Breast augmentation and breast reduction are two of the most commonly performed cosmetic surgical procedures. The American Society of Aesthetic Plastic Surgeons (ASAPS) reports that in 2006, breast augmentation surgery surpassed liposuction as the number one surgical cosmetic procedure for women in 2006, with more than 380,000 procedures performed.
Breast augmentation and mastopexy (surgery where breasts are "lifted") are considered cosmetic procedures and typically not covered by health insurance. Breast reduction may be covered if you can document physical or emotional repercussions from having large breasts.
All breast aesthetic procedures should be performed by a plastic surgeon. The surgeon should be board certified by the American Board of Plastic Surgery. In addition, the operating room used for the procedure, whether in an office, hospital or outpatient surgery center, should be accredited by a national organization like the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF).
Women choosing implants for breast augmentation or breast reconstruction can opt for either saline or silicone gel-filled implants. Saline breast implants are filled with salt water after insertion; silicone gel-filled breast implants are in their final shape before insertion and offer a more natural look. Today's silicone gel-filled breast implants benefit from 15 years of improved manufacturing technology that reduce the risk of rupture and leaking; they have thicker outer shells and more cohesive gel. Silicone gel-filled breast implants are approved for breast augmentation in women 22 and older and for breast reconstruction in all women.
You should be in good health to undergo breast augmentation or reduction. If you smoke or are obese or very overweight, you may not be a good candidate. You will also require a full medical examination. A consultation with a plastic surgeon is necessary to assess your eligibility.
During breast augmentation, the breast implants are placed behind the breast tissue (called subglandular), primarily in women who have enough underlying fat to cover the breast implant, or behind the chest muscles (called submuscular).
Risks and complications associated with breast implants include rupture, deflation and capsular contracture. In capsular contracture, the scar tissue that forms around the implant becomes thickened and contracts. Such complications may eventually require removing or replacing the breast implants.
It is recommended that women with silicone gel-filled breast implants have an MRI three years after the implants are first inserted and every two years thereafter.
Breast implants, mastopexy and breast reduction should not interfere with your ability to breastfeed.
There is no increased risk of breast cancer or any other cancer with breast implants. However, they can interfere with mammograms. When you schedule your mammogram, ask if the screening center offers a specialized technique that has been shown to improve the accuracy of mammograms in women with breast implants. This technique involves shifting the breast implant so the compression paddles compress and examine only breast tissue.
It is important that you have realistic expectations of breast aesthetic surgery. You should understand the limitations given your body size and shape, the potential short- and long-term complications and the costs of the procedure.
The best candidates for mastopexy or breast lifts are healthy, emotionally stable women with realistic expectations. You should not attempt mastopexy until you've finished childbearing since another pregnancy and breastfeeding will stretch your breasts again. However, keep in mind that the results aren't permanent; eventually, gravity and age will again take their toll.
Breast reconstruction after mastectomy or other surgery for breast cancer is covered by health insurance, no matter how long after your initial breast surgery you choose to have breast reconstruction. Your insurance company must also cover the cost of surgery on the other breast to make the two breasts look the same, or symmetrical.
Women choosing breast reconstruction can opt for implants or autologous reconstruction, in which tissue from another part of their body is used to create the breast. They can choose immediate or delayed breast reconstruction depending on their cancer stage, post-surgical cancer treatment and their own wishes.
Many women are eligible for an immediate breast reconstruction at the same time they undergo mastectomy. Studies find that immediate breast reconstruction after mastectomy is safe and doesn't delay chemotherapy or increase the risk of complications. Women who undergo immediate breast reconstruction tend to feel better emotionally than women who wait.
Immediate breast reconstruction is less expensive than delayed breast reconstruction, less disruptive and may provide better results.
If possible, involve a plastic surgeon as part of your medical team even before undergoing mastectomy.
Autologous breast reconstruction is a more complex operation than breast implant reconstruction, requiring a longer surgery and recovery. However, it can result in a more natural-looking breast.
Women who smoke or have diabetes or other conditions that affect the health of their blood vessels are generally not good candidates for autologous transplant. Neither are thin women or those who have previously had surgery in the area from which the tissue will be removed.
The two most common types of autologous reconstruction are latissimus dorsi flap, involving tissue from the upper back, and TRAM flap, involving tissue and muscle from the abdomen. Newer versions of the TRAM flap preserve the abdominal muscle, but require greater surgical skill and may have a higher complication rate.
