Breast Augmentation: Questions Answered
What is the one thing that woman are most self-conscious about? Of course body weight, but more than anything it is what Mother Nature offered us in breast size. Yes, ladies, this is an area of our body that most wish were bigger or – the more endowed ones – smaller.
As female athletes/bodybuilders, we work very hard in perfecting our physique. What more would we want than to have our breasts reflect all that work of toning and developing curves? I know from experience that the first thing that goes when you are losing weight or trying to build muscle, well you guessed it, the breasts.
There are many concerns when shopping for breast augmentations: choosing the right plastic surgeon, type and placement of implant, recovery time, the ability to still lift weights and work out. With a little internet research, you will find websites such as: breastimplants.com, plasticsurgery.com, and board-certifiedplasticsurgeons.com. Thesewebsites can be very helpful.
Through my own research 
I have found that the best decision is to choose a board certified plastic surgeon – and one you feel most comfortable with. This may entail making several appointments until you find the right surgeon. Remember, anyone can wear a white coat and claim to be the best. Do your homework to ensure they are board certified. You may even want to research the Better Business Bureau to see if there are any outstanding complaints. This will help ease your mind in making your decision.
Now that you have done your homework, there is the decision of what type of implants and their placement. This is something you will need to discuss with your doctor, but be prepared before your initial visit. The most common implants are saline and silicone. Both implants have had good reviews. Talk to any doctor and they will tell you the type of implant depends on the patient and what look they are trying to achieve.
Michael Law, MD, a plastic surgeon in Raleigh-Durham, had some really good points that he brought to the surface with both types of implants. He raised the question: Are silicone gel implants better than saline implants?
According to Dr. Law, selecting silicone gel or saline implants is different for each patient and depends on the patient's personal feelings and opinions about a host of issues related to implants. This includes implant cost, monitoring of ruptures, incisions, and the potential need to replace the implants. Other factors that can affect your choice of implant include the pre-operative breast size and the desired post-operative breast volume.
Dr. Law suggests that when choosing the type of implant, it’s wise to be familiar with the size and location of the incisions. Silicone gel implants are pre-filled and require a larger incision for implant insertion depending on the size of the implant that is used. On the other hand, saline implants are filled after insertion, and can be rolled into a long, narrow shape for insertion through a smaller incision.
Although most surgeons agree that silicone gel breast implants feel more natural than saline breast implants, the difference varies with the amount of breast tissue that exists prior to augmentation, and the size of the implant that is used. “The more natural feel of a silicone gel implant will be much more important to patients who are slender and fit in an A cup bra preoperatively, as they have less subcutaneous soft tissue to conceal the implant. The difference will be less noticeable to a patient who is more full-figured,” according to Dr. Law.
According to Dr. Law, smaller saline implants simulate natural breast tissue better than larger implants. If your goal for a breast augmentation is to produce a natural-appearing breast profile, meaning that it matches the rest of your figure and does not look like surgery, it would be best to have an implant smaller than 300cc in volume. In his experience as a surgeon, he has found that saline implants in this size range tend to produce results that not only look natural, but feel natural.
Another common question asked is whether sub-pectoral or pre-pectoral implant position is better. Dr. Law found that currently there is really only one acceptable position for breast implants in an elective cosmetic surgery patient and that is behind the pectoralis major muscle (sub-pectoral augmentation). “There are a number of very compelling reasons to place implants behind the pec major, and the most compelling one of all is the fact that radiologists report that the mammographic imaging of breasts for the purpose of breast cancer screening tends to be more easily accomplished when implants are sub-pectoral (compared to pre-pectoral, also referred to as the sub-mammary position).
An American woman's current lifetime risk of breast cancer is approximately 1 in 8 to 1 in 9, so the issue of breast cancer screening must be taken very seriously. Mammography is by no means a perfect screening study, but it is the standard of care at this point in time. The most sensitive and specific test for breast cancer is a contrast-enhanced MRI scan. Breast implants do not impair breast tissue visualization by MRI, according to Dr. Law.
