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 The
most frequently performed cosmetic surgery procedure in the U.S.,
breast augmentation can give women with small or unevenly sized
breasts a fuller, firmer, better-proportioned look through the
placement of implants in the breast. Women may elect to undergo
breast augmentation for many different medical and aesthetic
motivations, including balancing breast size and compensating
for reduced breast mass after pregnancy or surgery. The procedure
may be combined with others such as a breast lift for more satisfying
results.
Implants are silicone shells filled with saline (salt water)
and are placed behind each breast, underneath either breast tissue
or the chest wall muscle. The procedure lasts one to two hours
and is typically performed with general anesthesia.
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Breast lift, or mastopexy, is performed to return youthful
shape and lift to breasts that have sagged as a result of
weight loss, pregnancy, loss of the skin’s natural
elasticity or simply the effects of gravity. The procedure
can also reduce areolar size (the dark skin surrounding the
nipple), and it can be combined with breast augmentation
for added volume and firmness. Breasts of any size can be
lifted, but results last longest when they are originally
small and sagging. Mastopexy may be performed in a hospital or at an outpatient surgery center. It is usually done under general anesthesia, and
lasts from one to three hours.
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Large breasts may cause physical and mental discomfort and can
even harm the women who have them -- the size and weight of large
breasts can result in self-consciousness, improper posture, pain
in the back and neck, indentations from bra straps, skin rashes,
breathing problems and skeletal deformities. Breast reduction
surgery is usually done to provide physical relief from these
symptoms. Performed under general anesthesia, the two- to four-hour
procedure removes fat and glandular tissue and trims resultant
excess skin to produce smaller, lighter breasts that are in a
healthier proportion to the rest of the body.
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 Modern surgical technology makes it possible to construct a
natural-looking breast after mastectomy (breast removal) for
cancer or other diseases. The procedure is commonly begun and
sometimes completed immediately following mastectomy, so that
the patient wakes with a new breast mound instead of no breast
at all. Alternatively, reconstruction may begin years after mastectomy.
Many insurance companies cover reconstruction following breast
cancer surgery, and legislation is currently before Congress
to make coverage mandatory.
Women whose cancer seems to have been eradicated with mastectomy
are the best candidates for breast reconstruction. Those with
health problems such as obesity and high blood pressure and those
who smoke are advised to wait. Others prefer to postpone surgery
as they come to terms with having cancer, consider the extent
of the procedure, or explore alternatives.
The reconstruction itself consists of multiple operations,
the first of which involves creation of the breast mound and
is performed during or after mastectomy in a hospital under general
anesthesia. Later surgeries, if necessary, may be done in the
hospital or an outpatient facility, with either general or local
anesthesia.
There are several ways to reconstruct the breast, both with
and without implants; your breast surgeon and plastic surgeon
should work together with you in deciding which is the best for
you.
Breast reconstruction has not been proven to affect the recurrence
of cancer or other diseases, chemotherapy or radiation treatment.
Nevertheless, in addition to the complications possible from
any surgical procedure (bleeding, fluid collection, excessive
scar tissue, or difficulties with anesthesia), there are some
risks inherent in breast reconstruction, including infection
around the implant, if an implant is used, and capsular contracture,
when the scar (capsule) around the implant tightens, causing
the breast to feel hard. Treatment for capsular contracture varies
from “scoring" the scar tissue to removing or replacing
the implant. Some patients may need time to come to terms emotionally
with their new breasts.
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