Follow Up After Breast Augmentation
Follow up after surgery is a very important part of the breast augmentation procedure. The follow up appointment serves several purposes. The most important purpose is to help ensure that the patients post-operative recovery is proceeding as expected. Another important reason is to assess the long term result, which can only be determined by long term follow-up. It is important the follow up care be done by the surgeon that performed the procedure. Follow up care for cancer surveillance is usually performed by a primary care physician.
The Breasts After Augmentation
The breast goes through several changes after the breast augmentation procedure. Some of the changes are visible and obvious and some are not. Immediately after surgery the breasts are very firm. This is partly a result of the breast implant stretching the breast tissue. The breast tissue is in a new position and is stretched over the breast implant which is a greater surface area than in the pre-operative state. As the recovery period proceeds, the breast tissue relaxes (dynamic response) in time over the breast implant and becomes softer. Usually there is a significant change in breast softness in about 6 weeks. Immediately after the breast augmentation procedure there is excessive fullness in the upper part of the breast. As the breast tissue relaxes, the breast is also firm as a result of swelling immediately after the breast augmentation procedure. Breast swelling (edema) is a natural response to the surgical procedure. The breast swelling will subside over a period of several weeks in most patients. After the swelling of surgery subsides and the breast tissue stretches, the breast will become softer and more natural feeling. The softness of the breast is partly dependent on the breast implant, and on the type of implant. Breast softness is also partly dependent on the amount of breast tissue, and the amount of glandular tissue versus fat (adipose) in the breast. The size of the breast will change after surgery. Early changes in breast size (decrease in size) are a result of the resolution of swelling. The change in size due to resolution of swelling is minimal and occurs in the first several weeks after the breast augmentation procedure. The breast will also decrease in size over a longer period of time (years) due to the natural aging process. As the breasts age, the glandular tissue decreases in volume which decreases the overall volume of the breast. The breast tissue can also decrease in volume as a result of dynamic pressure atrophy. The phenomenon can be observed in almost any living tissue (with a few exceptions). Pressure applied over a long period of time to living tissue causes change, and in this case, decreases in volume of the breast tissue. This can occur to the ribs under the breast implants, although this is a rare observation.
As the breast age over time tissue integrity decreases. Breast tissue can also decrease in tissue integrity as a result of pregnancy. The result is more breast sagging as aging progresses. This is a very gradual change and at some point patients may want a breast lift (mastopexy) at a later time. The incision site of the breast augmentation surgery also goes through stages of healing. After breast augmentation, the skin and the subcutaneous tissues (tissue just under the skin) are swollen. This causes what is sometimes referred to as a “healing ridge”. Just as with the breast tissue, the skin swelling subsides in about three weeks. The appearance of the of the incision (the scar) for breast augmentation improves over a 2 year period in most patients unless there is an adverse wound healing diathesis (tendency) for adverse scars (hypertrophic scar, keloid). Research over the last 25 years has shown that there are therapeutic measures that can be performed after surgery to improve scars. We always use these therapies for patients undergoing breast augmentation. This emphasizes the importance of follow up after the breast augmentation procedure. Tissue changes that cannot be seen are also occurring inside the breast. Within hours after the breast augmentation procedure a “capsule” (scar tissue) begins to form around the breast implant. This is the body’s normal response to the presence of a foreign body, the foreign body being the breast implant. If the “capsule” remains larger than the implant, the breast will remain soft. If the “capsule” shrinks, thickens, and becomes tight, the implant will be more firm. The status (condition) of the capsule should be closely followed by the Plastic surgeon to help ensure that a problematic “capsular contracture” does not occur, and if one does occur, to discuss treatment options. As with post-operative care for the scar after breast augmentation, the inside of the breast can also be followed by the Plastic surgeon. The Plastic surgeon should follow breast augmentation patients after surgery to monitor the incision site (scar) and the breast “capsule” so that if adverse healing (keloid, hypertrophic scar, hyperpigmented scar) occurs then treatment can be offered.
Breastfeeding After Breast Augmentation
Patients frequently ask if it is possible to breast feed a baby after breast augmentation. The two issues related to breast feeding after breast augmentation are the ability to breast feed, and the quality of the breast milk. Studies have shown that the breast milk after breast augmentation does not contain any more silicone than breast milk in the patient without breast augmentation. Breast milk after breast augmentation is generally thought to be safe, although some researchers write that this has not been “proven”. The ability to breast feed could be affected by breast surgery. Breast augmentation procedures that cause the least injury to the breast glands, breast ducts, and the nipple-areolar process are less likely to affect the ability to breast feed. The breast augmentation approaches that dissect under the breast (infra-mammary incision, axillary incision) as opposed to through the breast (peri-areolar incision) would be desirable based on this assumption. While not a random controlled trial, which is the gold standard in medical research, many anecdotal cases have been seen where patients successfully breast fed a baby after breast augmentation. However, there is no guarantee that a patient will be able to breast feed with or without breast augmentation.
Attainable Goals, Limitations, and Realistic Expectations
There are many benefits gained from the breast augmentation procedure. As with any elective cosmetic Plastic surgery procedure, there are goals that can be accomplished, and there are also limitations. Breast augmentation can increase the volume of the breasts and can also give a small degree of lift in some patients. Following breast augmentation, clothes and bathing suits will fit better, and many patients report improvements in self confidence and self image. Some clothes that were inadvisable to wear for patients with hypomastia (small breasts) can be comfortably worn after breast augmentation, such as a low cut evening dress or a bikini. There are aspects about the breast that cannot be changed or improved with the breast augmentation procedure. Some of these conditions are a result of aging or pregnancy, and some are developmental (natural conditions as a result of development). Skin tone cannot be changed or improved with augmentation mammaplasty. Extreme amounts of excess skin cannot be corrected with an augmentation mammoplasty alone. Stretch marks cannot be eliminated with an augmentation mammoplasty. Patients should not expect to look exactly like another person after surgery, because all patients are unique before and after breast augmentation. Chest wall asymmetry, pectus carinatum and pectus excavatum cannot be eliminated with an augmentation mammoplasty. Breast augmentation will not stop the aging process. It is extremely important that the patient seeking augmentation mammaplasty understand that there are some limitations to the breast augmentation procedure and the procedure is not a panacea (cure all).
Aging of the Breasts
As with any elective cosmetic procedure, the aging process is not interrupted by the breast augmentation procedure. The breasts will change with aging irrespective of the presence or absence of breast implants. The breast tissue can thin to some degree after breast augmentation, which may or may not be attributable to the procedure since this can occur without the presence of breast implants. Breast sagging progresses naturally without breast implants. The presence of breast implants, especially very large implants, may speed the progression of breast sagging. Breast implants are mechanical devices, and like all mechanical devices, can deflate or rupture. At the time this was written, the Mentor company (breast implant manufacturer) has a limited lifetime warranty. Saline breast implants have been used since the early 1990’s with a very high satisfaction rate. This means that the saline breast implant group of patients has been followed for about 25 years. It is generally believed that saline breast implants are safe. It is also believed that saline breast implants are effective. It can also be concluded that most saline breast implants last a long time in most patients. Because the new fifth generation breast implants are relatively new when compared to saline implants, less time has been spent studying them.