Category: Breast health


Nipple Sensitivity After Breast Augmentation: What Are the Facts?

Nipple sensitivityBREAST AUGMENTATION surgery remains the most frequently performed cosmetic surgery in the United States. The demand for BREAST IMPLANT SURGERY increased 4% in 2011 to 307,000 women according to the American Society of Plastic Surgeons. 

As its popularity grows, women are becoming more proactive about educating themselves about their decision. One of the most significant concerns is about sensitivity to the nipple post operatively. Women want to know the statistics, not just “opinions” not backed up by any evidence. They want to make fully informed decisions.

An excellent study on this subject was published in the October 2011 issue of Plastic and Reconstructive Surgery. A plastic surgeon from Rome collaborating with a British colleague published data on 1222 patients (that is 2444 breasts!) examining nerve function after breast enlargement surgery. They reported the following:

  1. Half of all patients experienced a TEMPORARY change in sensitivity that goes away by itself in 6-8 weeks. 
  2. At six months, 94.8% of women had normal sensation, unchanged from before surgery.
  3. Large breast implants did not increase the incidence of sensory change.
  4. Patient age did not factor into sensory change.
  5. Placing the implant above or below the pectoral muscle did not make a difference in sensation.
  6. A decrease in feeling was present in 2.7% of women post op. Discomfort was noted for 3.5%.
  7. The only risk factor identified for altering nerve sensation was use of the periareolar incision.

In fact the periareolar  incision resulted in more than double the number of women with altered sensation.  Fortunately this sensory change affected only a small number of women. If a scar around the areola is what you prefer, it is good to know the facts up front.

Breast Augmentation, Breast health, Breast Implants, Mommy Makeover

What Does the Future Hold for Silicone Breast Implant Imaging?

MRI findings

Diagrams of MR imaging findings in implant rupture. At left, intracapsular rupture where silicone is contained by the surrounding fibrous scar tissue (black arrows). The collaped outer shell (curved arrow) and often fluid droplets are seen within the gel. At righ, an extracapsular rupture, where silicone gel extends beyond the fibrous scar or capsule.

Silicone breast implants are one of the most extensively researched medical devices in the US. They have a high safety profile and are being used increasingly with good product performance. Breast implant shell failure is one of the concerns many women express when investigating choice of implant type. If the shell of a saline implant develops a break the fluid spills out and deflation occurs within days. If a silicone implant experiences a break in the shell, it generally requires an imaging study to confirm.

The implants currently marketed in the United States are referred to as “Fourth Generation Responsive Gel.” These implants have a silicone center that is thicker than earlier implants. Because of the viscosity, if there is a break in the envelope, shell failure, the gel tends to stick to itself, rather than oozing out of the sac like syrup.

Detecting a leak involves some form of an imaging study. Mammograms give a certain amount of information about the status of an implant, but are not sensitive enough to pick up every rupture. A negative study can give false reassurance that the implant is intact.

An MRI, magnetic resonance imaging, is considered the Gold Standard. The FDA has recommended a post operative MRI at year three and every two years thereafter. There is no scientific evidence that backs the timing of this recommendation, and most plastic surgeons believe the recommendation is overly cautious. Both the cost and the inconvenience of MRI exams are barriers to women using this for follow up. Additionally, MRI exams can over read, meaning give the appearance of a rupture where none exists. This can lead to unnecessary surgery.

Technology advances in some areas with mind boggling speed. Medical imaging is a field of rapid technological expansion. As predicted, there is an emerging technology that is not yet market ready that promises to vastly improve post operative imaging of silicone implants.

High resolution ultrasound is being studied for its ability to give accurate information about the shell of silicone breast implants. Preliminary research is published in the Aesthetic Surgery Journal, February 2012, p.157. The authors report that as they refine this ultrasound technique, it may provide relative affordability, accessibility, and availability. It’s good news for the future of monitoring the shells of silicone breast implants.

Beauty, Breast Augmentation, Breast health, Breast Implants

The Ideal Breast

Breast-augmentationWhat’s ideal? What’s normal? Women’s breasts vary so widely that there really is no way to define the “normal.” Each person’s experience, cultural background and preferences create  their personal “ideal” and there is remarkable difference of opinion. So what do plastic surgeons consider when trying to get the very best appearance for each woman choosing breast surgery? In order to communicate aesthetic ideas with their patients, plastic surgeons analyze basic characteristics of the breast and try to describe what features are possible to change and how to create the best surgical strategy for improvement. After your surgeon has listened well to your preferences, these are a few of the features that your surgeon may want to analyze with you.

