Breast Aesthetic Surgery Tool Kit - National Women's Health Resource Center/Healthywomen.org

Breast Augmentation

The decision to have breast augmentation is typically a personal one and one made for a variety of reasons: to feel more feminine; to reconstruct breasts after cancer surgery; to enhance or reduce breast size or shape. For example, some women have very small breasts, called micromastia. For these women especially, breast augmentation may significantly improve their overall self-confidence, self-perception and sense of attractiveness.

No matter what your reason for choosing breast augmentation, it is considered cosmetic surgery and it is unlikely that your health insurance will cover the procedure. The average cost of breast augmentation surgery in the United States is $3,600 for the surgeon's fees. You must also pay for the operating room, postsurgical hospital stay, anesthesia and other related costs.

Breast augmentation is performed with one of two types of implants: saline, or salt water, or silicone gel-filled. The major benefit of saline implants is that that if they break, your body can easily absorb the saline solution. However, they are prone to rupture and sometimes create a less natural-looking breast than silicone gel-filled breast implants.

Silicone Gel-Filled Breast Implants: Back on the Market

In the 1980s and 1990s, concerns were raised about the possible long-term effects of silicone gel-filled breast implants. Due to reports of leaking silicone and possible health implications, including the potential for autoimmune and connective tissue disorders, in 1992 the U.S. Food and Drug Administration (FDA) called for a voluntary moratorium (delay) on the use of silicone gel-filled breast implants until new safety information could be thoroughly reviewed by the FDA's advisory panel. Within three months, the FDA allowed silicone gel-filled breast implants to be used again for reconstructive surgery and revision (implant replacement) surgery under clinical study protocols. Silicone gel-filled breast implants were not permitted for women seeking cosmetic breast augmentation.

Similar to other medical devices on the market today, silicone gel-filled breast implants have evolved over the last two decades. The structure and design of today's breast implants have been refined and, as a result, the thicker shell and additional barrier layer distinct from earlier breast implant devices, have an improved safety profile.

In the past 15 years, more than 100 studies have been conducted on the safety of silicone gel-filled breast implants in the United States and around the world. These studies find no increased risk of connective tissue diseases, breast or other cancers or neurological disorders in women using silicone gel-filled breast implants.

As a result, the FDA is now allowing silicone gel-filled breast implants to be used again. Silicone gel-filled breast implants are approved for breast reconstruction in women of all ages and for breast augmentation in women age 22 and over. The approved silicone gel-filled breast implants are manufactured and sold by Allergan, Inc., and Mentor Corp.

If you are considering breast implant surgery, with either saline or silicone gel-filled breast implants, there are important factors you should discuss with a plastic surgeon:

Breast implants may require a special type of mammogram in which the breast implant is shifted so that the compression paddles compress and examine only breast tissue. This technique has been shown to improve the accuracy of mammograms in women with breast implants. When you schedule a mammogram after having breast implants, ask if the screening center has this capability and tell the technician that you have breast implants when you arrive for your test.

Like many other medical devices, breast implants are not lifetime devices and likely will need to be removed or replaced at some point. You should talk to your surgeon about this prior to surgery. An FDA study found that about eight percent of breast implants used for augmentation had been removed after three years, and 12 to 14 percent after five years. According to one study of 455 women undergoing breast augmentation for the first time, conducted by Allergan, Inc., one in four women (23.5 percent) required another operation within four years. Overall, 7.5 percent had their breast implants removed and replaced. Additional surgeries are generally not covered by insurance.

To check for tears and ruptures, breast implant manufacturers and the FDA recommend that women undergo an MRI three years after their initial surgery, then every two years thereafter.

Overall, women are still generally very pleased with the results of their breast augmentation. One Allergan, Inc. study found that of the 364 women who were first-time breast augmentation patients and provided a satisfaction rating four years after breast implantation, 95 percent said they were satisfied.

The key to being satisfied, however, is having realistic expectations. Make sure you talk to your surgeon about why you are considering breast augmentation, your surgery goals and your expectations, the possible post-surgical and long-term complications and the cost of the procedure and any follow-up care.

This resource is part of an educational initiative sponsored by Allergan, Inc., maker of the NATRELLE™ Collection of breast implants.

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