Breast Augmentation

Breast augmentation is one of the most common procedures performed by plastic surgeons, and breast implant surgery is the most popular, effective, and safe way to improve breast size and shape.

Persons who are good candidates for breast augmentation have one or more of the following conditions:

-You feel that your breasts are too small.

-clothes are too large around the bust but fit well around the hips.

-you feel self-conscious wearing a swimsuit or form-fitting top.

-your breast have become smaller and lost their firmness after children.

-weight loss has changed the size and shape of your breasts.

-one of your breasts is smaller than the other.

During your consultation, you will be asked about your desired breast size and anything else related to the appearance of your breasts that you feel is important. A full medical history will be asked of you including medical conditions, medications you are currently taking, drug allergies, and any previous surgeries. You will also be asked about any possible family history of breast cancer, your results of mammograms if you have had one, and your smoking history. Your plastic surgeon will examine your breast and will consider such factors as size and shape of your breasts, the quality of your skin, and the position of your nipples and areolas.

For women contemplating breast augmentation, there are more choices today than ever before regarding implant shape, profile, and type, as well as, techniques to place these implants into proper position.

IMPLANTS

Since November of 2006, silicone gel implants have been approved by the FDA and released for use in primary cosmetic breast augmentation. This now gives American women the choice not available to them since 1992.

The primary advantages to silicone gel implants are their more natural feel, with less risk of rippling or wrinkling that is common in saline filled implants, especially in thinner women with minimal breast tissue. Silicone gel implants are also more durable than saline implants, decreasing the likelihood of a secondary surgery for implant leakage (rupture), especially in the first ten to fifteen years.

There are a number of disadvantages to silicone gel implants, however. When a silicone gel implant ruptures, it is ‘silent’, and there is no change to the appearance of the breast (unlike the deflation seen with a saline implant). Therefore, silicone gel implants require periodic monitoring using either ultrasound or magnetic resonance imaging (MRI), beginning 5 to 6 years after surgery. Because silicone gel implants are filled and sealed at the factory, they require incisions on or just below the breast for placement, in contrast to incisions that can be placed in the belly button or armpit for saline implants. Finally, silicone gel implants are three times more expensive than saline filled implants.

Implants come in a variety of ‘shapes’, from traditional round to the teardrop, contoured, or anatomic types. In general, the non-round implants are oval, being taller than they are wide, with their most projecting point located toward the lower portion of the implant. Because these implants can rotate, affecting its positioning, and because they offer no advantage to a ‘natural’ look, most surgeons use round implants almost exclusively.

Implants come in a variety of projections, thereby affecting their overall width and height for any given volume. This allows the surgeon the ability to match a particular implant to the size of the patient’s chestwall and breast dimensions. The surface of an implant can be smooth or textured, the latter most common in non-round or teardrop implants. In general, most surgeons utilize smooth implants because their walls are thinner, making it less likely to feel rippling or wrinkling once surgically placed.

INCISIONS

There are four potential incisions that are available for placement of breast implants. The periareolar or nipple incision is most commonly thought to decrease nipple sensibility, which is not true. (In fact, nipple sensibility is most affected by the size of the implant). It tends to heal well with an inconspicuous scar. The quality of scarring cannot be determined beforehand, however, and therefore there is uncertainty of its ultimate appearance.

The inframammary incision is also very commonly performed, yielding a scar in the crease below the breast (if there is a crease). This and the periareolar incisions are utilized most for silicone gel filled implants because of their proximity to the breast for ease of placement.

The armpit or transaxillary incision is a remotely placed incision primarily used for saline filled implants. Some surgeons use this site for placement of silicone gel filled implants, but requires an incision that is much larger than the usual inch and one half. Surgery can be performed with or without an endoscope or television camera.

