Breast Augmentation Massage

A breast implant is a prosthesis used to alter the size and shape of a woman's breasts (known as breast augmentation , breast enlargement , mammoplasty enlargement , augmentation mammoplasty or the common slang term boob job ) for cosmetic reasons, to reconstruct the breast (e.g. after a mastectomy or to correct congenital chest wall deformities), or as an aspect of male-to-female sex reassignment surgery. Pectoral implants are a related device used in cosmetic and reconstructive procedures of the male chest wall. A breast tissue expander is a temporary breast implant used during staged breast reconstruction procedures. According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure in the United States. According to data collected by the American Society of Plastic Surgery, in 2007, 307,230 breast augmentation procedures were performed in the U.S., a 12% decrease compared to the previous year. This decrease has been associated with the financial challenges posed by a struggling economy. Despite the decrease, however, breast augmentation surgeries remained as the number one surgical cosmetic procedure performed in the U.S.

There are two primary types of breast implants: saline-filled and silicone-gel-filled implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel. Several alternative types of breast implants had been developed, such as polypropylene string or soy oil, but these are no longer manufactured.

History

Implants have been used since at least 1895 to augment the size or shape of women's breasts. The earliest known implant was attempted by Vincenz Czerny, using a woman's own adipose tissue (from a lipoma, a benign growth, on her back). Gersuny tried paraffin injections in 1889, with disastrous results. Subsequently, in the early to mid-1900s, a number of other substances were tried, including ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, polyvinyl alcohol-formaldehyde polymer sponge (Ivalon), Ivalon in a polyethylene sac, polyether foam sponge (Etheron), polyethylene tape (Polystan) or strips wound into a ball, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses. In recent history, various creams and medications have been used in attempts to increase bust size. Furthermore, Berson in 1945 and Maliniac in 1950 performed a flap-based augmentation by rotating the patient's chest wall tissue into the breast to add volume. Various synthetics were used throughout the 1950s and 1960s, including silicone injections, which an estimated 50,000 women received. Development of silicone granulomas and hardening of the breasts were in some cases so severe that women needed to have mastectomies for treatment. Women sometimes seek medical treatment for complications up to 30 years after receiving this type of injection.

Indications

Breast implants are used primarily for:

  • primary reconstruction (to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality such as the tuberous breast deformity)
  • revision-reconstruction (revision surgery to correct or improve the result of an original breast reconstruction surgery)
  • primary augmentation (to increase breast size for cosmetic reasons)
  • revision-augmentation (revision surgery to correct or improve the result of an original breast augmentation surgery)

Patient characteristics

Patients seeking breast augmentation have been reported as being usually younger and less-educated than those who seek other plastic surgeries. Many of these patients have reported greater distress about their appearance in a variety of situations, and have endured teasing about their appearance.

Studies have identified a pattern (shared by many cosmetic surgery procedures) that suggest women who undergo breast implantation are slightly more likely to have undergone psychotherapy, have low levels of self-esteem, and have higher prevalences of depression, suicide attempts, and mental illness (including body dysmorphia) as compared to the general population.

Post-operative surveys on mental health and quality of life issues have reported improvement on a number of dimensions including: physical health, physical appearance, social life, self confidence, self esteem, and sexual function. Longer term follow-up studies suggest these improvements may be transitory, with the exception of body esteem related to sexual attractiveness. Overall, most patients report being satisfied long-term with their implants even when they have required re-operation for complications or aesthetic reasons.

Holland is the country with most breast augmentation surgeries. More than half of the women in the United States who undergo cosmetic surgery earn less than $25,000 annually. National health care plans subsidize breast augmentation in Sweden, Holland, and elsewhere in Europe.

Mental health

A 2007 Swedish and US longitudinal study found that women who get cosmetic breast implants are nearly three times as likely to commit suicide as other women. No notable increase was seen in the first 10 years after surgery, but 10 to 19 years after, risk was 4.5 times higher, and six times higher after 20 years, compared with the expected suicide rate.

The same study found that women with breast implants also had a tripled risk of death from alcohol and drug use. Seven studies have been made connecting breast implants to a higher rate of suicide.

Researchers believe that breast implants themselves do not directly cause the higher suicide rate amongst the women who undergo the procedure. The hypothesis is that women with an inclination towards psychopathology (psychological problems) are more likely to get breast implants in the first place. For example, a Danish study found that eight percent of women who underwent cosmetic breast augmentation also had a history of psychiatric hospitalization before surgery.

Procedure

The surgical procedure for breast augmentation takes approximately one to two hours. Variations in the procedure include the incision type, implant material, and implant pocket placement.

Incision types

Breast implants for augmentation may be placed via various types of incisions:

  • Inframammary - an incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible or thicker scars.
  • Periareolar - an incision is placed along the areolar border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola's circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5 cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment. There is a higher incidence of capsular contracture with this technique, and this incision causes the most problems with breast feeding, due to cutting milk ducts and nerves lead to the nipple.
  • Transaxillary - an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast, but is more likely to produce asymmetry of the inferior implant position. Subsequent revisions of transaxillary-placed implants usually require inframammary or periareolar incisions. Transaxillary procedures can be performed with or without an endoscope.
  • Transumbilical (TUBA) - a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. Transumbilical procedures are performed bluntly, with or without an endoscope (tiny lighted video camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell if attempting insertion through the small 2 cm incision in the navel, and as those implants are pre-filled they cannot be passed through that incision.
  • Transabdominoplasty (TABA) - procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.
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