This really gives us something to think about ladies, especially with the growing cases of breast cancer. I know we all want beautiful breasts, but we also need to take into consideration our annual visits for our check-ups.
Another compelling reason to select sub-pectoral placement is a cosmetic one. “Implants placed on top of the pec major tend to stand out in the upper pole of the breast, creating a rounded, convex and distinctly unnatural-appearing breast profile. With implants in a sub-pectoral position, the upper pole of the implant is flattened somewhat by the muscle, helping to create a smooth transition from the area in the upper chest where the breast begins, and a gradual slope towards the nipple that is not excessively rounded or convex,” according to Dr. Law.
“In some patients with a fuller breast volume preoperatively, one may get an acceptable appearance with pre-pectoral placement… initially. The problem is that as breasts age, the fatty tissue atrophies and breast tissue thins out, and the area where this is most obvious is in the upper pole and cleavage area. A pre-pectoral implant that was initially well-concealed may, after a few years, become painfully obvious (including visible implant folds and ripples) in the upper pole,” Dr. Law continued.
Dr. Law also brought to light the misleading terms of 'under the muscle' and 'sub-pectoral'. He stated that in most cases the implant is only partially sub-pectoral. “The anatomy of the pectoralis major muscle is such that it is actually just the upper/medial half of the implant that is covered by the muscle, while the lower/lateral half of the implant is sub-mammary. The pectoralis major thus provides an additional layer of tissue to conceal the implant in the most cosmetically significant area of the breast: the cleavage area. This is why saline implants are often easy to feel laterally, as they are covered by breast tissue only in lateral aspect of the breast, and in slender patients who have small breasts preoperatively the implant is often immediately under the skin in this area,” Dr. Law stated.
What about recovery time? According to Dr. Law, the recovery from sub-pectoral breast augmentation used to be a rather unpleasant experience, but that’s no longer the case. He explains, “a space for the implant must be developed behind the pectoralis major, and a portion of the muscle's inferior origin must be released. Surgery on a muscle in most cases produces significant post-operative pain, and that is certainly true for breast augmentation. However, by using a local anesthetic infusion device (the On-Q 'Pain Buster') for the first two to three days after surgery, the pain associated with this procedure can be reduced quite dramatically.”
It has been reported that most patients experience little to no pain the day after surgery, and perhaps some mild discomfort on post-op day one and two. Most patients can resume all normal, non-strenuous activities of daily living immediately after surgery, and can begin pec major range of motion exercises on the evening of their procedure.
Many doctor’snote that post recovery time varies:
Working patients usually return to work within a week following surgery.
Stay-at-home moms may need some help with toddlers for the first two to three days after surgery.
Athletic patients are limited to walking only for the first two weeks; in weeks three and four some light exercise is permissible. Patients can gradually increase their exercise/workout level within five to eight weeks. It is noted however that it is a full eight weeks before patients are allowed to return to activities that require forceful, repetitive, sustained pec major contractions such as pushups and heavy weight lifting. Ladies, it is very important to ensure that you wear a sports bra after surgery and, eventually, when returning to impact exercises such as running or aerobics.
So, now the question is, are you willing to be out of commission for eight weeks with regard to working with the weights? I know personally – as an exercise enthusiast and competitor – it would be pretty hard for me not to lift heavy weights for eight weeks.
Everyone heals differently, and in some cases you might be able to hit heavy lifting before eight weeks, but the most important thing to remember is to listen to your doctor’s orders. You want to allow yourself enough time for your body to heal and for you to get used to your new addition.
After you do your research, you may opt not to have breast augmentation and just go with what Mother Nature provided you. Either way, rememberthat beauty comes from within. Yes, we all want beautiful breasts to go with our tight, toned, muscular bodies; however, are you willing to go through surgery, downtime, and the upkeep to have them? It is a question you should really think about before taking the “BIG” plunge.
Contact Michael Law, MD @ http://www.michaellawmd.com
Photo credits: http://www.docshop.com, Breast Augmentation, Submuscular Placement, Subglandular Breast Implants
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