You have taken an important decision to undergo breast augmentation. However you are worried what will happen next. Once you take a decision about this surgery, ill informed people may misguide you. Take your time; learn the facts about this surgery before you go in for what is best for you.
INTRODUCTION
A woman may choose to undergo augmentation surgery for the following reasons-
1. To enhance the body contour, she feels her breast size is too small
2. Following weight loss/pregnancy to restore breast volume
3. To achieve better symmetry when breasts are moderately disproportionate in size and shape.
4. To improve the shape of breasts that is sagging or has lost firmness
5. After breast cancer surgery/benign tumor surgery to provide foundation of a breast contour
6. Loss of breast due to trauma, infection, heredity or congenital reasons.
WHO IS ELIGIBLE?
For silicone gel implants-healthy women of more than 22 years
For saline implants-healthy women of more than 18 years
For reconstruction purpose-any age.
WHO IS NOT ELIGIBLE?
1. Women who are currently pregnant/nursing
2. Women who have an existing cancer/or pre malignant cancer, have not received any treatment.
3. Active infection any where in the body.
SURGERY
Will be done in a hospital, under general anesthesia on day care basis. No need for the admission.
Detailed discussion will be done about incision,scar,plane of implant, type of implant, shape & size of implants, trial of implant can also be done and other details.
PROCEDURE
After the discussion about the above, under anesthesia, a pocket or a space created beneath the breast tissue. The implant is placed and positioned inside this pocket. The incision is closed using absorbable stitches. The surgery lasts for one to two hours. The cut will be in inframammary crease [most common], peri areolar, transaxillary route. The cut will be of about 5 cms length on each breast.
IMPLANT PLACEMENT
1. Subglandular-which is between the chest muscle and breast tissues. The advantages are shorter surgery time and recovery time. Less painful. Easy to take out the implant if re operation is required.
The disadvantages are –more capsular contraction, imaging of breast with mammography may be difficult.
2.Submuscular-which is below the chest muscle.the advantages are less palpable/visible implants, less capsular contraction, easier imaging with mammography.
The disadvantages are-longer surgery, more pain, and longer recovery, more difficult re surgery if required.
SAFETY
1. Selection of right surgeon and place.
2. Selection of USA, FDA approved implants may save some money by selecting cheaper implants/small place, however with the risk of compromise in safety.
3. By following pre surgery and post surgery instructions.
RECOVERY
Immediate post surgery care in the form of pressure garment and massage: long term follow-up very important for long life of the implant and prevention of capsular contraction.
FAQ
1.Breast augmentation surgeries are very popular and are considered 'normal' in countries like Brazil etc. Why is it that in India there is still a taboo associated with it?
While breast augmentation is an accepted procedure in Brazil, India is picking up the pace as well. Though Indian women are not very open about discussing this procedure, there is no taboo about undergoing the surgery. There is also a negative perception surrounding cosmetic procedures as a result of which women may not feel comfortable talking about these to the male members of their family or to plastic surgeons. But we are increasingly seeing women from all age groups and all walks of life coming to us and discussing their needs for breast augmentation.
2.This concept in India is popular among the elite. Other than that, women who are probably in the glamour/fashion/entertainment industry. How and why do you think women belonging to normal backgrounds should go for this surgery?
While the men and women from glamour industry tend to undergo cosmetic procedures to maintain their bodies, people who are not from fashion and entertainment industry are also opting for cosmetic procedures on a regular basis. Breast augmentation is one procedure which has broken all barriers of age and profiles, their reasons might be different but women across all segments of society are opting for breast augmentation. These women opt for surgery as they feel it improves their confidence and self image. While girls between the age group of 22-30yrs are opting for this procedure to get better body proportion and to enter few careers like tourism industry, hospitality industry, client servicing profiles, older women are opting for it because they have had kids and now want to get back to their pre-pregnancy body shapes. Many women also feel that having a shapelier body improves their sex lives.
3.How safe is it? Does it have any medical implications later on in life? For instance women who are young and they get a breast uplifted/enlarged etc., would they not have any complications after they become mothers?
