Breast Augmentation

Women with small or underdeveloped breasts who wish to enhance their appearance may choose to have a procedure called breast augmentation or mammoplasty. It can dramatically improve the appearance of a woman’s breast. A fuller body contour can be safely achieved through the placement of implants directly under the breast tissue or beneath the chest wall muscle. Implants that are filled with saline or salt-water, silicone or gel can be used for breast augmentation procedures. 

Is it safe?

Recent studies have supported the safety of breast implants. Should these saline implants leak, the saline is safely reabsorbed by the body as the implants deflate. Most of the implant companies provide replacement warranty.

Is Breast Surgery for You?

During your Consultation with Dr. Hamdan, Discuss your goals and expectations of the surgery. Dr. Hamdan will assess the nature of your breasts, your expectations, and explain the probable outcome of your procedure.

You may be shown several before and after treatment photographs of patients having similar breasts, and your surgeon will explain the treatment you can expect to receive. You may also try some different size implants on in a bra to give you an idea as to the look you desire. Often a mammography (X-Ray) will be required pre-operatively. Be specific about what you would like done. 

Silicone Breast Implants

In the early 1990's it was reported that silicone breast implants were responsible for connective tissue diseases in some women. After a comprehensive evaluation of the evidence for the Association of Silicone Breast Implants with human health conditions, the Institute of Medicine concluded in June that there is "no definitive evidence linking breast implants to cancer, neurological diseases, neurological problems or other systemic diseases." However, silicone implants are still not available to the general public in the United States . They are still widely used in Europe and South America and are available again in the USA. 

Your procedure

Minimal Incision breast augmentation is performed on an out-patient basis using a general or local anesthesia. No incisions are made on the breast or into the breast tissue. The procedure usually takes less than two hours. Through this tiny incision, a space or pocket is made under the pectoral chest muscle to accommodate the saline implant. Placing the implant below the muscle helps it appear and feel more natural. For this procedure the surgeon utilizes an endoscope. This device is a small diameter tube containing a camera that is inserted into the pocket. The space is visualized on a monitor so that an exact pocket dimension can be created and any bleeding controlled. An empty saline implant is placed in the pocket and then filled with IV sterile saline. The majority of implants being used today are saline-filled implants. These have a silicone rubber shell and are filled with sterile salt water. 
The surgeon then can adjust the amount of saline injected into the implant based on the size you have selected and correct any asymmetry of your breasts.

Breast augmentation will enlarge your breasts. It will not improve nipple asymmetry, move breasts closer together, or lift droopy breasts.

Most patients can resume to normal activities within 5-6 days following surgery. Sutures are removed in 7 to ten days and your surgeon may recommend a surgical support bra. Exercise and other strenuous activities may be resumed in about one month. 

Surgical Technique

Inframammary incision:
The incision is made on the lower portion of the breast, in the crease where the breast meets the chest, so that any scar will still be hidden. This incision allows your surgeon the best visibility during surgery. Most commonly done. 

Periareolar incision:
The second most common incision is made in the areola. The incision is usually a small semi-circle. The scar is camouflaged by the nipple. However, if there are any imperfections in the scar, it will be highly visible. This type of incision has an increased risk for diminished nipple sensation. 

Axillary incision:
The incision is made in the armpit, and may require the use of an endoscope. The scar is well-hidden, but provides poor visibility for the surgeon. 

Umbilical incision:
The incision is made in the BELLY BUTTON. No scars are anywhere on or close to the breast. Only Saline filled implants can be used with approach. It is very popular with young, single woman, who desire no scars on or around their breast prior to getting married. 

GENERAL QUESTIONS:

Pain Level:
• Breast Implants above the muscle: Mild to moderate discomfort. 
• Breast Implants below the muscle: Moderate to severe discomfort following placement under the muscle.1-2 weeks of pain medication.

Swelling: 
• Above the muscle: 4 days-2 weeks. 
• Below the muscle: 2-12 weeks. 
Bruising: Up to 2 weeks. Some patients experience no bruising. 

Numbness: 1-2 weeks.

Work: 
• Above the muscle: 1 week 
• Below the muscle: 1-2 weeks. 
If job is strenuous or requires lifting, wait a month.

Exercise: Wait 2-4 weeks.

Final result: Breast Implants above the muscle: 1 month. Breast Implants below the muscle: 4 months. 

On the day of surgery you will feel sleepy and may feel pain or be nauseated. Your chest may feel tight and uncomfortable. Your arms and back may also be sore. Pain medication will be prescribed to minimize your discomfort. After breast augmentation surgery your breasts will be very firm, high, and swollen. After about a month, the swelling will be gone and they will be lower, smaller and softer. It may take up to a year for the breast implants to settle into a permanent position. 

For faster recovery:
• Keep ice packs applied to your chest on the day of your surgery 
• Sleep in an upright position. Do not sleep on your stomach for the first 2 weeks of surgery 
• To avoid unnecessary swelling or bleeding, do not bend over, strain, exercise or do any other activities that could increase pressure in your chest during the first week. 
• If you have smooth implants, massage them daily to keep them softer, avoid capsular contracture and keep them in proper position. Do not massage in the first 24 hours and do not massage textured implants. 

Your doctor knows your particular case best, these are only general guidelines. 

Risks/Complications 

• Rupture of the implant (often due to injury):
• Rupture of Saline Implant 
If a saline implant breaks, it will deflate and the salt water will be absorbed by the body. Alert your physician right away as the implants will have to be replaced. Some implants deflate or rupture in the first few months after being implanted and some deflate after several years. You should also be aware that the breast implant may wear out over time and deflate. Additional surgery is needed to remove deflated implants. In a study conducted by Mentor , 3% of 1264 patients had deflation after 3 years. In a similar study by McGhan, the deflation rate was 5%of 901 women after 3 years. Another study indicates that 10.1% of women followed for an average of 6 years had at least one implant deflated. 

• Rupture of Silicone-Gel Implants
When silicone gel implants rupture, women may notice decreased breast size, hard knots, uneven appearance of the breasts, pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation. According to the FDA, 69% of 344 women had at least one ruptured breast implant. Factors that were associated with rupture included increasing age of the implant, the implant manufacturer, and submuscular rather than subglandular location of the breast implant.

• Implant displacement 
Implants can move out of position at anytime after surgery. If they move only a little, it may not be noticeable. If they move a lot, you may need surgery to put them into position. This is very uncommon except in women who have very large implants. The larger the implant, the greater the chance that it will displace.

• Scars 
Surgical scars are permanent. However, the incisions are placed so that they are not normally noticeable except on very close observation. Scar location will depend on the incision site (either in crease below breast, armpit, belly button or areola).

• Anesthesia reaction 
• Asymmetry 
• Bleeding 
• Breast droop 
• Capsular Contracture (hardening of scar tissue around breast implant) 
• Deflation (approximately 7%)
• Hematoma (pooling of clotted blood; risk is 3-4%) 
• Implant leak 
• Infection (risk is less than 1%; always involves removal of implant) 
• Interference with mammography 
• Keloid (heavy scar) 
• Nerve Damage 
• Nipple numbness 
• Pain 
• Permanent numbness (risk is 15%) 
• Reactions to medications 
• Rippling 
• damage by surgical instruments during surgery 
• under filling of saline (only) breast implant 
• capsular contracture 
• trauma, injury, or intense physical manipulation 
• excessive compression during mammographic imaging 
• placement through the belly button 
• normal aging of the implant 
• Seroma (pooling of watery blood) 
• Skin irregularities 
• Sloshing 
• Slow healing 
• Swelling Symmastia (breasts merge into one mass)