If you're considering breast augmentation...

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To correct a reduction in breast volume after pregnancy.
• To balance a difference in breast size.
• As a reconstructive technique following breast surgery.

By inserting an implant behind each breast, surgeons are able to increase a woman's bustline by one or more bra cup sizes. If you're considering breast augmentation, this will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please ask us if there is anything you don't understand about the procedure.

The best candidates for breast augmentation

Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Types of implants

When it comes to breast implants, you can never have too many choices. There are currently 2 approved options for breast implant fillers: silicone and saline. Each filler has a silicone outer shell and has been approved by the Food and Drug Administration.

The newest generation of silicone gel-filled breast implants has a cohesive silicone gel-filler. Basically this means that silicone inside the implant acts more like a soft solid than a liquid. Beyond the implant filler material, there are other variables that can help you and your surgeon achieve the desired result. Dr. Nein will discuss your choices in detail and you will be able to determine which type of implant is right for you.

All surgery carries some uncertainty and risk

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A very small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body.

If a break occurs in a gel-filled implant, it may be undetected without a mammogram or MRI. Both types of breaks may require a second operation and replacement of the leaking implant.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with Dr. Nein to make sure you understand the risks and consequences of breast augmentation.

Planning your surgery

In your initial consultation, Dr. Nein will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, we may also recommend a breast lift.

Be sure to discuss your expectations frankly with Dr. Nein. He will be equally frank with you, describing your alternatives and the risks and limitations of each. You wish, we can provide you with a copy of the manufacturer's insert that comes with the implant he or she will use -- just so you are fully informed about it. And, be sure to tell us if you smoke, and if you're taking any medications, vitamins, or other drugs.

Most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

Preparing for your surgery

We will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where your surgery will be performed

This procedure is usually performed as an outpatient in a freestanding surgery center.

Types of anesthesia

Breast augmentation is usually performed with a general anesthesia, so you'll sleep through the entire operation. Some surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you'll be relaxed but awake, and may feel some discomfort. Dr. Nein prefers general anesthesia for your comfort and safety.

The surgery

The method of inserting and positioning your implant will depend on your anatomy and Dr. Nein's recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.

Placement of the implants behind your chest muscle may reduce the potential for capsular contracture. This placement may also interfere less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Placement behind the muscle however, may be more painful for a few days after surgery than placement directly under the breast tissue.

The surgery usually takes about an hour to complete. Absorbable stitches are used to close the incisions, which may also be taped for greater support.

After your surgery

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed.

Getting back to normal

You should be able to return to work within a few days, depending on the level of activity required for your job.

Follow our advice on when to begin exercises and normal activities.

Your scars will be firm and pink for at least six weeks. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician may use a special technique to assure that you get a reliable reading.

Your new look

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success.