Olivia Hutchinson, MD | New York, NY
Breast augmentation surgery is the most popular cosmetic surgery procedure, according to the latest statistics obtained by the American Society of Plastic Surgeons (ASPS). Every year, almost 300,000 women undergo breast augmentation in the US, including silicone gel, saline and the newer structured implants. Along with the popularity of the procedure comes increased media coverage and open discussion of the procedure, as well as some common assumptions about breast implants that often are not based on scientific fact but rather on public lore. If you are one of the many women considering breast augmentation surgery, here is some pertinent factual information to help dispel myths about the operation.
“All implants need to be replaced after 10 years”
Breast implants are prosthetic devices that are not expected to last forever, and there are known complications that are associated with breast implants, just as there are with any foreign bodies used in other types of surgery. The most common reasons implants may need to be replaced include rupture or leakage and capsular contracture. If saline implants leak, the saline is reabsorbed by the body, whereas if silicone gel implants leak, the extruded silicone gel will need to be surgically removed. Capsular contracture describes an abnormal scar formation around the implant that usually presents with pain and hardening in the breast; the condition is usually progressive, resulting in distortion of the breast and displacement of the implant. Women may develop capsular contracture in either one or both breasts at any point following implantation, and rupture or leakage may likewise occur at any time subsequent to surgery. The longer the time since implants are placed, the higher the chance that there may be a leak or rupture, but there is no absolute indication to remove or replace implants at the 10-year mark. Breast implant removal with or without replacement should be considered if and when either of these complications occur. In addition, routine follow-up is recommended for all women, with breast exams along with mammograms, sonograms, or MRI, depending on each patient’s age and risk factors for breast disease. Routine follow-up is essential in detecting any issues with the implants and determining appropriate therapeutic intervention, if any.
“Breast implants cause autoimmune diseases”
There are anecdotal reports, some of which receive much media attention, of patients who claim to have developed any number of health problems and diseases as a result of their breast implants. Scientific studies including hundreds of thousands of women with implants have refuted an association between implants and systemic or autoimmune diseases. In addition, there is no increased risk of breast cancer in patients with breast implants. It is also important to note that the implants that are currently available in the US, including all silicone gel, saline and structured saline implants, are all FDA cleared. The previous generation of implants that had been used starting in the 1960’s did not undergo the extensive testing and data collection that current implants were subjected to in order to ascertain their safety and effectiveness. Recently, a rare type of lymphoma called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has been identified in association with implants. BIA-ALCL usually presents as a late seroma (fluid accumulation) or a breast mass, and should be treated with surgical removal of the implant and surrounding capsule.
“Implants are dangerous during breastfeeding”
Many women who undergo breast augmentation are in their 20’s and 30’s, and may be concerned about potential risks for the baby should they subsequently become pregnant. Studies have shown that there is no medical risk for babies who are born to or breast-fed by women with saline or silicone breast implants. Pregnancy is normally associated with many hormonal effects on breast tissue which may change the size and shape of the breasts and the appearance of the breasts relative to the implants. There are no inherent risks in breast augmentation that would make the surgery a contraindication to future pregnancy. Because the operation involves incision and dissection of breast tissue, there is a small risk that nipple sensation and breastfeeding may be affected. Plastic surgeons may use certain techniques for placement of the implants to minimize interference with nipple sensation and breastfeeding. These include:
- Using an inframammary incision (in the breast fold under the breast) or axillary incision (in the armpit) rather than a periareolar incision (around the nipple)
- Placing the implant under the muscle (subpectoral) rather than under the breast (subglandular)
- Choosing a smaller implant to avoid wide dissection and limit potential disruption of nerves supplying nipple sensation
It is also important to recall that some women who have never undergone any type of breast surgery may not able to breastfeed regardless, due to an innate anatomical anomaly of the milk ducts or nipple.
“Women can choose to be whatever bra cup size they want”
With the hundreds of types and sizes of breast implants currently on the market, there is indeed an enormous range of possible results from breast augmentation. The exact cup size that may be expected to be obtained from surgery, however, is not entirely predictable, primarily because there is such an enormous variation in what each cup size refers to for each brassiere manufacturer. For the most natural results, the chosen implant should match the patient’s own breast dimensions and characteristics, in terms of breast width, diameter and position on the chest wall. Placing a very large implant under a small, narrow breast will most likely result in an implant that may be palpable or whose edges may be visible at the top or sides of the breast. Another consideration is the actual weight of the implants themselves, and the progressive stretch of the tissues due to the effects of pressure from the implants and the downward pull of gravity. Bigger is not necessarily better in the long run when it comes to breast implant selection.
“Any cosmetic surgeon can perform breast augmentation surgery”
Breast augmentation surgery provides both physical and emotional benefits, as it most often improves patients’ self-confidence and boosts their self-esteem. When choosing their plastic surgeon, patients should be reminded that “cosmetic” surgeons are not the same as “plastic” surgeons. Only board certified plastic surgeons have completed years of rigorous training and passed written and oral examinations in order to become certified by the American Board of Plastic Surgery (ABPS). The designation “cosmetic surgeon” does not indicate the level of extensive training inherent in an ABPS certified plastic surgeon. Breast augmentation surgery may seem like a relatively simple operation, but ensuring best results involves a long and comprehensive process on the part of the plastic surgeon. This includes:
- A detailed pre-operative assessment of each patient’s anatomy, including breast size and shape; breast symmetry or asymmetry; characteristics of breast tissue, nipple-areola and skin; and degree of breast sag (ptosis) to determine if additional breast lift procedure is indicated
- Discussion with and understanding of each patient’s wishes and desires for their post-operative results and analysis of limitations of possible outcomes
- knowledge of and familiarity with all different types of breast implants to best advise patient on implant selection: silicone gel, cohesive silicone gel “gummy bear”, round and anatomical “tear drop” shaped implants
- experience with and ability to use any number of different surgical techniques to produce desired results
- Close follow up and attentive management of patients post-operatively to address any issues that may arise
As with any plastic surgery procedure, breast augmentation does not offer any guaranteed results, but most patients who undergo breast enhancement are extremely satisfied with their outcome, with a relatively small percentage undergoing revision or removal of their implants. Separating fact from fiction is essential for patient education prior to surgery and for meeting patient expectations so they are happy with their breast augmentation.