The bellybutton or transumbilical or TUBA incision is only for saline filled implants. It is the only technique yielding a singular incision, utilizing the one incision for both breasts. Few doctors are adequately trained or have enough experience for this surgery. There are many misconceptions regarding this surgery, propagated by both laypersons and doctors too. In the right individual, this is an excellent way of placing implants.

IMPLANT POSITION

Although there are many different names for the locations implants are placed, there are really only three potential places that exist: below the breast (subglandular), below the pectoralis muscle (subpectoral), and below all the chest wall muscles (submuscular), the last being the least common.

There was a tendency for surgeons to place silicone gel implants in the subglandular position prior to and during the early days of saline filled implants. The imposed restrictions on silicone gel implants in 1992 gave surgeons more experience with saline implants and their more pronounced tendency to wrinkle or ripple. This prompted surgeons to place implants into a submuscular or subpectoral position, giving the saline implant more tissue coverage with a better look and feel.

Today, there is a general consensus that implants placed under the pectoralis muscle look and feel better, and have a lower risk of abnormal scarring called capsular contracture compared to implants placed in the subglandular position. Regardless of this, there are some doctors who prefer the subglandular position for implant placement.

IMPLANT SIZE

The issue potential breast augmentation patients worry over the most is ‘how big are my breast going to be?’ Most patients are worried that their breast augmentation will be too big, and they will look out of proportion. The reality is that after surgery most women wish they had bigger implants!

Unfortunately, there is a significant increase in risk of complications, both short and long term, with placement of implants that are too large for the patient’s breast and chestwall dimensions. Worse, some of these complications can be difficult or impossible to correct. The most important parameter for the surgeon and patient to consider is the matching of the base width of the breast with the width of the implant to be used. By keeping the diameter of the implant equal to or less than that of the breast, the risk of many complications can be minimized.

PREPARATION FOR SURGERY

The risks, alternatives and benefits of breast augmentation surgery will be discussed by your surgeon and again separately by his consultant. Ample time will be given for your questions, so that you will feel perfectly comfortable about your decision to proceed. Remember, this is the beginning of building a long and trusting relationship with your surgeon.

In certain instances you will be asked to get a baseline mammogram before surgery and some months after surgery to detect any future changes in your breast tissue. If you are a smoker, you will be asked to stop well in advance to decrease the risk of poor healing and infection, increased bleeding and bruising, and abnormal scar formation (capsular contracture). A list of medications to be avoided will be provided, including aspirin (Excedrin, Buffrin), ibuprofen (Motrin, Advil), and naprosyn (Aleve). Other instructions will be provided as well.

The surgery is performed in a fully accredited outpatient surgery center located in the same building as your plastic surgeons office. A board certified anesthesiologist will provide general anesthesia, because it is the safest type of anesthesia. After your surgery, you will be taken to the recovery area and closely monitored. You will be permitted to go home after about an hour.

RECOVERY

There is usually minor pressure and stiffness experienced by most patients immediately after surgery that is managed well with a muscle relaxer and pain medication. The following day, the tight wrap is taken off and a bra is placed. Most patients are driving in 4 to 6 days, and feeling back to normal in two weeks. Most people begin light exercise then, and resume their regular athletic routine by 3 to 4 weeks.

Your breasts will be somewhat swollen and may have some minimal bruising, but this disappears quickly. They will appear too high and full on top, and have an odd shape. Over the course of weeks to months your breasts will drop, soften, and take a more pleasing shape.

It is important to make all follow up visits with your plastic surgeon so that your recovery can be monitored. It is also important to note that your questions and concerns are addressed in a timely fashion, making follow up essential.

RESULTS

Breast augmentation will make your breasts fuller and enhance their shape. You will find it easier to wear certain styles of clothing, and like many women, have a boost in self-confidence.

The results of your breast augmentation surgery will be long lasting. However, implant deflation, the effects of gravity, and aging will eventually alter the size and shape of your breasts. If after a period of years you become dissatisfied with the appearance of your breasts, you may undergo a breast lifting procedure to restore their more youthful contour.