relaxed.

By inserting a salt-water-filled implant or silicone-gel-filled behind the woman's own breast tissue, it is possible to increase the size of the breast. The implant can be placed either in front of, or behind, the chest wall muscles. With all the woman's own breast tissue located in front of the implant, that means she can still nurse an infant, she can self-examine to check for lumps, and she can have mammograms done.

The implants can be inserted via a small incision in any of a variety of locations:

under the breast near the crease around the edge of the colored nipple-areola high in the underarm area inside the navel ('transumbilical breast augmentation' or 'TUBA') (The incision inside the navel is so tiny that this incision is suitable for saline implants only, not for silicone gel.)

Every procedure has positive aspects and negative aspects. There are advantages and disadvantages of breast enlargement, which must be considered when deciding whether the procedure is correct for the woman. In addition, patients should be aware that every operation has potential complications, which can occur in a small percentage of patients even in the best of hands.

| Back to the top | To Home page | Advantages (See Frequently-Asked Questions for details) The advantages of breast enlargement in general are:

a breast that never developed sufficiently can be made larger. a breast that lost volume with pregnancy can be made larger again. a relaxed breast is lifted to some degree. the woman is able to wear the clothing she desires. relief from having to repeatedly focus on her small breast size. often an increase in self-assurance, or a regaining of self-confidence.

There are additional advantages specific to doing the breast enlargement through the

navel:

less time under anesthesia than the other incisions. generally a faster recovery than with the other incisions. very large implants can be used because there is no breast incision that could pull open from breast skin tension. no tell-tale scar on the breast, only a tiny one inside the navel.

| Back to the top | To Home page | Further, there are additional advantages specific to doing the breast enlargement through the navel in front of the muscle:

less postoperative pain than with any other method. the recovery is more rapid than with any other method. there is no cutting in, on, or behind the breast.

the chance of any complications is the lowest of any method. there is the greatest likelihood of keeping nipple sensitivity.

| Back to the top | To Home page | And there are advantages specific to doing the breast enlargement through the navel behind the muscle:

less postoperative pain via navel than with other behind-the-muscle incisions. the recovery is more rapid via navel than with other behind-the-muscle incisions. with the navel method, there is no cutting of, in, on, or behind the breast.

| Back to the top | To Home page | Disadvantages (See Frequently Asked Questions for details) The disadvantages of breast enlargement in general are:

there must be a permanent scar someplace. mammograms require special techniques, take longer to perform, and longer to read. a possibility of firmness due to internal scar tissue hardening, called capsular contracture. the definite certainty of implant failure at some future time, both saline and silicone. a possibility of permanent nipple numbness.

There are disadvantages specific to doing the breast enlargement through the navel:

can only use saline-filled implants, not silicone-gel filled. can not use pre-filled saline implants. can not correct severe breast deformities.

isadvantages of Breast Implants

If you've ever considered getting breast implants, there are plenty of advantages, sure. But there are also disadvantages and potential problems and difficulties that should be taken into consideration when making this weighty choice in one's life. Disadvantages of Breast Implants:

Unnatural look and feel ("inflated balloon" - this artificial look is quite common). This can actually be offset by a great surgeon and also the knowledge the patient has of their own body, and not taking things too far when it comes to size. Most doctors will not encourage a patient to go way to big since this often results in a tight, unnatural look that most patients wouldn't be as happy with unless that was the look they were going for. Artificial is bad, natural breast enhancement can be good! Breast implants tend to feel hard when you are cold or when you have not massaged them in a few hours, at least this has been the experience of some women. You have to consistently keep up with massaging them, or they do feel hard to the touch, and are almost uncomfortable to have in your chest. They also look very unnatural when lying down, as they stick up obviously, unlike natural breasts that "lay down with you" when you lie on your back. Rippling effect (the breast implant takes on a rippled look on the side of the breast which is very visible) Scar tissue around the implants, which in turn causes the breasts to feel and look hard and artificial. It can also be a very painful condition if it's severe, and can even require surgery to get the scar tissue removed, and at it's worst, may require the implants to be removed. A serious disadvantage! Price is high for most people to afford without taking out a small loan or getting some other sort of assistance. Recurring price of implant replacement every 10 years (you may not know this, but the implant needs to be replaced every ten years - this means another surgery of course) Massaging of breasts several times a day is required to keep the implant pliable, looking natural, feeling comfortable, and preventing hardness (even this is not enough to keep them from feeling hard and unnatural many times) Scarring of areola, underarm, or wherever else you choose to have the implant inserted which can make the fact that one has gotten implants more conspicuous, when most women want it to be very discrete and natural looking. Also, if the scar areas are not properly cared for, this can make the scarring worse.

