Breast Augmentation – Implant Profiles, Incisions, Recovery, and Risks
Women choose to undergo breast augmentation for many reasons. Some lose volume and fullness after pregnancy, breast feeding, and weight loss. Others have breasts that did not develop proportionally with their hips, shoulders, and frame. Some women have congenital breast issues including significant asymmetries. Breast augmentation creates breasts that are shapely and full, often promoting a tremendous increase in self-confidence.
3-d imaging and breast augmentation
Each woman has unique physical attributes and goals. Dr. Kunkel uses Vectra XT 3-dimensional imaging to help create a customized treatment plan. Six cameras take photographs of a woman’s torso and the system software reconstructs those photographs into a 3-d image. The Vectra Breast Sculptor program contains information about almost every breast implant available in the U.S. With a few clicks of the mouse, the software alters the 3-d image to show what the woman may look like with specific implants. Want something bigger or smaller? Just a few more mouse clicks. The Vectra system does not show a woman exactly what she will look like. It is a terrific way to make sure the patient and Dr. Kunkel are seeing and talking about the same things. Dr. Kunkel does not decide for his patients, he decides with them.
Types of Breast Implants
Round breast implants come in different ‘profiles‘: moderate, moderate-plus, and high. The image on the left demonstrates different profiles of breast implants, with all three implants having the same volume. The profile refers to the combination of width and projection (front-to-back dimension) of the implant. Think of it as having three differently shaped glasses of water, each glass holding the exact same amount of water. Maybe one glass is short and wide, another is tall and thin, and the third is in between those two, but all three contain the same amount of water. A moderate profile 300 cc breast implant is wider and has less projection (like the implant on top in the image on the left) than a high profile implant (the implant on the bottom), and a moderate-plus implant is in between those two. All three may contain 300 cc’s of saline or silicone, but the shapes are different. It’s pretty hard to look at pictures on websites, trying to determine what volume and profile implant might work best for you. That’s where the Vectra 3-d system adds real value to the consultation, helping see potential outcomes with specific implants.
Breast Augmentation Surgery – Incision site options
The breast augmentation procedure takes about 1 – 1½ hours. Incisions are made in inconspicuous areas to help minimize scar visibility. The incisions may be located:
- in the crease beneath the breast
- in the armpit
- along the lower edge of the areola
Each incision has advantages and disadvantages. Published studies indicate that implants placed through an incision along the lower edge of the areola or through the armpit have a higher risk of capsular contracture (firmness) than implants placed through an incision beneath the breast. The incision beneath the breast, however, may result in a scar that is more visible in an intimate setting.
Saline implants may also be placed endoscopically through an incision around the navel. This technique is known as a transumbilical breast augmentation (TUBA) approach. Dr. Kunkel does not use this approach for breast augmentation. He believes that the TUBA approach is more traumatic to the tissues than the other options and does not allow the implants to be placed as accurately.
Breast Augmentation Surgery – above or below the muscle?
After making the incision a pocket is created for the breast implant. The pocket is either immediately behind the breast tissue or under the pectoralis major muscle. The muscle adds a layer of tissue over the implant in the upper part of the breast. This extra layer is beneficial in thinner patients who have minimal breast tissue. Implants placed behind the muscle also have a reduced risk of capsular contracture. A potential disadvantage of placing implants behind the muscle is some distortion of breast shape when the pectoralis muscle contracts. This may be more important for women who participate in body-building competitions than most women in general.
Most women feel tight after breast augmentation surgery but don’t actually have much pain. It is common to return to work within a few days. Fridays are often Dr. Kunkel’s busiest days for breast augmentation because many women are actually able to return to work on Monday (3 days later!).
The breasts look full at the top and feel firm for about 4 weeks. In the fifth week the tissues stretch and settle a bit and the breasts feel more normal. Over the following two or three months the swelling goes down and the breasts achieve their final appearance.
Scars are pink for 4 to 6 months and then fade over the next 6 months. It is uncommon for women to have complaints about their scars after breast augmentation.
Risks of Breast Augmentation
All surgical procedures include some risks. Common to all operations are risks like visible scars, infection, bleeding, and pain. Breast augmentation surgery has its own risks. Here is a link to the FDA website detailing risks of breast implants: FDA website . Additional details about each type of implant by each implant company can be found here . A summary of the information in these sites includes risks of capsular contracture (hardening of tissues around the implants), infection, change in nipple and breast skin sensation, leakage (rupture), visible wrinkling from the implants, an implant may not end up in the desired position, a woman may end up being larger or smaller than she hoped, and there may be a need for additional surgery at some time during her lifetime. Dr. Kunkel and his staff go over this and more in detail during your visit to the office.
Two additional issues have been in the news recently. One of these includes what is referred to as breast implant illness, and the second is breast implant-associated anaplastic large cell lymphoma.
Breast Implant Illness (BII) is a term used by women who have breast implants who describe a variety of symptoms including fatigue, headaches, anxiety, rashes, sleep disturbance, “brain fog”, sleep disturbance, pain, hair loss, chills, sensitivity to light, body odor, depression, neurologic issues and hormonal issues that they feel are directly connected to their breast implants. An extensive review of studies by the Institute of Medicine demonstrated no clear link between silicone implants and any systemic illness. Numerous studies have looked at specific autoimmune disorders and diseases. These studies show few to no links between breast implants and any disease. Studies of patients who have symptoms that they have related to their breast implants have not shown consistent laboratory abnormalities that define a distinct syndrome. To date, there has been little research into this entity. A few studies show some degree of improvement in patient symptoms after removal of their breast implants, some of which are temporary. There are no studies that specifically show which symptoms may improve with implant removal. There is no current definitive evidence to support a direct link between breast implants and any specific disease process. Further study is being done regarding these concerns.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of lymphoma that can develop in the scar tissue capsule near saline or silicone breast implants. This very rare disease is currently being investigated as to its relationship with breast implants. The family of ALCL is an extremely rare cancer of the immune system that can occur anywhere in the body. The United States Food and Drug Administration (FDA) estimates the total number of US cases of BIA-ALCL to be around 400. It has been noted that the majority of BIA-ALCL patients have a history of having had a textured-surface breast implant. The lifetime risk of developing BIA-ALCL has been estimated at 1:1,000 to 1: 30,000 for women with textured breast implants. The way BIA-ALCL usually shows up is swelling of a breast an average of 3 to 14 years after the initial breast implant operation. Most cases are cured by removal of the implant and the scar tissue capsule surrounding the implant; however, rare cases have required chemotherapy and/or radiation therapy for treatment.
what happens when a breast implant leaks?
When a saline implant leaks the body absorbs the salt water and the breast loses volume. This may happen over a matter of hours but could also take several days or weeks. Loss of saline from a breast implant results in one breast being substantially smaller than the other. It is noticeable but not dangerous. It’s actually more of a social emergency than a medical emergency. The implant will need to be removed and potentially replaced.
With silicone implants leakage is different. A woman with a leaking silicone implant may not notice a change at all. Often a leaking silicone implant is noticed on a routine mammogram. Some women may notice a small lump that they had not noticed before, or maybe firmness develops. Ruptured silicone implants should be removed, and most women choose to replace them.
Regular monitoring of breast implants is recommended after breast augmentation to ensure breast health.