  1. Where is the breast located on the chest wall?  The base of the breast (breast disc or footprint) should meet the chest wall in a way that is the foundation for the overlying three dimensional structure of the breast. This footprint is constant throughout life. An abnormal location of the footprint or an irregular chest wall can interfere with the aesthetics of the breast. Is your breast fold too high or too low?  Is your spine straight?  Does one side of the chest project more than the other?  Are your ribs crooked? 
  2. What is the shape or “conus” of the breast? Breast shape varies widely among women and quite a bit over a given woman’s lifetime. In adolescence the breast is cone shaped. Over time there should be a progressive transition with a greater portion of its volume resting in the lower outer quadrant. The nipple should be at the area of maximum breast projection, roughly at the apex of the cone shape. 
  3. What is the quality and quantity of the breast skin? Too much skin leads to a drop in the breast position on the chest wall. The skin provides the major support for the breast gland. If elasticity is poor, the skin envelope cannot contain the gland in a suitable shape.
  4. Is the areola size a good match for the volume of the breast? Is the nipple position correctly located on the projecting portion of the breast and in the middle or slightly lateral to the middle of the breast?
  5. Do the two breasts look alike? Most women’s breasts are more like sisters than identical twins, but symmetry is one feature of the hoped for end result.
  6. Is the volume appropriate for the rest of the body’s proportions? You should express your size concerns to your surgeon and have a careful discussion about any possible downsides to your choice. 

Tubular Breasts

The term “TUBULAR” refers to SHAPE for a tubular breast. It is used to describe a breast shape that is long and narrow, rather than being broad at the base with a gradual decrease in width up to the top, like a cone or pyramid. Women that have tubular breasts often have a very high fold at the base of their breast, and they have puffiness in the nipple-areolar region where the breast seems to bunch out of the top. A mild tubular breast shape is quite common. Extreme tubular breast deformity can be very troubling  to have, and women often want the shape improved.

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Beauty, Breast Augmentation, Breast health, Breast Reduction, Mommy Makeover, Tubular Breasts

Disproportionate Breasts Can Interfere with Sports

Seattle is a community were women are involved in all kinds of athletics. Having breasts that are uncomfortable can be a barrier to many types of activities.

Women with breasts that are too large have trouble with high impact movements. Bras can pull on the shoulder straps and rub around the chest band. Repetitive motion like running can cause chafing and heat rashes. Even wearing two sports bras may not be support enough to prevent bouncing. This can discourage large breasted women from participating in the type of workout they might enjoy.

A breast reduction or breast lift can make a huge functional as well as cosmetic difference. For the woman with breasts that are overly large or one with the right size but drooping breasts, plastic surgery has a variety of offerings to address these concerns.

Women with very small breasts may be as uncomfortable in the gym as those with large breasts. One of my patients is a competitive body builder. She disliked wearing a padded bra for her contests. Another woman swims regularly for exercise but felt unfeminine in her bathing suit. Both of these chose a breast augmentation to improve their confidence in these settings. I had women seek breast enlargement that were personal trainers, yoga instructors, pilates teachers and coaches. These professionals recognized that making changes in their breasts improved physical function, appearance and self image.

Breast health is an important contributor to a woman’s over all well being. Don’t neglect your breast health.

Breast health

Summer sports

Summer seems to be an ideal time for setting  personal fitness goals. When the days are long and the sun is out Seattelites seem to have lots of energy and see that much is possible. I have long been a fan of triathlons, especially the Danskin. The terrific thing about the Danskin is that there are women of all ages and sizes who have just decided to get more fit. The idea of the race seems to be for the many participants to have a goal to work towards and have fun accomplishing that goal. It’s a helpful supportive environment that is about enjoying fitness, not competition.  

Having a summer sporting goal such as a triathlon can be a good way to schedule exercise on a regular basis to maintain a healthy lifestyle.  It’s helpful for weight loss, body toning, aerobic fitness and of course, fun.  

Many of my patients are athletic and recognize that regular workouts are a critical part of feeling good about your body.  Plastic surgery works best on those who maintain their fitness. For some, body contouring procedures can be a confidence lifting step that helps to motivate them for healthy choices.

I’ll be doing the Seafair and the Danskin triathlons this summer.  Hope to see you there.

Breast health, Nutrition, Personal Fitness

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