BREAST AUGMENTATION

Breast enlargement has been one of the most popular cosmetic operations since the advent of the silicone breast implant in the late 1960s. The goal has always been to enlarge breasts in a soft, natural manner which should complement the sensual form of a woman's body. They should look, feel and move as real breasts.

Yet no other procedure in plastic surgery has been fraught with as much controversy as breast implant surgery. The great furor of the 1990s over the alleged danger of silicone led to withdrawal of silicone implants in a most contradictory manner. In spite of a lack of factual medical evidence and at least fifteen retrospective scientific studies supportive of their safety, the FDA had prohibited the use of silicone filled implants for cosmetic breast enlargement. Ironically they have always been used in women undergoing reconstruction after mastectomy. Now since November of 2006, silicone implants have been released again in a modern more cohesive gel formulation, which allows Plastic Surgeons to implant them for our cosmetic patients. These have replaced saline implants as the standard of choice for most women as they produce the most natural and pleasing outcome on a long term basis. We are currently enrolling our implanted patients in a national monitored study which is being reviewed by the FDA and will eventually include thousands of patients over many years. At the present time, there is no evidence of any rash of medical problems.

All studies and all plastic surgeons have recognized a number of mechanical complications inherent in this operation. These are not medical diseases which threaten a woman's health, but do include problems such as excessive scar encapsulation, mispositioning, unnatural 'hardening', and failure of the implant shell which causes a collapse of the breast.

To a great extent the technique used and care taken by your surgeon can minimize the incidence of these complications. In my experience the finest results are produced by placing implants beneath the chest wall muscle, i.e. in the subpectoral plane. By using your muscles as a cover the implants are overlayed by an additional plane of soft tissue. This produces natural draping of the upper chest rather than a telltale bulge of round fullness. Muscle activity automassages the scar membrane surrounding the implant, inhibiting tight capsule formation. Because of this muscle action, combined with the presence of an additional tissue layer of cover, a submuscular implant feels more natural.

Operations to place implants submuscularly require general anesthesia, demand greater skill of your surgeon, and impose a day of rest on patients to manage increased post-operative soreness. This limits the quick "in-and-out" marketing approach so commonly used by "Cosmetic Surgery clinics" as such care cannot be properly given in freestanding office facilities. Women considering breast augmentation should be informed of these alternatives as they are choosing a procedure which alters their body for life. This should be an alteration of joy and pleasure.