Adobe Plastic Surgery

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Dr. Burkhardt has retired. See our home page for more information.

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Many women are unhappy with their appearance because their breasts are too small or too droopy. Breast enlargement has become one of the most common cosmetic operations in the world. A very high percentage of women who have implants are quite pleased with the results.

Augmentation Procedure

We prefer the inflatable (saline-filled) implants inserted through an incision around the nipple or under the breast and placed behind the breast gland or behind the muscle. We have used the inflatable implants almost exclusively and have one of the most extensive experiences in the country. Because these implants can be completely collapsed, they can he inserted through a very small incision and filled up after they are positioned. We have almost never seen a noticeable scar using this approach.

Although a very small percentage of these implants do eventually leak and deflate, requiring replacement, they leak only saline. The valve, though small, sometimes causes alarm when patients feel it for the first time during self-examination. Especially in very thin breasts, the natural folds in the outer surface of the implant can be felt or even seen as rippling in the upper part of the breast.

There are some advantages to putting the implant behind the pectoralis muscle. This position puts another layer of tissue on top of the implant, which means that the folds and rippling are better concealed. In addition, the implants are more likely to stay permanently soft when put behind the muscle. Disadvantages of this technique include more discomfort after surgery, tighter muscles around the implant producing more fullness in the upper part of the breast, and inability to fully correct the really droopy breast.

Some reduction in nipple sensation can occur with any technique of breast enlargement, but is usually temporary. We have never found it a significant problem.

The biggest single problem in all breast enlargement surgery is breast firmness, which can occur within a few weeks of surgery, several years later, or not at all. A thin layer of scar tissue that normally lies loosely around the implant gradually contracts, compressing the implant and making it firm. The cause is not known.

This firmness is not a reaction of your "body" to the implant since many women develop firmness only in one breast and others never develop it at all. We believe that it is less likely to occur with implants placed behind the muscle. Although "massage" exercises are commonly used to try to prevent this problem, we do not recommend them because they cause discomfort and there is little evidence that they help.

When firmness does occur, it usually is not severe or especially troublesome. Some patients actually prefer moderate firmness to a completely soft breast. In most cases, it is best to leave the firmness alone, because correction is usually difficult and often temporary. If you do develop a problem of firmness, we will be happy to discuss the options with you in detail.

Breast implants do not prevent the detection of breast cancer by manual self-examination, but can make X-rays (mammograms) more difficult to interpret. Routine two-view screening mammography may not be adequate, and certainly, if cancer is suspected, special views should be taken. We do not diagnose or treat cancer of the breast, but do recommend routine self-examination, mammograms and regular examination by your family doctor, internist, or gynecologist.

If secondary surgery is required to correct a firm breast or deflated implant within one year of your operation, we do not charge a professional fee, but you will be responsible for any implant, operating room and anesthesia costs.

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