(surgery on an outpatient basis or with a day of hospitalization)
The primary indication for augmentation mammaplasty is an inadequate volume of breast tissue, either developmental or involutional nature. Augmentation mammoplasty is the second most commonly performed cosmetic surgical procedure in the United States, after suction-assisted lipectomy, and the most commonly performed on women between 19 and 34 years of age. More than 1% of the adult female populations have breast implants. Three separate incisional sites- inframammary, periareolar, axillary – have been used for placement of breast prostheses. Each location has its advantages and disadvantages, depending on the individual surgeon’s experience, patient’s anatomy, the preference of the patient and the positioning of the implant. The implant can be placed in a subglandular, subpectoral, or “dual-plane” position.
The patient is placed in a light gauze dressing and comfortable stretch brassiere on leaving the operating room. A spectrum antibiotic is prescribed. The patient is instructed to refrain from exercise and all activities except those necessary in her daily activities, for one week in most cases, avoiding heavy exercise for two or four weeks. Gentle massage of the breast is encouraged between the third and the fifth postoperative day.
Acute complications (please see the links below)
Hematoma: The incidence of hematoma after augmentation mammaplasty has been reported to be 2% to 3%.
Infection: The incidence of infection after augmentation mammaplasty has been reported to be from 0.5% to 2%. The most common aerobic organism found has been Staphylococcus epirmidis and Propionibacterium acnes, two specimens found in patient skin. Management of infection depends on severity and the presence of exposure. Mild infections without implant exposure sometimes can be successfully treated with antibiotics alone. Infection may cause the loss of an implant, either because the device extrudes through a dehisced wound or because removal is necessary for treatment of the infection. In cases of severe infection, the implants cannot be salvaged.
Seroma: incidence of seroma after augmentation mammaplasty has been reported to be 0% to 1%.
Chronic complications (please see the links below)
Sensory dysfunction: Changes in nipple sensation are estimated to occur in 10% of women after augmentation mammoplasty. Injury to the lateral branch of the fourth intercostals nerve may be reduced with submuscular implant placement.
Capsular Contracture: Encapsulation of any breast prosthesis resulting in a firm fibrous periprosthetic shell, or capsular contracture, is the most common complication reported after breast enlargement. Recent multicenter data showed a 20.4% rate of significant capsular contracture (Baker grade III or IV) 13 years after placement of saline implants. Open capsulotomy or capsulectomy is the treatment of choice for symptomatic capsular contracture. Women with high grades of capsular contracture often require treatment. The management of severe capsular contracture involves in open capsulotomy combined with implant exchange with placement of the new implant in a virgin pocket, in a subpectoral pocket.
Implant malposition: Implant malposition and an unfavorable shape are the second most common cause, after capsular contracture, of patient dissatisfaction following augmentation mammoplasty. Rippling: Is an uncommon complication, where there is a perception of the implant in breast, almost occurring in thin women. Prophylactic measures to avoid rippling include the subpectoral placement, special in thin women. First-line treatment of rippling includes conversion to subpectoral placement if previously subglandular, changing from a textured to a smooth implant. Fold : Uncommonly the implant can also be felt in the fold of the breast.
Silicone effects on pregnancy, lactation, and breast-fed children
Currently, there is no scientific evidence that silicone is a mutagen or teratogen. Implants do not interfere with lactation or increase the amount of silicone in breast milk over baseline levels present in women without implants. Clinical studies conducted by the British Department of Health and the Institute of Medicine of the National Academy of Sciences both demonstrate that silicone breast implants are safe for pregnancy, lactation, and breast-feeding. Dr. Marisa Marques is finishing her PhD about “Pathogenesis of capsular contracture in breast implants”; the follow articles published by Dr. Marisa Marques about breast implants and complications, mainly capsular contracture:
http://goo.gl/1tO2H8 · http://goo.gl/fqmOhF · http://goo.gl/tF2DPJ
http://goo.gl/e1CW5R · http://goo.gl/jt2PzE · http://goo.gl/2m7Cxk