Cosmetic surgery is as safe as any other medical surgery but it is advised that only healthy persons undergo this procedure. In cases of breast enhancement surgeries, it is important to go to a surgeon who is experience in this kind of surgery, choose us FDA implants which have proven safety and to get operated in a clean, well-equipped healthcare set-up. It is also important to follow pre-op and post-op advice given by the surgeon and to go in for their scheduled follow up visits. Women below the age of 35 years are required to visit their doctor only once in two years after a surgical procedure while those above the age of 35 years need to go once in year.
Many women with breast implants have successfully breast fed their babies. Current studies indicate that more silicone is present in cow’s milk and infant formulas than in the breast milk from women with breast implants. While silicone allergies may occur, they are extremely rare.
The institute of medicine (iom), an independent non profit organization after reviewing research and medical studies regarding breast implants concluded that no evidence was found of silicone implants being responsible for any major diseases like breast cancer or tissue disorders.
4.What is the procedure for this surgery? How long does it take? Does the body accept the surgery or does it take time to recuperate?
The surgeon makes an incision and creates a space within the breast tissue to insert the breast implant. After positioning the implant, the incision is closed with stitches.
The surgery usually lasts one or two hours. A sub glandular breast implant procedure takes lesser time than a sub muscular breast implant. It is important to understand that no breast tissue is removed during the surgery; instead the implant is inserted in the gap between the tissue layers.
Although patients can return to their daily routine within a few days, it is advised to wait a few weeks before performing any strenuous activities.
5.Is it money wise feasible for women to go for it? How much would a surgery cost? On what does the cost depend upon?
The surgery costs around rs 85000 – rs 100000 including the cost of implants. The cost mainly depends upon the cost of the implants. High quality us FDA improved implants would cost anywhere between rs 35000 – rs 40000.
It is advised that people who are planning to undergo breast augmentation should make sure that they choose high quality implants and not accept cheaper implants to save a little bit of money.
6.In India how common is it for such surgeries to take place? How many hospitals provide these surgeries? Or are these only restricted to specialized clinics or private practitioners?
India is an emerging market for this industry. It is just taking the first steps with non intrusive procedures like Botox, hair transplants and hair removals. But the market for surgical procedures like liposuction and breast augmentation is slowly opening up.
People generally are not very open about these types of surgeries and hence opt for smaller clinics for confidentiality purposes. Before undergoing the procedure, people should firstly make sure that the hospital or clinic they have chosen has the right type of infrastructure available to perform cosmetic procedures in a safe manner.
7.What are the current statistics? What is popular among women right now? How much time would it take for women in India to accept these surgeries?
Women from all age groups (18-60 years) are opting for different types of cosmetic procedures. In general girls in the pre-marital age group of 22-28 years go for breast augmentations for professional and personal reasons while women in the post marital age group of 30-40 years undergo breast augmentation to reduce the effect of sinkage of breasts that comes with age.
Some of the common cosmetic procedures being performed are liposuction, tummy tucks, nose correction. Breast augmentation is not as popular as these procedures mainly because of the wrong information being spread about it. At the moment only 5-6 percent of the candidates who come for consultation actually opt for the surgery.
8.Normally fitness experts recommend staying natural and away from these surgeries. There are many studies involved which recommend staying away from surgeries. As opposed to that how would you suggest women to take a step towards something that is not natural?
Natural is not always the best. Not everyone is blessed with good looks as our genes and environment plays a major role in shaping our bodies. Every medical treatment from an antibiotic tablet to a life saving surgery can be considered unnatural. If undergoing cosmetic surgery helps someone’s self image and confidence then there is nothing wrong in it.
Moreover, people who want to undergo a cosmetic procedure generally end up asking people who are not qualified to give a medical opinion about it. It is important that candidates for surgery consult a certified cosmetic surgeon about any procedure they may want to undergo.
9.Once a liposuction/tummy tuck etc is done, is there any diet to follow? Because there are cases where women put on all the fat which they had lost as early as in one month.
It is important to understand that liposuction is not a medical weight loss surgery like bariatric surgery. It only involves removal of fat from certain areas of the body to improve the shape of the body. It is very important to regularly exercise and maintain a proper diet to ensure that the results of cosmetic surgeries are sustained.
10.What about the skin? Does it get lose with time?
In the case of breast implants, some skin rippling may occur if the people opt for implants which are too big for them. The issue can be avoided by carefully choosing the implants of the right size. In case of other procedures like liposuction, skin sagging occurs when a large amount of fat loss occurs and a tucking procedure will be needed.
