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| Breast Augmentation Is Back! |
| by Michael Kulick, M.D. San Francisco, CA |
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Once one of the most popular operations, breast augmentation is again the number one surgical procedure performed for women between 19 to 34 years of age.
In the early 90s, there was some "controversy" about the safety of silicone gel implants. Although saline filled implants are of a different design, they too had a drop-off in use as the FDA and plastic surgeons looked into the anecdotal reports and tried to establish the safety of the gel and saline implants. On May 10, 2000, the FDA ruled that saline-filled implants made by Mentor or McGhan could continue to be marketed and used for breast augmentation for women over the age of 18.
While investigators were looking at patients with implants, I took a different approach. I studied patients that had "somatic" complaints, aches and pains in their back, neck and arms to see if they had implants as the cause of their complaints. My study looked at 100 consecutive patients. The findings published in Aesthetic Plastic Surgery in 1996, Vol. 22:9-11, showed that there was NO correlation between the women that had somatic complaints and breast augmentation. Other studies are also finishing that demonstrate that there is no causation between "autoimmune" disease and breast augmentation.
As these studies have become public, the frequency of breast augmentation has again increased. Between 1998 and 1999, there was a 51% increase in the number of breast augmentations performed by plastic surgeons.
While gel implants may soon be vindicated from any association with an autoimmune disease, my own personal preference has been to use saline implants. In general, they can be inserted through smaller incisions and then once in position, can be inflated to the desired size. Adjustments in patient's asymmetry with respect to breast volume can be performed to a degree by placing more or less saline in one implant to try and match the opposite side. Deflation rates are low and most manufacturers are providing replacement implants if this does occur.
 
My favorite location for the placement of the incision is under the arm. Once healed, the incision is very difficult to see. Other options include at the edge of the pink areola or under the breast. In most cases, I recommend putting the implant beneath the pectoralis muscle. This "extra" layer of tissue between the skin and the implant provides the patient a natural slope at the top of the breast. In addition, the muscle contraction during normal daily activity helps keep the implant moving in the pocket, providing a softer feel to the breast. Certain breast shapes require placement of the implant above the muscle if the patient wants to avoid a breast lift.
Breast implants are contraindicated for women with the following conditions:
- Existing malignant or pre-malignant cancer without treatment
- Active infection at the time of surgery
- Augmentation during pregnancy or nursing
In summary, breast augmentation is a safe and predictable method of enhancing the size of a woman's breast when performed correctly.
Getting Started
If you are considering a cosmetic medical procedure, consult a board-certified plastic surgeon about the process, risks, recovery time and costs. For confidential, personalized information at no cost or obligation, use the Find A Specialist tool to find a board-certified plastic surgeon near you. It’s your first step to looking and feeling better today!
Share your thoughts and questions about breast augmentation in the discussion Forums.
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Learn more about breast augmentation now.
Learn about other plastic surgery procedures to consider in addition to breast augmentation.
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