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Breast Implant

Also known as Breast enlargement or Breast enhancement surgery, the procedure of breast implant aims to reform, increase, enhance or regain the size of the breasts and thus also aims to restore the balance of the figure. This is a much sought-after procedure in cosmetic surgery and it also has a good track record of safety, success, and satisfaction in most cases.
Enhancements can be made by implants or fat transfer from one’s own body.
It is a procedure which leads to the long-term betterment of one’s figure and shape.

When should one consider breast implants?

One may consider a breast implant surgery when they want to:
1. Have a better-proportioned figure that is appealing.
2. Reconstruct an absent breast either congenitally or due to a
breast removal surgery (Mastectomy).
3. If you want a better proportioned or more appealing figure and
want clothes to fit better.
4. To restore the shape when one breast looks a lot different from
the other.
5. When aging, breastfeeding, pregnancy or weight loss has
affected the appearance of the breasts.

What are the most common reasons for seeking breast implant surgery?

* When a woman feels that her breasts are too small for her body.
* When clothes fit perfectly at the hips but are loose on the top.
* When one wants to have a shapely figure while wearing a swim-suit or low neckline dresses and have firm breasts.
* When one wants to regain the pre-pregnancy shape of the body.
* When one suffers from Poland Syndrome where one breast is absent or very small in comparison to the other breast

Procedure of breast implant surgery

In this procedure, the surgeon will make an incision and make a pocket underneath the breast tissue to place the implants. The implants are then placed in this tissue and the incision is closed, most commonly with absorbable sutures.

The different types of incisions in practice that can be made to
place the implants are:
* Inframammary: In the breast crease underneath the breast.
* Transaxillary: Near the arm-pit.
* Periareolar: halfway around the black area surrounding the
nipple.
* Transumbilical: In the belly-button/navel (Only for Saline
implants)

The planes where the implants can be placed under the breast may be
behind the gland or behind the muscle. The surgeon is the best
person to suggest where should the implants be placed depending on certain
factors which are best discussed after the physical examination.

Implant with fat

In this method, the fat from one’s own body for e.g. the thighs, the abdomen or the buttock is used. The fat is harvested by the method of liposuction, filtered and purified for injection and the fat is inserted at different planes of the breast through injections. This can be considered a virtually scar-less technique. This method is still in its evolution phase, although it has shown much promise. A breast lift may be combined with any of these procedures if the breasts are droopy and need a lift as well as volume.

What are my options for different types of implants?

There have never been more choices for breast implants. The following options are available, depending on your medical history, body shape and aesthetic goals.

1. Silicone breast implants (gel-filled)
These are the most commonly used breast implants throughout the world. They are pre-filled with soft silicone gel in a silicone shell.

2. Silicone breast implants (cohesive gel)

These are pre-filled implants also called as gummy-bear or form-stable implants. The silicone gel used in these implants is more form-stable and are
firmer than the soft silicone implants. They also hold their shape better than the other variety. The silicone implants may require a longer incision for placement in comparison with a saline implant.

3. Saline breast implants

These implants have sterile salt water filled in them instead of silicone. They may be pre-filled or may be inflated after the implant has been placed in the pocket of the breast, hence the incision used for their placement is smaller than the silicone implant.

Are breast implants safe?

The USFDA has approved the usage of silicone implants in breast enhancement surgeries. It is important for women having breast implants to know that although the implants last quite long, it may need to be replaced.
One must stay in touch with her aesthetic surgeon to have periodic
examinations and checks and must report in case of any change that seems to require attention like sudden swelling and pain in the breast after the implant.

In the long-term studies that have been conducted, it has been found that the implant does not give rise to breast cancer, has no impact on the reproductive life.

How do I prepare for my implant procedure?

Once you have had a consult with the Plastic Surgeon you would most
likely be advised:
* A baseline mammogram or an ultrasound of the breasts.
* To quit smoking or at least stop it a couple of weeks before and after the surgery.
* To stop taking any blood thinners if you take it or to stop certain drugs that cause blood thinning.
* To keep up the water intake.

After the procedure

After the breast implant procedure, you will experience stretching and pain in the breasts because of the breast tissue stretches while implant placement.
The breasts may also be sensitive to touch and may be red and swollen. However, the discomfort subsides in a couple of days and gradually one can return to normal activities within a week.

You will also be advised to wear a support bra immediately after the surgery and you will be advised by your surgeon about the duration for which you would need to wear it, probably about 4-6 weeks.

Physical activity should be minimized for a couple of weeks and one must gradually increase the level of physical exertion. Intimate contact with your partner will be guided by your recovery from the procedure.

In the long term, you will need to stay in touch with your surgeon and have periodic checkup every few years and have repeated mammograms (recommended otherwise too for women after a certain age).

Associated Costs

1. The cost of breast implant surgery would depend on factors like surgeon, geographic area, implant choice etc.
2. Insurance does not cover the surgery.
3. One should choose her surgeon based not only on cost but also on experience, training and one’s comfort with the surgeon.

Limitations and Risks

Fortunately, significant complications from breast implants are infrequent. Your specific risks for breast implants will be discussed during your consultation.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
• Adverse reaction to anesthesia
• Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
• Infection and bleeding
• Changes in sensation
• Scarring
• Allergic reactions
• Damage to underlying structures
• Unsatisfactory results that may necessitate additional procedures

All surgical procedures have some degree of risk. With breast implants, minor complications occur occasionally but do not affect the outcome. Major breast implants complications are very unusual.

Other risks specific to breast implants are outlined below:
• Infection
• Capsular contracture
• Implant rupture
• Mammography shadows affecting breast cancer detection.

Implants and ALCL

In the January of 2016, the USFDA observed and confirmed that women with breast implants may be at an increased risk of BI-ALCL, this is not breast cancer and neither is it a cancer of the breast tissue. It is cancer arising in the capsule of the implant and is a very rare type of non-Hodgkins lymphoma. This can be easily detected and is highly treatable in the majority.

In women who develop this cancer, the implant should be immediately removed. Women with breast implant should continue their routine breast
examinations as recommended for other women.

The USFDA and the Institute of medicine still believe that breast implants are fairly safe and effective.

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