BREAST ENLARGEMENT: BANE OR BOON? Breast enlargement, otherwise known as breast augmentation, mammoplasty enlargement or augmentation mammoplasty, is a prosthesis to increase the size of the women’s breasts. Breast enlargement procedure is done for the following reasons: Reconstruction After a mastectomy, a woman has to have breast enlargement to keep up with society’s notion of what beauty is. It is highly acceptable in society for women to have larger breasts to be considered sexy. Scanty dressed women modeling for a swimwear line and showing off enlarged breasts further strengthens this notion of beauty and sexiness. Being flat cheated is less feminine to some that they have to undergo breast enlargement. > Sex Change A male to female reassignment surgery has to include breast enlargement for the sex change to be complete. History reveals the continuous evolution of breast enlargement procedures. Implants range from the use of adipose tissue, paraffin injections, ivory, and glass balls to cartilage. There were creams and medicaments used in attempts to breast enlargement and even rotation of chest wall tissue to the breast to add volume. More other synthetic implants were used like silicone injections to an estimated 50,000 women who availed of breast enlargement operations. Breast enlargement approximately takes two hours to complete. Implants are put into the breast through different types of incision. The implant material and the desired effect of the patient dictate type of incision to be used. > Inframammary incision is the most common type of incision and is placed below the breast, in the infra-mammary fold. Because of the longer incision required, this is preferred for silicone gel implants. This method though leaves visible marks in smaller breasts which can cover the infra-mammary fold. > Periareolar incision is along the areolar border and provides maximum approach when adjustment to the infra-mamary fold position or breast lift is desired. This type is hard for silicone gel breast enlargement because of the length of the incision it requires. Scars will be less visible since it is placed on the edge of the areola. > Transaxillary incision is placed in the armpit and the dissection tunnels medially and allows no visible scars on the breast. > Transumbilical incision is placed on the navel and dissection tunnels superiorly, a less common technique and no visible scar on the breast. This incision can be done bluntly or with the use of an endoscope during the dissection process.. The implant shell may be damaged during insertion that this type is not approriate for breast enlargement using silicone gel. > Transabdominoplasty is similar to transumbilical incision where implants are inserted up from the abdomen. There are two types of implants that can be used for breast enlargement, silicone-gel-filled implant using silicone shell filled with viscous silicone gel and saline implant. using silicone elastomer shell filled with sterile saline liquid. Alternative implants, though not common, has also been developed to enlarge breast. These two implants can be differentiated as follows: Saline Implant > Saline implants, first developed in France in 1964, are simple breast enlargements through small incision > Implants, made of silicone elastomers, are filled with water after it is placed in the body. > Resulted to smaller incision in the breast since it was smaller when inserted in the breast. > More famous breast enlargement than silicone implant due to restrictions in the silicone implants > More likely to cause cosmetic problems such as rippling, wrinkling, and be noticeable to the eye or the touch. Particularly for women with very little breast tissue, or for post-mastectomy reconstruction.. Silicone Gel Implants Developed by Texas plastic surgeons in 1961 and had its first breast enlargement attempt in 1962. It can be described in five generations based on its manufacturing techniques used. > Generation 1 Implants are made of silicone rubber envelope or sac filled with viscous silicone gel with a Dacron patch on the posterior shell. Are firm and had an atomic teardrop shape. > Generation 2 Redesigned in 1970 to be softer and more lifelike, second generation silicone gel breast enlargement has thinner gel and thinner shell but has the tendency to rupture or leak. This bleeding of silicone has resulted to complications such as capsular contracture and involved the manufacturer in class action suits in the early 1990. To diminish this complication, polyurethane foam coating on the implant shell was used but this was briefly stopped due to concerns of possible carcinogenic breakdown products from polyurethane. It was later concluded that the risk was minimal and that there was no need for explantation of the devices from patients. Second-generation breast enlargement using silicone gel also features a double lumen wherein a silicone implant is within a saline implant. This provides cosmetic benefit of a silicone gel while saline implant in the outside lumen can be adjusted. The complexity of the design resulted to a high failure rate of this breast enlargement procedure > Generation 2 & 3 The mid 1980s breast enlargement had advances in manufacturing principles. Elastomer coated shells are filled with thicker more cohesive gel to decrease leaking or bleeding. Shells of various shapes have become available, uniformly textured anatomic shaped implants to reduce rotation while round implants are available in smooth or textured surfaces. > Generation 5 The 5th generation of silicone implant for breast enlargement is characterized by highly cohesive, form-stable gel. Possibility of silicone migration is reduced and studies have shown significant improvements in the safety and efficacy over older implants. Low rates of capsular contracture and rupture were also shown. The pectoralis major muscle always figures in the placement of the implant for breast enlargement. > Subglanular implant placement is between the breast tissue and the pectoralis muscle. This has the most aesthetic but is likely to to show ripples and wrinkles of the underlying implant in patients with this soft tissue coverage.Capsular contracture rates higher in this approach. > Subfascial position is placemnt of implant in the subglandular position but underneath the fascia of the pectoralis muscle. The benefits of this breast enlargement have to be established but advocates of