All you need to know about Boob Jobs
23/08/2011 at 11:35 AM
According to the American Society for Aesthetic Plastic Surgery (ASAPS),
311, 957 breast augmentation surgeries AKA, "Boob Jobs", were preformed in 2009, making it the #1 surgical cosmetic procedure in the US.
What makes this procedure so popular? What do us med students & general practitioners need to know about this procedure? How is it preformed?
Breast Augmentation Surgery is the use of a breast implant to change the shape & size of women's breasts.
Throughout history women have tried to enlarge their breasts in attempt to become more attractive to the opposite sex. The first breast augmentation was performed by Vincenz Czerney in 1895. He used a women's own adipose tissue to enlarge her breasts. The use of silicon for enhancement began in the late 50's, starting with silicone injections and later with introduction of the silicone implants in 1962. Since then, approximately 1.5-2 million women in the US have undergone breast implant placement surgery. Of these, 20% were reconstructive procedures, most commonly following mastectomies, and 80% were purely for cosmetic purposes.
The surgical procedure takes approximately 1-2 hours and differs in incision type, implant material, and implant pocket placement.
The different incision types include inframammary, periareolar, transaxillary, transumbillical & transabdominoplasty. Inframammary is the most common incision. Its long incision makes it the preferable approach for silicone gel implants but it leaves more visible scars than other approaches. The transumbillical incision ( TUBA) is a recently new approach. The incision is made in the navel and dissection tunnels are made till the breasts. This can be done with or without an endoscope; it leaves no scars on the breast but is suitable only for saline implants only since they are filled after placement in the breast.
There are 2 kinds of implants, saline & silicone filled. Saline implants have a silicone shell and are filled with saline after the implant is placed in the body, therefore requiring a smaller incision. These implants are less favorable since they more commonly cause cosmetically visible complications such as wrinkling and contracture.
The first silicone gel implants were developed by Dow Corning Corporation in 1961. Since then there have been 5 generations of implants. Each successive generation has reduced its risk of rupture & leakage by producing elastomer coated shells and more cohesive gels. The fifth, and most recent generation, consists of a solid highly cohesive gel but still not approved for use in the US.
The location of implant placement differs in relation to the pectoralis major muscle. The implant may be placed in a subglandular pocket, between the breast tissue & the muscle, subfacial, under the muscle facia, subpectorial, partially under the muscle and submuscular, totally under the muscle. The most common approach in the US is the subpectorial pocket.
Recovery is usually fast and the patient can return to normal activity after 1 week time, although advised to avoid strenuousphysical activity for 6 weeks. Recovery may be longer in supectorial & submuscular implant placement and scars may take several months to disappear.
Complications include risk factors common to all types of surgery like anesthetic reactions, bleeding& infection, and specifically for this type of surgery, such as asymmetry, wrinkling and unfavorable scaring. Breastfeeding may be impaired using the subglandular & periareolar approach. Complaints of implant leaks, rupture and capsule contracture have also been reported. Just recently, Poly Implant Prostheses company (PIP) made news headlines as they fraudulently used unauthorized silicone gel for their implants leading to high rupture rates, therefore causing a ban on their sales. Although rupture of silicone implants may be dangerous if the silicon migrates, most of the reactions are local granulomas and accumulation in the lymph nodes. It should be noted that all implants eventually break down, requiring removal. Silicon implant rupture commonly goes unnoticed by the patient, and may be difficult to detect by physical examination therefore requiring an MRI.
Many complaints regarding the relation of implants and different medical conditions, especially autoimmune disorders lead to one of the largest research studies in medical history by The Institute of Medicine (IOM) in 1997. The study examined potential complications of silicone implants. After years of research it was concluded that silicone implant patients were at no higher risk for development of medical conditions such as autoimmune, neurological, connective tissue disorders and malignancy than the general population.
In 2006 the FDA lifted its restrictions on the use of silicone implants with a warning that implants are not without risk and recommended an MRI exam three years after breast augmentation and two years thereafter to search for leakage.
As a med student you may have been asked this trick question: "What is abnormal in this chest X ray?"
311, 957 breast augmentation surgeries AKA, "Boob Jobs", were preformed in 2009, making it the #1 surgical cosmetic procedure in the US.
What makes this procedure so popular? What do us med students & general practitioners need to know about this procedure? How is it preformed?
Breast Augmentation Surgery is the use of a breast implant to change the shape & size of women's breasts.
