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Breast Augmentation:
What You Need to Know
Breast augmentation is incredibly popular. Last year over 300,000 women had their breasts enlarged. That number has more than tripled since 1997. Breast implants get a lot of attention in the media as well, and most people are justifiably confused by the conflicting information they hear.
I've performed 1,400 cases breast augmentations and reconstructions with very good results. I've heard all the arguments, studied copious amounts of literature and directly experienced outcomes from various techniques first-hand. Here is some of the critical information that I think will be important for you to consider.
Implants are not permanent.
Most people don't know this. I'd hope that you'd hear this simple fact anywhere you go, but you might not. Implants last typically 10-15 years. Keep in mind that you are having a man-made device inserted into the body, and it's going to have to be serviced. The most common problem is that body's tissues contract around the implant over time. They eventually become hard and uncomfortable. At some point we'll need to treat the implant or treat the tissue - something will have to be done.
Timing is important.
I make sure that patients wanting augmentation before having children or planning to have more children are aware that they may need to have more operations in the future. When a woman has implants, the skin stretches. If she later has a baby, her breasts will enlarge, and the tissues will stretch even more. Afterwards they may require other operations to reduce the skin or increase the size of the implants.
If the person is younger than 18 I won't do the augmentation. They need to be an adult. They need to have enough experience in life to make these kinds of decisions for themselves.
Incisions
There is a lot of discussion in the media about incisions. I prefer a more practical incision such as low on the breast as opposed to under the nipple, under the arm or through the navel. Those more exotic types of incisions have limitations. Visibility is not as good, that makes it harder for the surgeon to do his job. The surgeon wants to create the optimum placement and shape and cause the least amount of damage to healthy tissues. So better visibility and control make a difference.
As I mentioned above, implants will require secondary operations. Incisions from under the arm, the navel or nipple are not as reusable. That's ultimately more scarring for all our efforts to make the incision more concealed, and that doesn't make much sense.
A small, 4cm incision low on the breast is just better. They are very safe, I can see the tissues extremely well. They offer more ease and control in placement and shaping. These "infra-mammary" incisions are also very reusable. The scars tend to be flat and tend to fade over time.
Motivations
In order to approach these kind of procedures in a balanced way, it's important to discuss the motivations behind them. This is the realm of cultural pressures. I try to emphasize that people are making these decisions based on an idea of a cultural norm. The kind of breast this culture seems to like is an augumented breast (round, full, nipples out). A natural breast is not as round as an augmented breast, especially when it gets to be a certain size. A natural female breast has some sagging. But that's not what today's media seems to like.
Gel vs Saline
Gel implants were allowed back on the market only a year and a half ago. The FDA took the gel implants off the primary augmentation market when there was an accusation it caused collagen vascular disease. That accusation turned out to be false. It was a huge scare for women, it was a great disservice to doctors, manufacturers and patients alike. The one good thing that came out of it was "informed consent." People hadn't yet realized that implants weren't permanent.
Gel implants are back on the market, they are even safer. If a saline implant ever ruptured, there'd be no health risks, they just go flat and the saline is absorbed by the body. When you put gel in your body, you have to make sure that it is staying put and not moving to other parts of the body. As a precaution, the FDA recommends scans to monitor that gel. Gel looks and feels a bit more natural, especially with thinner women. Today I install almost as many gel implants as saline (43%), which is about the national average.
Size
I encourage people to have moderate size implants. There is a more natural look to a smaller augmentation. Once you get to a certain size it becomes very obvious that the breast has been augmented, which can seem overtly unnatural. The larger the implant the more they stretch the skin. Heavier implants have more problems such as loss of sensation, sagging of the breast, and stretching of the tissue.
It's also interesting to note that I do a lot of operations each year to make breasts smaller. Sometimes these breast reductions end up being the same size that others want to enlarge. I explain to women who want a medium sized breast enlarged that they may experience shoulder, neck and back pains.
I then make some measurements of the breast. From my years of experience with breast augmentation, I have an understanding for the effects certain sized implants will have with various body types. I can provide the patient with feedback tailored to her exact situation. I avoid discussing things in terms of cup size, it's too variable. Look at the implant, hold it, see what it is, put it in your clothes, it's helpful.
I don't pressure the patient. I talk to them about what they are trying to accomplish and I make suggestions. But I like to let a patient make the decision about volume for herself. I want to make the decision about size to be made through a informative, dynamic discussion.
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 James Green, MD | Plastic Surgery, Santa Fe | Phone (505) 988 2215
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