Breast Implant Disadvantages

Alternatives Explored

Breast implants can be a great choice for many women, but there are some drawbacks to implants that range from slight to serious, and you definitely want to go into the buying process knowing the risks and the disadvantages that can possibly occur before you make such a large investment in yourself. The first disadvantage of implants is the most obvious. It's invasive surgery that you do not need to ensure your health or sustain your well being. You are essentially putting yourself at risk by going under the knife, for no reason other than to improve a part of your body. Now I'm not saying that it's not worth it in many cases, but most women who would not even think of getting implants quote this very reason for not getting or considering them.

The second disadvantage is one that a lot of women do not consider when contemplating the breast augmentation procedure. The breast implant is not a lifetime addition to your body. Like any other man made item, the implant wears out over time and erodes, so that it must be replaced if it is to remain a safe device to have inside one's body. The safety net is about ten years. Most doctors will tell you to go back and have them redone every ten years to insure against breaking or rupturing. Undesirable changes to your breasts after the implants are sewn in are generally irreversible. Say you decide to have the implants removed a couple years later. It will not be so transparent that you have done so, because you will most likely see dimpling, puckering, wrinkling, and other unsavory cosmetic changes in appearance happen to your breasts.

This is a major reason that so many women are searching for all natural breast enlargement alternatives like devices, pills and other alternative versions of augmenting the breasts. One of the biggest disadvantage is that health insurance premiums may increase for patients who have undergone the elective cosmetic surgery, even if it was for reconstructive purposes. You also need to be aware that complications related to the actual implant or the augmentation procedure are generally not covered by most insurance companies. This is a big deal, since most women who get implants scraped their money together just to get the implants in the first place, and probably would not have money to pay extensive medical bills related to any complications. The Alternative to Breast Implants, without the Above Mentioned Disadvantages There are natural breast enhancement products, as widely discussed here which are what I like to call, the secret alternative weapon that most plastic surgeons don't want you to know about, or they very well may lose business. What they do is naturally give your more volume, shape and size in your breasts, depending on which breast pill you use.

Breast Implants: Advantages and Disadvantages

For years breast implants have been the talk of the plastic surgery world, and now all these breast augmentation surgeries that have resulted in big breasts are beginning to cause an increase in the need for breast reductions. Women around the world have begun to realize that big breasts are not everything in life (although this may be the fact for men) and many times breast implants result in a

later need for breast reduction. Why would women want to go through this type of invasive surgery twice? Breast implants are often the result of a need to fulfill a related desire to look or feel better about oneself. Many women have found themselves under the knife just for the purpose of bigger boobs. Breast augmentation surgery is both costly and painful and unfortunately it often is performed in vein. Women are often faced with back problems, infections, and other breast augmentation nightmares simply because they once felt the need to have bigger boobs as a means of "looking" better. It seems that society has made boobs so overly important that the resulting negative effects of breast augmentation and breast implants go unheard of or under estimated. Women do not go into a plastic surgeon's office to be told about the negative side effects of big breasts and breast implants nor are they looking for breast reduction most of the time. When a woman walks into a plastic surgeon's office with the expectation of a breast implant consultation, the last thing that the surgeon is talking about is the negative side effects that breast augmentation could have. Surgeons are in the business of breast augmentation to make money, not to disclose all those dirty little secrets that would wipe a business out. For many women, had they known that breast implants would cause severe backache and other related pains they likely would never have had breast implant surgery at all. A woman should not go to the surgeon to get big boobs that are only going to cause problems later on in life. Breast implants and breast augmentation should be avoided at all costs except in the eyes of breast reduction which actually results in less trauma to the woman. For many women, early lifetime breast implants have resulted in the need to have later life breast reduction. For any woman who has actually had breast reduction, she will tell you that any type of breast augmentation it isn't fun. While most women have had to have breast reduction in the past due to their own genetic makeup causing them to have larger boobs, today's breast reduction surgeries are often based around a common theme-breast augmentation gone awry! Women are forced to make the decision later in life to have those beautiful breasts which they once paid so much to make bigger, reduced through another breast augmentation surgery called breast reduction! Breast reduction is almost as common these days as breast implants and as long as there is an abundance of breast implant surgeries going on it looks like we can expect an abundance of reductions in the near future. What a way for surgeons to keep their business rolling and bringing in the profits. A young woman walks in, asks for bigger boobs, walk out after receiving breast implants and then 20 years later that same woman (not so young anymore) walks back in requesting breast augmentation a second time around, this time breast reduction. It seems like a two fold, win win, situation for plastic surgeons.