this technique insist that the thin vascularized fascia covers and maintains position of the implant. > Subpectoral implant position is underneath the pectoralis muscle and is the most common positioning technique used. Capsular contracture is lower after widespread adoption of this technique. > Submascular implant position is below the pectoralis muscle but without release of the inferior origin of the muscle. This technique is common for maximal coverage of implant in breast enlargement and reconstruction. The Boon of Breast Enlargement After all is said about breast enlargement, proponents of the procedure have several motives in undergoing the surgery. The primary reasons why women and men who had sex transplants underwent breast enlargement were aethetics and complete and total sex change respectively. Furhermore, breast enlargements covered by insurances are added inducements for women and men in undergoing breast enlargement. Breast enlargement is an answer to most women who wanted to look and feel sexy and beautiful . These women are usually younger, healthier and from a socio-economic upper crust who can afford to pay to further improve their looks. They can keep up with the trend in fashion and with their sexy peers who had breasts enlargement themselves. Marriage and children tend to make breasts sag especially if these mothers breast fed their young. This makes breast enlargement interesting to these mothers who want to maintain or restore their looks; either to ensure attractiveness to their spouse, enhance their self-worth or hold on to youth. A high level of self esteem is one benefit of breast enlargement. Studies showed that most patients who underwent the surgery had psychotherapy before the breast enlargement because of their low level of self esteem and had depression and suicidal tendencies. Patients may also have suffered body dysmorphia. This is mental disorder wherein a patient believes she has damaged body image and is highly critical of this image despite the fact that there is no disfigurement or defect..This dissatisfaction about appearances and being teased because of these are reason for the distress. A person having this illness may have breast enlargement to be happy with her looks. Post operative breast enlargement surveys revealed improvements in physical health and appearance, social life, self confidence aelf esteem and sexual function. Some patients reported long term satisfaction in their breast enlargement. Even if they were required to have another operation due to complication or due to surgical repair, the satisfaction level of breast enlargement still stays high. The improvements in aspects of life like physical health, physical appearance, social life, self confidence and esteem and sexual function brought about by the implant makes breast enlargement a procedure always worth a try. Breast Enlargement: Bane? Comprehensive reviews concerning breast enlargement using silicone gel breast implants and systemic diseases resulted in a consensus that there is no clear evidence of links between diseases and breast enlargement. Thousands of women though have complained of neurological and rheumatological problems and had become ill after they had breast enlargement. Studies suggest that these subjective and objective symptoms will diminish after removal of implants. But a larger study revealed that breast enlargement has no direct effect on the mortality increase in women. There was also a study that suggested fibromyalgia increase in women wih extracapsular silicone gel leakage than among women whose implants do not bleed silicone. The US FDA though has not ruled that there is such as an association between fibromyalgia and breast enlargement. Complications resulting from breast enlargement may include hematoma, seroma or fluid collections, infections, breast pain, changes in nipple sensations, breast feeding interference, visible wrinkling of the breasts, asymmetric appearance, thinning of the breast tissue and disruption of the natural plane between breasts or synmastia. It must be considered always that breast enlargement is not for a lifetime. As such, recipients must always be aware that implants can rupture or deflate and has to be re-operated on or removed. Manufacturers have a duty to inform patients of breast enlargement of the impermanence of the device and the need to have a reoperation after some time. Rupture being a reason for re-operation or removal of the device can be caused by chest trauma, pressure of mammogram or damage during the breast enlargement process itself. The age and design of the device are are also to be considered in implant ruptures. Magnetic resonance imaging or MRI is one technology that can detect almost 86% of the ruptures compared to experienced plastic surgeons who can detect only 30% of the ruptures. The breaking of the silicone implant can cause silicone to leak out and result to intracapsular and extracapsular rupture. Non-removal of this rupture causes silicone to migrate and lead to clinical complications in the breast and axillae in the form of ganulomas band axillary lympadenopathy or enlarged lymph nodes in the armpit. The health effects cannot be established but surgeons agree that it is difficult to remove. Capsular contracture is also one ill effect of breast enlargement. Capsules form around the implant device as an immune response tending to wall off the implant being it a foreign body, When it tightens and squeezes the the implant, capsular contracture becomes a complication that can be painful and can deform the breasts. As in any surgical procedure, breast enlargement also leads to scarring. Breast enlargement scars can differ according to patients’ ethnicity, tissue quality, trauma from surgery, wound tension and other factors. After breast enlargement, a patient can lose feelings in the nipple and breast. If not, intense sensitivity and chronic breast pain can be felt by the patient.. Breast enlargement can also affect sexual activity and breastfeeding function of the mother. Breast Enlargement as a Choice Breast enlargement as a choice depends on women who want to maintain their beauty, feel young and be at ease in the society they belong to. Breast enlargement may have its complications but this can be outweighed by the desired effect they wanted and that is having happiness and being beautiful. 

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