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Breast augmentation is a procedure to enhance the size and shape of a woman's breasts. This is done by inserting an implant behind each breast.

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PROCEDURE: An incision is made in one of several places, such as in the fold under the breast (inframammary incision), or around the nipple (periareolar incision). A pocket is created for the implant, either directly under the breast tissue, or under the breast tissue and chest (pectoral) muscle. The implant is inserted and filled with saline, a saltwater solution.

Capsular contracture: The body will create a capsule of scar tissue around the implant. This is normal. However, sometimes, the capsule begins to contract and squeeze the implant. This can be painful and cause the breast to appear unnatural, but it is not dangerous. If the contracture is severe enough, further surgery to release or remove the scar capsule may be performed, and in rare cases, the implant may need to be removed or replaced. Placing the implant partially beneath the pectoral muscle seems to reduce the risk of capsular contracture.

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Sensitivity: It is not unusual for areas on the breast, particularly the nipples and around the incisions, to be oversensitive, undersensitive, or even numb following surgery. In the vast majority of patients, this improves with time. However, in rare cases, this may be permanent.

Infection: The use of antibiotics greatly reduces the risk of infection. If infection around the implant does occur, it may be treated with additional antibiotics, or in a small number of patients, the implant may be removed and replaced when the infection clears.

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Leakage/Breakage: Saline implants are filled through a one-way valve, so leakage is rare.

However, if it does occur, there is no danger. Since the implants are filled with saline, the salt water will be harmlessly absorbed by the body within a few hours. The implant is then replaced in a surgical procedure.

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Breast Cancer: There is absolutely no evidence linking implants to breast cancer. In fact, a few studies indicate that women with implants are more likely to have their breast cancer identified at an early stage. However, more views are required when a mammogram is performed, so patients should be sure to inform the radiology technician that they have implants.

Nursing: If performed properly, breast augmentation should have no impact on the ability to nurse a child.

Implant Placement: The implant may be placed directly behind the breast tissue (subglandular position) or behind the chest muscle (subpectoral position). The subpectoral placement of the implant seems to reduce the risk of capsular contracture. It also makes it more difficult for the edge of the implant to be seen through the skin. However, placing the implant behind the chest muscle may be more painful for a few days after surgery. Implant texture: Implants may be either smooth or textured.

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Textured implants were thought to reduce the risk of capsular contracture. However, if the implant is placed subpectorally, this may not be true. Also, some doctors find that textured implants are more likely to leak.

Implant shape: Implants may be either round or anatomically (teardrop) shaped. Round implants produce a fuller shape, while anatomical implants produce a more "mature" shape.

Incisions: There are three common incision sites for implant placement. The incision may be placed around the nipple, in the fold under the breast, or in the armpit. Each site has risks and benefits, so the incision site should be discussed with the surgeon.

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Anesthesia: Most surgeons perform breast augmentation with general anesthesia, so the patient is unconscious during surgery. Some, however, prefer local (area numbing) anesthesia with a sedative, so the patient is calm and drowsy, but awake.

AFTER SURGERY: Patients are generally able to return to work within a few days after surgery. A surgical bra is worn for several weeks. Swelling should be dramatically reduced, and a natural look should appear in three to six weeks. The scars should be protected from the sun, and should fade almost completely within a year. The result of the surgery should be natural, full, even breasts, proportional with the patients body shape and size.

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