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Mamma...mia.!!!! Since times immemorial breasts have always held the fascination of mankind irrespective of the age. And the fact is just as true today as it was many years ago. But the only thing that has changed is the fact that women themselves also are starting to take notice of them. So let us examine and learn a few things about breast augmentation or as it is fondly called " A boob Job!" Who undergoes a breast augmentation….?. Is it the celebrities or routine people?? What drives them to get the operation? Do they understand the risks involved and about the procedure??? For the first question the answer is no! It is not only the celebrities, but routine people, the housewife, the teacher, the software engineer, the doctor… people from all walks of life who undergo the procedure. What drives them to get the procedure done?? Well a few have pathological problems in the chest area and hence have to go in for an augmentation. But, majority of the women undergo the procedure because either the volume was less to start off with or decreased with age and multiple pregnancies or sudden weight loss. What drives them is the fact that breasts are a sign of femininity and these women feel that the decreased volume of the breasts affects the way they see themselves. First of all let us understand some facts regarding breasts : 1. Breast size is variable in people and there is no fixed size which is the norm. Several deciding factors like the amount of breast tissue, heredity, how fat the person is and the fact that whether the person has been pregnant before all contribute to breast size. And of course age is a contributing factor as always 2.There is nothing like a perfect breasts.Usually perky breasts without a sag and nipples pointing forwards and a little laterally are acceptable as the norm but they vary with the size. Small perky breasts look good if the person is thin but not on a well built female. So its all about proportion. 3. 99.9% women have asymmetrical breasts the left usually being larger than the right. The nipples may be erect, flat, inverted, the areola may be large or small, with or without few hairs growing long, or the areola may be bumpy all of which are normal. Regarding understanding the procedure and the risks involved, I’m sad to say that though most of the patients are educated women, hardly 10% of them really know about the procedure and the risks involved. Broadly there are two categories of women undergoing the procedure. The first category or age group is the young women who are in their 20's who want to increase their bust size because they have underdeveloped breasts. The second category or age group of patients are those in their 30's who are usually mother's who have finished with their families and now have their children off to school and have done with their responsibilities and want to get back into shape and feel they way they used to maybe 10 years and two children back. This section of patients has seen a steady increase and I'm sure we are going to see more of them. But in this group many a times they might require certain ancillary procedure along with a breast augmentation which is usually a breast lift or a areola reduction or the such. Breast augmentation surgery was first performed in 1962 by a Texas plastic surgeon who used silicone breast implants to enhance the size of a woman’s breasts. 1997 HBO film "Breastmen" starring David Schwimmer and Chris Cooper shows a cinematic representation of the introduction of the concept of the breast implant to increase breast sizes and the early days of breast augmentation surgery and its pitfalls. Breast augmentation surgery has come a long way since then with lots of advancements in the type of implants and techniques, though the basic methods remain the same. A common fear amongst women is the fear of cancer with implants. This is totally unfounded as per research done by various medical fraternities. Recently even in the US, the FDA has cleared the use of Silicone Gel implants. Otherwise, silicone gel implants are used widely all over Europe, South America, and Asia, though saline implants are also equally in vogue though more in North America.. Implants are commonly filled with saline or silicone gel. Both implant types have advantages and disadvantages. The saline implants are silicon bags into which saline is injected to fill it up. The advantage of this is that smaller incisions to place the implant can be used and the sizes can be increased or decreased in case of volumetric discrepancies between the right and the left breasts. But the disadvantage is that some of the saline may leak over a period of many years and the implant may have to be replaced. The silicone gel implants are permanent as they do no deflate. But they require a larger incision size. They have a natural feel and the new highly cohesive gel implants do not leak even if they are punctured or cut. The choice of the implant is usually left to the patient. The implant can be inserted in three ways either through the armpit or through a cut below the breast or through a cut around the nipple/areola. The approach is determined by the size of the implant and the individual patient. Recently the so called “Scar less Breast Augmentation” has been in demand also known as the “TUBA” Here a saline filled implant is inserted through the belly button and hence the scar is hidden giving it the name scar less. The implant can either be placed in front of the muscle of the chest wall, “Sub glandular” or behind the muscle, “Sub muscular”. Placement of the breast implant under (behind) the pectoralis muscle is preferred in women with anatomically less breast tissue since the results are more aesthetic. Placement behind the muscle does not stop you from using those muscles, though body builders and weight lifters tend to prefer placement over the muscle. Placement under the muscle allows for a more natural look and feel than placement over the muscle. Also, the incidence of capsular contracture is decreased with this placement. Placement behind the muscle allows easier breast self-examination and improved images with mammography when compared to placement in front of the muscle, all this because it is far away from the normal breast tissue. The common problems after a breast augmentation surgery are mild pain and discomfort after the procedure. This is a little more in the sub muscular placement of the implant. Scar maybe a problem if you have an incision below the breast which will be seen in the initially but fades over a period of time. You might be required to do some regular massages for the next 6 months which your surgeon will explain after the surgery. The most common cause of dissatisfaction amongst women undergoing the procedure worldwide has been the size of the implant with most women feeling that they should have gone in for a bigger implant. The cause for this is that initially because of the swelling the size looks more and as the swelling settles down the size feels a little smaller . But the size has to be determined by the amount of tissue she has, the incision , the type of implant. In the end one has to realize that the final decisions are taken after a proper consultation and examination. Also the fact that, all surgeries have their associated risks and complications, which every surgeon operating on you will surely address. This article was aimed at educating women about the procedure of breast augmentation, allay few fears and misconceptions and to help them make educated decisions regarding the same. Dr.Surindher #Note: This article is the sole property of and Dr.Surindher. No part may be reproduced in complete or in part without permission from Dr.Surindher.

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