Throughout history women have tried to enlarge their breasts in attempt to become more attractive to the opposite sex. The first breast augmentation was performed by Vincenz Czerney in 1895. He used a women's own adipose tissue to enlarge her breasts. The use of silicon for enhancement began in the late 50's, starting with silicone injections and later with introduction of the silicone implants in 1962. Since then, approximately 1.5-2 million women in the US have undergone breast implant placement surgery. Of these, 20% were reconstructive procedures, most commonly following mastectomies, and 80% were purely for cosmetic purposes.
The surgical procedure takes approximately 1-2 hours and differs in incision type, implant material, and implant pocket placement.
The different incision types include inframammary, periareolar, transaxillary, transumbillical & transabdominoplasty. Inframammary is the most common incision. Its long incision makes it the preferable approach for silicone gel implants but it leaves more visible scars than other approaches. The transumbillical incision ( TUBA) is a recently new approach. The incision is made in the navel and dissection tunnels are made till the breasts. This can be done with or without an endoscope; it leaves no scars on the breast but is suitable only for saline implants only since they are filled after placement in the breast.
There are 2 kinds of implants, saline & silicone filled. Saline implants have a silicone shell and are filled with saline after the implant is placed in the body, therefore requiring a smaller incision. These implants are less favorable since they more commonly cause cosmetically visible complications such as wrinkling and contracture.
The first silicone gel implants were developed by Dow Corning Corporation in 1961. Since then there have been 5 generations of implants. Each successive generation has reduced its risk of rupture & leakage by producing elastomer coated shells and more cohesive gels. The fifth, and most recent generation, consists of a solid highly cohesive gel but still not approved for use in the US.
The location of implant placement differs in relation to the pectoralis major muscle. The implant may be placed in a subglandular pocket, between the breast tissue & the muscle, subfacial, under the muscle facia, subpectorial, partially under the muscle and submuscular, totally under the muscle. The most common approach in the US is the subpectorial pocket.
Recovery is usually fast and the patient can return to normal activity after 1 week time, although advised to avoid strenuousphysical activity for 6 weeks. Recovery may be longer in supectorial & submuscular implant placement and scars may take several months to disappear.
Complications include risk factors common to all types of surgery like anesthetic reactions, bleeding& infection, and specifically for this type of surgery, such as asymmetry, wrinkling and unfavorable scaring. Breastfeeding may be impaired using the subglandular & periareolar approach. Complaints of implant leaks, rupture and capsule contracture have also been reported. Just recently, Poly Implant Prostheses company (PIP) made news headlines as they fraudulently used unauthorized silicone gel for their implants leading to high rupture rates, therefore causing a ban on their sales. Although rupture of silicone implants may be dangerous if the silicon migrates, most of the reactions are local granulomas and accumulation in the lymph nodes. It should be noted that all implants eventually break down, requiring removal. Silicon implant rupture commonly goes unnoticed by the patient, and may be difficult to detect by physical examination therefore requiring an MRI.
Many complaints regarding the relation of implants and different medical conditions, especially autoimmune disorders lead to one of the largest research studies in medical history by The Institute of Medicine (IOM) in 1997. The study examined potential complications of silicone implants. After years of research it was concluded that silicone implant patients were at no higher risk for development of medical conditions such as autoimmune, neurological, connective tissue disorders and malignancy than the general population.
In 2006 the FDA lifted its restrictions on the use of silicone implants with a warning that implants are not without risk and recommended an MRI exam three years after breast augmentation and two years thereafter to search for leakage.
As a med student you may have been asked this trick question: "What is abnormal in this chest X ray?"
Many of us are familiar with this scenario. We look & look again and we don't find anything…. and then we turn red and sweat in front of the professor. Now you won't have to panic, the answer is: Nothing! The patient is a woman with breast implants which appear as large opacities in the breast tissue.
Breast implants are known to interfere with mammography results. Eklund Mammographyis a special mammographic view for breast implant patients. The implant is pushed back against the chest wall and the breast is pulled forward over it. Although breast cancer is not of higher prevalence in implant patients than the general population, breast cancer is more palpable in these patients due to stretching of the breast tissue, not due to bigger tumor size.
Breast implants are commonly used in post- mastectomy breast reconstruction. They also do not interfere with subsequent lumpectomies and external radiation therapy.
And now, for the reason plastic surgery is such a desired residency. The cost of breast augmentation ranges from $3,000-$5,000 and up. This procedure is rarely covered by insurance. However, if enlargement is part of breast reconstruction after a mastectomy, health plans may pay for some or all of it.
Currently, Holland breaks the record for the country with the most breast augmentation surgeries so guys, plan your next trip to Amsterdam!
