The quest for cleavage has never been greater.As part of our indefatigable efforts to keep our finger on the pulse of New Hampshire, we conducted an informal and very unscientific survey of Granite State women in which we asked: Do you feel pressured to look good? Responses ranged from "Absolutely" to "All the time." The point being, many women do feel compelled to look appealing according to societal standards, which in America these days means having a full bosom.If a woman is not naturally well endowed but wants to be, cosmetic surgery can be an option. Breast augmentation also can appeal to women seeking reconstructive breast surgery, such as breast cancer patients who have had a mastectomy. Since suffering a setback in the 1990s, when questions surrounding implant safety sparked an uproar and panic among many women who had implants, breast augmentation has soared in popularity, with nearly 300,000 U.S. women undergoing the procedure in 2010, according to the American Society of Plastic Surgeons.Even though implants are now considered safe - although not risk-free - and augmentation so common that it has spawned countless "does she or doesn't she" conversations, deciding to have the procedure is not something to be taken lightly. "A breast augmentation is a major operation even though it's done electively, for cosmetic purposes," says Wayne K. Stadelmann, MD, FACS, a plastic surgeon with Concord Plastic Surgery. After all, "your body doesn't know the difference between having an elective procedure and having gall bladder surgery," he says.Factors to considerFor those who want to pursue augmentation surgery, what lies in store? Typically, the surgery lasts one to two hours and is performed as an outpatient procedure. Post-surgery, patients must restrict their activities while they heal and avoid lifting anything heavier than 10 pounds, which means possibly enlisting help with grocery bags, small children and housework for several days.Long before the surgery, however, women must make decisions about not just the size of implants they want to use to change the appearance of their breasts, but also the type. Saline implants are filled with sterile salt water, while silicone implants (also referred to as "gel" implants) are filled with a silicone-based gel, says Mark B. Constantian, MD, FACS, a rhinoplasty specialist and plastic and reconstructive surgeon at the International Center for Rhinoplasty in Nashua, St. Joseph Hospital and Southern New Hampshire Medical Center, and clinical assistant professor of surgery at the University of Wisconsin School of Medicine.Both types of implants share a similar outer shell, but saline implants do not come pre-filled - the surgeon inflates them during surgery according to the size the patient wants to achieve. Saline implants are usually less expensive than silicone, Constantian says. But silicone implants can feel more natural and, in very thin patients, are less likely to look ripply on the surface, he says.A decision must also be made regarding point of entry. Some surgeons prefer to make the incision for an implant at the base or fold of the breast, some like to insert the implants through the armpits and others choose to enter the breast through the areola, the pigmented skin around the nipple. Some even make the incision in the belly button. Each method has its pros and cons, from producing a less visible scar to limiting the type of implant that can be used or increasing the chance of infection.Unfortunately, no matter where the incision is made, scarring is unavoidable. Cosmetic surgeons do their best to minimize it. "But we can't get skin to heal any differently than any other surgeon," Constantian says. "Skin doesn't heal with skin, it heals with scar. So it always looks different" than the surrounding skin.Do they leak?Unlike the scarring that stubbornly persists, breast implants do eventually wear out. "If you have breast augmentation, you have to plan on having another operation at some point to either take out the implant or replace it or do some minor modifications," Stadelmann says. "It's not a one-time deal. It's like having an expensive sports car; you have recurring costs to maintain it."The average lifespan of an implant varies, but silicone implants tend to last longer than saline-typically about 20-25 years, compared to saline's 12-14, Stadelmann says. When a saline implant ruptures, the breast goes flat. But when a silicone implant ruptures, the woman might not realize it because the silicone will remain in a membrane that the body forms around the implant, he says. To check for "silent rupture," the FDA recommends that silicone implant patients have an MRI periodically, beginning three years after the implantation, Stadelmann says.Implants and breast cancer preventionAlthough today's common practice of placing breast implants under the chest muscle minimizes interference with mammogram screenings, implants do partially obscure mammography images. However, women with implants can take advantage of mammography imaging called Eklund views, which can reduce the amount of concealed breast tissue to about 5-10 percent, as opposed to 30 percent, which would otherwise be the case, Stadelmann says.Perhaps surprisingly, breast implants can in some ways be beneficial when women are checking for signs of breast cancer. Self-exams tend to be more accurate when performed by augmentation patients because the implants provide a more uniform surface than would naturally occur, allowing women to more easily detect small changes, Stadelmann says.Also, some studies indicate that women with implants have a lower cancer rate, although the reason why is unclear. "Some surgeons have postulated that the implant may change the temperature of the breast tissue and affect tumor growth that way," Constantian says. Others theorize that since breast implant patients care about their appearance, they might be more attuned to self-care than the average woman, he says.Nevertheless, women who have a strong family history of breast cancer should discuss their situation with their plastic surgeon, Constantian and Stadelmann say. Some surgeons recommend or even insist that a patient in such cases undergo genetic testing before proceeding with augmentation.Great expectationsAlthough some women yearn for a voluptuous shape, it's probably a good idea to experience reality with those curves before committing to surgery. After all, most patients will live with the implants for many years, Stadelmann says. To that end, some augmentation patients get a homework assignment from their surgeon: fill a Ziplock bag with a substance such as flour, sugar or water, buy a bra in the size you think you want to be and live with it for a while, trying on different types of clothing. Stadelmann says, "I always tell patients you have to be really accurate and choose what you want, because once it's done, that's it." NHA breastfeeding-friendly approachConsidering breast augmentation but hoping to have a family and breastfeed your children someday? Good news: Augmentation surgery should not affect your ability to breastfeed, as long as the breast gland is not violated. That means an augmentation procedure that goes through the fold underneath the breast or in the armpit should not pose a problem, says Mark B. Constantian, MD, FACS, a rhinoplasty specialist and plastic and reconstructive surgeon at the International Center for Rhinoplasty in Nashua, St. Joseph Hospital and Southern New Hampshire Medical Center, and clinical assistant professor of surgery at the University of Wisconsin School of Medicine. Inserting implants through the nipple area, however, will disturb the breast gland, putting future breastfeeding at risk, Constantian says, so be sure to discuss any breastfeeding concerns with your surgeon.
This article appears in the October 2011 issue of New Hampshire Magazine