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Women turning to breast surgery
in record numbers Public opinion and recent scientific studies have once again swung the pendulum in favor of breast implants in the United States. After the FDA restricted the use of silicone implants in 1992, plastic surgeons experienced a precipitous drop in the number of breast augmentations they performed. The government's concern at the time centered on reports that silicone implants were causing generalized symptoms in some women- rheumatoid arthritis, lupus and other auto immune diseases. In the years that followed, multiple large studies were performed at leading medical centers yielding consistently favorable data. In 1997, the Institute of Medicine independently reviewed this data for the U.S. Congress and found conclusively that there was no evidence that silicone implants were responsible for any major diseases of the body and that these devices did not increase the risk of primary or recurrent breast cancer. Since then, many other studies have solidified these conclusions reassuring the public that silicone and saline implants are indeed safe. With this increased confidence in implant technology, more women chose to have breast enhancements in 2001 than ever before. In fact, the American Society of Plastic Surgeons reported that 216,754 American women underwent the procedure in 2001 compared to 32,607 in 1992. This number continues to rise steadily and the Lake Norman and Charlotte regions are no exception. Breast augmentation has become one of the most commonly performed cosmetic procedures in the United States, and in our Lake Norman practice it is by far the most popular surgery. We now perform over 400 breast augmentations yearly, an 800 percent increase from our 1994 numbers when we opened the first plastic surgery clinic at the lake. The number is not surprising considering a full 34 percent of American women in a 1998 study were found to be dissatisfied with the shape and size of their breasts. Improving breast contours and unevenness may seem trivial and vain at the surface, but the emotional implications are far reaching. The boost in self-confidence that we witness in our patients makes this procedure extremely rewarding. A significant number feel a lack of femininity and have an altered body image similar to our mastectomy patients before their reconstruction. Those who are severely underdeveloped avoid bathing suits and instead wear bulky t-shirts to obscure their flat chests. Their gratitude after the surgery is unparalleled and patients invariably become an important source of referrals to our growing practice. These days, once women have decided to undergo augmentation they are faced with a plethora of options: silicone versus saline, round shape versus contoured, smooth surface versus textured, pre-filled versus inflatable, under the chest muscle versus over, in the hospital versus in the office, sedation versus generation anesthesia; not to mention the different size implants and manufacturers available, as well as which incision to use and whether or not other procedures are required. Sometimes breast lift and constriction release are issues. It can be overwhelming! First, the issue of silicone versus saline implants. Although the Institute of Medicine unequivocally ruled out the association between silicone gel implants and systemic diseases, local problems with the breasts such as silicone leaking and hardening, while non life-threatening, were concerning to this committee. My personal preference is to use saline implants. These can and do eventually deflate (less than one percent yearly) but the salt water used to fill them is completely harmless to the body and gets reabsorbed, making them safer than silicone implants. It is noteworthy that very thin patients who exchange their silicone implants to saline implants will occasionally report a "less natural feel." In addition, the silicone implants weight less and have a lower chance of "rippling." However, the health benefits of saline implants, I think, far out weigh these advantages. To replace a deflated saline implant is an I5-minute procedure with no down time. To replace a ruptured silicone gel implant on the other hand often requires a total capsulectomy of two-plus hours in order to remove all the tissue that has been contaminated with the gel. Furthermore, unlike saline deflations where the patient soon notices a decrease in size and seeks attention, the ruptured silicone implants can go undetected for years until the breast starts hardening and becomes painful. As far as round shape versus anatomic shape (teardrop), I agree with a recent study by Dr. Hamas that found very little difference between the two. In fact, paradoxically, the round implants were found to be more anatomic or "natural" than the anatomic implants in the laying position. The additional cost of the anatomic implant and possible rotation deformity reported at 14 percent by Dr. Baeke does not, in my mind justify their use. The next choice to be considered is smooth versus a textured or rough surface. My bias has changed in the last decade from mostly textured to mostly smooth implants. Research in the early 199Os indicated that textured silicone, implants hardened less frequently than smooth ones. It may not be the case for saline implants however. Some studies show a small difference, others no difference at all. Our research indicate similar very low rates of hardening with both textured (1994 to 1998) and smooth (1999 to 2002), although the long term follow up for the second group is not yet available. What we have noticed, as other surgeons have, is that
textured implants wripple, or have surface irregularities, twice as much
in our study. This is especially true in patients who are underweight
(low BMI), that have visible ribs and / or a pinch test on the chest,
of less than two cm or less than an inch. So smooth is better. Which incision to use for placing the implant, by contrast, is much less important. Excellent results can be obtained with all four approaches: under the fold, in a crease of the armpit, through the areola or the belly button. I generally prefer the armpit crease incision as it is a more direct route behind the muscle and leaves no scar on the breast itself. Nipple sensation and breast feeding potential remains intact. The two dominant manufacturers of implants in the U.S., McGhan and Mentor, are equivalent in most respects and I use them to equal degree without preference. As to the size of the implant, the majority of our patients are conservative, wanting simply to restore fullness after having children or slightly enhancing underdeveloped breasts. The width of the chest, how much breast tissue exists and the desired target cup size are the major factors in choosing the volume in "cc's" of the implant. The aesthetic "norm" in the U.S. appears to be a full "C" cup, unlike Europe and South America where B / small C is more common. Although not an exact science, the majority of patients are content with their final volume. In our one-year post-op survey that patients fill lout, 91 percent of women are I happy with their size, six percent would like to have gone bigger and three percent would have liked to have gone smaller. The issue of where to do the surgery (in the office versus in the hospital) and which surgeon to choose is an important one. Do your homework. There are quite a number of excellent plastic surgeons in the greater Charlotte metro area. Make sure they are board certified specifically in plastic surgery and that they perform this type of surgery regularly. Ask how many procedures they perform per year, look over before and after photos and ask for references. If the surgery is done in the office, as we do, there is a greater level of privacy and cost is more easily controlled. However, verify that the facility is accredited (AAAASF or AAASH) as this will insure that the office surgical suites have been thoroughly inspected and that the practice is held to a high standard of care. Be knowledgeable about the complications that can arise. No surgery is without risks, but these should be minimal. Visit our Web site for our reporter rates- www.riouplasticsurgery.com. Some of the complications include revisional surgery for implant malposition (34/1,712 or 1.9 percent), deflation of implant (2 /1,712 or 1.6 percent), hardening requiring surgery (6/1,712 or 0.3 percent), infection (4/1,712 or 0.2 percent) and bleeding (0/1,712 or 0 percent). Finally, take your time and do the research. Don't rush into the surgery. Know that it is safe and ever more popular, but do it for the right reasons, mainly to feel better about yourself. Copyright © Riou Plastic Surgery Center.
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