Augmentation mammoplasty is a surgical procedure for the sole objective of
enlarging the size of the breasts. Currently there is no diet, medications,
hormones or exercises that will effectively increase breast size short of
pregnancy or massive weight gain. The most practical method of enlarging the
breasts is by insertion of a breast prosthesis consisting of a silicone envelope
beneath the breast tissue. It is a very common operation, having been performed
on well over a half million women in North America alone, over the last 20 years.

Who can benefit from this operation?

The three general groups of women that can benefit from this operation are those
who have failed to ever develop adequate breast size, those who have lost breast
fullness following pregnancy, weight loss, or age, and finally those women who
have significantly different sizes of their breasts.

What can the operation achieve and what are the limitations?

he implant increases or restores lost breast volume. The operation does not
affect the skin and therefore does not remove stretch marks. It increases volume
and may disguise but does not correct breast droop or sag. It can often reduce
but not totally eliminate pre-existing asymmetry. The size is increased but the
general shape of the breast is unaltered. The margin of the implant is
occasionally felt or seen as a wrinkle (especially with larger implants).

How does the body normally react to the prosthesis?

The body normally forms a thin layer of scar tissue around the silicone
prosthesis enclosing it in a loose pocket that does not distort the implant shape
and feels soft as a normal breast.

What happens with pregnancy?

The implant does not prevent lactation however not all women even without
augmentation can breast feed. Following breast-feeding the breast tissue usually
returns to pre-pregnancy size and normally sags.

What about the risk of breast cancer?

There is no relationship between implants and the development of breast cancer.
The risk is neither increased nor decreased. The implant is behind the breast
tissue and does not prevent detection of breast lumps, however investigation of
the presence of a lump may be more complicated with an implant in place.
Mammograms may be done, however, more X-ray views may be required and the
implant may mask or distort the appearance of a cancer on a mammogram.

What are the choices of incisions, implant position and type of implant?

The three incisions available are around the areola (the dark area around the
nipple), the fold beneath the breast, and in the armpit. The most common are the
former two. The implant can be placed behind breast tissue or both pectoral
muscle and breast. Each has advantages and this can be discussed with Dr.
Horton. All implants are made of a silicone envelope and differ in the contents.
Presently the only implants available in Canada are filled with saline (salt water).
Similar to any mechanical device these may rupture due to injury or normal wear
over time releasing the saline solution resulting in deflation and required removal.

How is the operation performed?

There are many variations of doing an augmentation mammoplasty as discussed
above. Your preferences influence the decision-making. I prefer using an incision
in the armpit or around the lower edge of the areola. The incision in the armpit
provides access to the space between the breast and the pectoral muscle or
beneath the muscle (see diagram). Through this incision the endoscope (surgical
telescope) is introduced to develop the pocket for the implant. In most patients
this leaves a permanent fine line scar in the armpit with no scars on the breast.

How is the size of the implant determined?

This is extremely difficult for most patients and is determined by discussion with
Dr. Horton of your goals and the physical limitations. These physical limitations
on the size attainable are basically related to the size of the breast's skin
envelope. Previously stretched skin (as in post pregnancy breasts) will tolerate
larger implants. In general, the larger the implants, the greater the risk of
complications, as more surgery is required to develop a large pocket for an
implant. It is important to realize too large an implant can be aesthetically
unpleasing.

What can I expect as the usual post-operative recovery?

Postoperatively, a clear plastic bandage is applied to the skin. There is bruising
and swelling for several weeks. Pain is usually moderate after the first day. Arm
activity is markedly limited for the first week, with a gradual return to normal and
vigorous activity after three to four weeks. You will be instructed to do breast
massage daily to stretch out any developing fibrous tissue to minimize the
chance of fibrous capsule contracture (see below).

What is the most common problem associated with the operation?

In 20 to 40% of patients the fibrous layer surrounding the implant can tighten and
apply pressure to the outside of the implant. This "fibrous capsular contracture"
causes the breast to feel unnaturally firm and appear too rounded. This is the
most common complication of augmentation and can usually be dealt with by a
simple manipulation in the office if done early. Certain patients may benefit from
a secondary operative procedure to surgically release this fibrous layer. Some
who are prone to this problem may continue to have firm breasts even after such
secondary surgery. Rarely this is severe enough to make removal of the implants
advisable.

What are the other common possible complications?

The complications of anaesthesia, whether local or general, are part of the risk of
even minor surgery. Breast augmentation is a relatively low risk procedure, but
as with any operation, there are certain potential problems. The basic
mechanisms of infection (which may require removal of the implant for treatment),
bleeding, circulatory compromise to the skin, and poor or painful scar formation
are complications in any surgery. Nipple sensation may be increased or
decreased, which can be temporary or permanent. Stretch marks in the skin can
occur. Calcium can form around the implant after many years. Asymmetrical
positioning of the implants is uncommon and is usually due to some pre-existing
breast asymmetry or shifting of the implant as the result of severe capsular
contracture. Occasionally, usually due to infection, the implant may erode
through the skin and be "rejected" by the body. Uncommonly the implants can
rupture requiring removal and replacement of the implant. It is postulated that an
autoimmune syndrome (Human Adjuvant Disease) may occur producing a
Rheumatoid Arthritis, Systemic Lupus, or Scleroderma like condition. Any of
these complications may result in temporary or permanent disability or deformity,
may require further surgical treatment, and a possibly prolonged recovery period
and time off work.