Women must become educated and informed about the risks and problems that are associated with breast implants, breast augmentation, and breast reduction. Breasts might just be better left untouched when it comes to breast augmentation, especially when it comes to making them bigger. There really is no need to go through two breast augmentation surgeries in one lifetime, and breast implants most certainly make this a necessity.

Ten Reasons Why You Should Not Buy Breast Implants

Things to Consider Before Getting Breast Augmentation

Most women with small breasts have envied women with huge breasts, wishing they could be as lucky. Some even consider breast implants, but is that the way to go? Here are 10 reasons why you should not buy breast implants. 1. Getting breast implants is painful. I don't think people consider how much it will hurt to have your skin stretched that much. Then there's the fact that you must massage your breasts everyday to break up the tissue in your breasts. This tissue is trying to protect the body from these foreign objects. If you don't break up this tissue, your doctor will have to and it will be much, much more painful. Regardless, it's painful either way. 2. Sometimes breast implants aren't what you were expecting. Sometimes things go wrong and you are left with breasts that are misshapen. Sometimes the breasts implants don't fall into place, leaving them sitting high on your chest. Other times the breast implants look wrinkly. Things do go wrong and you'll wish you hadn't had the surgery at all. 3. Breast implants can cause infections. I watched a show on the Discovery Channel about a woman who had terrible problems with her breast implants. Eventually her nipples rotted and fell off.Infections aren't always this extreme, but they can make you very, very sick. 4. Most guys find breast implants unattractive. That's right, I said unattractive. You can tell they are fake and most men would rather have a woman with small breasts than large, fake breasts. Plus you should never get breast implants just to please the opposite sex. You'll only attract sick perverts, rather than intelligent men.

5. Breast implants are not permanent. You must have your breast implants replaced every 10-15 years. This means that not only will you have to go through all that pain again, but you'll also have to pay for the surgery again. 6. Breast implants are expensive. To get breast implants you'll pay up to $10,000. This is extreme, especially when you consider the fact that you'll have to pay this amount every 10-15 years. The cost will depend on how big you want your breasts and how qualified your doctor is. 7. As long as a doctor has been certified to do surgery, they can put in breast implants. They don't have to specialize in breast augmentation. This means, that if you don't do the proper research, you could end up with breasts that look disfigured or have horrible infections. 8. Breast implants do not feel like real breasts. Most women complain that after getting breast implants their breasts were hard as rocks. Men complain that this is very unattractive and that they don't even want to touch their partners' breasts anymore. 9. Breast implants can rupture. If you have breast implants you must be careful and protect your breasts more than you would have before. All women have experienced hitting their breast on something and it hurts, but that quick turn around the office hall corner could result in a visit to the emergency room to remove the breast implant and saline. 10. Getting breasts implants could result in losing the feeling in your breasts. Sometimes when you get breast implants, the nerves that lead to your nipples can be damaged resulting in loss of feeling in that area. Breast implants may look great on TV and you may wish you had breasts that looked like that, but many women who have them complain and wish they hadn't had the surgery. Be happy with what you have and if you have a guy, who isn't happy about your breast size, find another guy.