11.How often could these surgeries be done? Or is it just a one time investment?
In normal cases, breast augmentation is a one time surgery. A second surgery is generally not advised unless a person is extremely dissatisfied with the results of the first one or in the case of a serious complication such as sagging or silicone leakage.
12.Further if you could elaborate other points that you would want to highlight.
There is generally a wrong notion about cosmetic procedures. Most of our major educational medical texts say little or nothing about plastic surgery. And sometimes because of the sensitive nature of the matter, people end up asking the wrong people for advice. It is important that people who want undergo any kind of cosmetic surgery consult a qualified plastic surgeon before making their final decision.
MYTHS AND FACTS
In this age of information overload, it’s not easy to sift fact from fiction. However, when it’s a matter of your health, it is best to know the correct picture. As breast enhancement surgery gains popularity, there are several doubts that have crept into the minds of people. There is a between the myths and facts associated with this surgery. Understanding the truth can help us make an informed decision about breast augmentation surgery.
It is important to understand the importance of using good quality implants while undergoing breast augmentation as these implants remain inside the body for a long duration on time. Which kind of implant is right for you and whether it is safe are all valid questions to ask your surgeon...
Some of the commonly held myths are as follows:
Myth 1: the breast is removed to accommodate silicone implants:
Fact: this is untrue. The plastic surgeon makes an incision and creates a "pocket," or space within the breast tissues, for the breast implant. The breast implant is placed in the pocket and positioned. Breast implants may be placed sub-glandular, which is between the chest muscle and the breast tissue, or sub-muscular, which is below the chest muscle.
Figure: Submuscular Placement
silicone implants have particularly been under the shadow of doubt about whether they lead to breast cancer. However, the fact is that women are constantly exposed to silicone in their daily lives. Special studies conducted by the institute of medicine have concluded that silicone implants are not responsible for any major diseases of the body. Us FDA believes that the totality of evidence continues to support a reasonable assurance that fda-approved breast implants are safe and effective when used as labeled.
Myth 3: loss of sensation in breasts post breast augmentation. A lot of women also believe that there is a loss of sensation in the breast after an implant is used during breast augmentation surgery.
Fact: though it is possible that feeling in the nipple and breast can decrease for a few weeks post surgery, such changes are a temporary phenomenon. As the body gets accustomed to the implants, the sensation in the breasts will come back to normal.
Myth 4: breast augmentation always leads to infections and implant rejection. It’s a commonly held belief that there are many complications associated with breast augmentation surgery. Infection and implant rejection are alleged risk factors that deter people from choosing the surgery. .
Fact: infections and implant rejection can be easily avoided by exercising caution while selecting the surgeon, healthcare set-up and the implants for breast augmentation. To minimize the risk of infection, it is important to select a surgeon who has considerable experience in conducting breast augmentation surgery and operates in a well equipped healthcare system.
The body's natural response to any foreign object is to reject it. The degree of this rejection response is partly dependent on the biocompatibility of the materials that make up the foreign object. The more biocompatible a material is, the less the body will reject it. The USA, FDA approved silicone breast implants have rigorously tested for biocompatibility and have been proven to be safe and well accepted by the body.
Myth 5: breast implants lead to capsular contracture and implant rupture in all cases.
Fact: as a natural reaction to any device placed in the body, scar tissue is formed around the breast implant surface creating a capsule. When the scar tissue or capsule that is normally formed around the implant tightens and squeezes the implant, this leads to capsular contracture. Capsular contracture is more common following infection, hematoma, and seroma. Surgeries done in a good healthcare system, by an experienced surgeon, using quality implants often reduce the chances of complications, including events such as capsular contracture. It is also advised to go for the follow-up check-up regularly to avoid complications.
Chances of implant rupture can be highly reduced by avoiding excessive physical pressure or trauma post-surgery.
Myth 6: implants have to be replaced after about 10 years.
Fact: USA, FDA approved silicone gel implants used for breast augmentation are built with impermeable and long-lasting shell filled with cohesive gel. They have been widely tested and are known for fewer complications. These do not require replacement before 20 to 30 years, if no failure is detected. This is contrary to the widely held belief that an implant needs to be replaced frequently.
Press Artciles on this topics by Dr. Naveen Rao
