New York Breast Expert: The Consultation & Surgery
THE CONSULTATION
At the initial consultation, the physician should thoroughly explain the operative
procedure, the post-operative course, and the possible risks and complications.
And of course there must be a discussion of the size of the implant desired.
You should also be shown many pre and post-operative photographs of other patients
he or she has treated.
There are several types of implants, including saline, silicone gel and hydrogel;
there are different size and shape implants with different types of coverings;
they can be placed over or under the muscle using local or general anesthesia
and there are four different incisions that could be made. A discussion of all
these options will follow.
THE PRINCIPLE OF THE SURGERY
A breast implant is essentially an inert object that is placed into a space
created surgically behind the breast. It pushes the patient's own skin and breast
tissue forward thereby increasing its size. It does not go into the breast tissue
itself. When properly done, it does not interfere with the breast function in
any way. It does not interfere with sensation or with nipple erection. Most
people believe that it does not reduce the ability to nurse a child, although
there is some evidence that lactation may be slightly diminished. An implant
does not interfere with breast cancer, neither causing it nor preventing it,
although some statistical studies have shown that women with breast implants
have less of a risk of breast cancer than the general population -- no one knows
why. Since the breast tissue remains in its normal position in front of the
implant, any tumor growing in the breast could still be detected on self-examination
or an exam done by a doctor. Most experts believe that mammograms, when done
by a skilled person, can detect breast cancer in women with implants at the
same stage as in women without them, but some minimal interference may occur.
And if a tumor ultimately had to be biopsied, it could be done without ever
disturbing the implant.
THE OPERATION
The operation can be done in an office or hospital operating room under general
or local anesthesia with intravenous sedation, the latter being my preference
as there is much less bleeding with local anesthesia and little if any nausea
after the surgery. It is also safer. The procedure takes an hour to an hour-and-a-half.
After a short recovery period the patient can go home with two small bandages
and return one week later for suture removal. If the implants are placed above
the breast there is only moderate pain after the surgery, much like muscle pain
after too many pushups. Mild pain medication is usually taken for the first
two or three days. Most patients can have the surgery done on Friday and go
back to work on Monday, still a bit sore, but perfectly able to function. Under
the muscle placement is much more painful and requires at least a week of immobility.
But I advise no vigorous exercise such as jogging or workouts for three weeks.
After that, virtually nothing one does can injure the implants.
CHOICE OF INCISION
The implants can be placed using one of four options: in the breast fold, around
the nipple, in the armpit (axilla), or through the navel. A surgeon may give
you a choice once you understand the implications of each.
1) In the breast fold: This is my preference as it hides the scar well should
it thicken. It provides the easiest and safest approach for the surgeon and
is the one most commonly used. I am able to do the surgery through an incision
measuring exactly one inch.
2) Around the nipple: This is often a very thin scar; if not, it will be very
visible. The biggest risk of employing this incision is loss of sensation in
the nipple that can occur up to 50% of the time.
3) In the axilla: This is a popular means of access when the implant is put
under the muscle, but it can also be used for over the muscle. My feeling is
that everyone is now aware of the implications of a scar in this area, so if
it thickens, raising your arm on the beach or in a low cut gown will be a dead
giveaway that you have implants. This incision also makes proper placement of
the implant very difficult. Unfortunately, I have seen many patients with implants
that were placed too high on the chest because of this approach. I use it only
rarely, when a patient insists on having it.
4) Through the navel: This is the only approach I feel is inadvisable. The
surgery is performed through a long tube called an endoscope. While the scar
may be imperceptible, it is nearly impossible to dissect a large enough pocket
for placement of the implant in this manner. Therefore, the method used is creation
of the space by blowing a dissecting balloon that tears open the area. This
does not create a large enough pocket for the implant, so that its outline can
be seen, producing a very unaesthetic appearance. If bleeding should occur,
stopping it can be very difficult. Furthermore, because the implant can be abraded
and weakened when pushed through the endoscope, the implant manufacturers will
not guarantee their products in the event of leakage.
Next: The Breast Implant
from Dr. Bellin's Beauty Science (copyright 2001)
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