Lifestyle Choices

Performed to enlarge small breasts, augmentation mammaplasty has proven to be dramatically successful in relieving self-consciousness in small- breasted patients and in restoring a feeling of normal femininity. The operation involves creating a pocket under the breast tissue, or under the muscle, and inserting an implant, a soft, plastic envelope containing a saline solution. (In the United States, silicone gel implants are no longer used for breast augmentation, despite the lack of scientific evidence that firmly links such implants to autoimmune disease.) After the operation, which is sometimes done under local anesthesia, the patient must wear an elastic bra that is specially designed to help minimize swelling and bleeding. This bra is worn night and day for a few weeks following surgery, and strenuous activity must be avoided for about six weeks after the operation.

Such surgery involves risks, one of which is the formation of a breast capsule that can contract. This process is called capsular contracture, in which scar tissue grows and tightens around an implant, causing it to feel hard. Several years ago, the use of silicone implants was associated with complications after surgery. The introduction of new, low-bleed, gel filled silicone implants and their placement into submuscular rather than subglandular pockets reduced the incidence of post-operative fibrous encapsulation, but silicone implants are no longer available. Saline implants and the newer textured implants are less likely to cause capsular contracture. A disadvantage of the saline implants is that they wrinkle and may not feel as natural. In addition, they are more visible than the silicone implants were. Approximately 10 percent of patients now require further treatment for fibrous encapsulation of the implant. About 1 percent of patients may need to have the implants removed.

An important consideration for women anticipating breast augmentation is the effect of the operation on the performance and interpretation of breast X-rays or mammograms. The implant obscures a portion of the breast in conventional views, and the radiologist is likely to have some difficulty seeing the entire breast and effectively ruling out any worrisome changes. In addition, such surgery may lead to a decrease or loss of feeling in the nipple and breast that may or may not return.

Other serious complications of such surgery are infection or deflation of the implant, which is likely to necessitate its removal. There may be breast asymmetry despite the best efforts of the surgeon. Women who have had breast enhancement can not breast-feed, and there is often a loss of sensation in the nipple.

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