Breast Augmentation

One of the more popular procedures requested is breast augmentation. The reasons for breast augmentation are varied: from being naturally having a genetic predisposition for a skinny body and a proportionally small breasts to “wanting” to retain her previously youthful, well-endowed bossoms that were loss to giving birth and nursing babies or simply to enhance her feminine sex appeal. Not to be outdone are transvestites who go to all extremes to look “naturally” female.

There are basically 2 types of shapes of breast implants: round shape and anatomic shape (“tear-drop”). Based on surface; there are 3 types: smooth, textured and polyurethane. Based on composition; 2 types: silicone (medical grade of course) and saline but both in elastomere bags made of silicone. With regards to approaches / incisions to insert an implant; 3 approaches for round smooth silicone implants: Axilla (armpit), peri-areolar or inframammary; for anatomic implants: peri-areolar or inframammary and for saline implants: peri-areolar, inframammary and transumbilical (TUBA).

The placement of the implants can be in a subglandular plane or in a dual plane, under the muscle on the supero-medial and subglandular in the infero-lateral pole.

The most common complication is that of Capsular contracture. It is the condition when the “pocket” created on the chest to accommodate collapses on the implant and causes the implant to be defined, “immobile” in its position and painful - the grade 4 capsular contracture. Normally, patients develop some form of capsule around the implant. This is brought about by the body’s reaction to a foreign material within the body – a grade 1 capsular “contracture”. A very thin envelope which encases the implant in the pocket that was created. Although a grade 1 capsular contracture is normal and its reason for formation is as part of our body’s defense mechanism, it is the grade 3 and grade 4 variety of capsular contracture that we would not like to happen. There have been a variety of “reasons” given for a grade 3 and grade 4 capsular contracture such as: hematoma formation (blood accumulation); bacterial contamination (from the natural pathogens found in the ducts of the nipple), surface of the implant (smooth vs. textured) none of which have been proven to be a 100% cause-and-effect variable. Thus, the cause of capsular contracture grade or grade 4 is still unknown.

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St. Luke’s Medical Center
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Our Lady of Lourdes Hospital
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