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Breast Augmentation

Breast Augmentation


Breast augmentation is the one of the most popular of all cosmetic surgeries both here in this country and abroad.  Patient satisfaction with this procedure is considered the highest of all cosmetic procedures. However, few surgeries require more input from the patient and interaction of the patient with the surgeon.  Within certain constraints, the breast augmentation patient can choose the type of implant (silicone or saline), the size and look she wants, where the incisions are placed to introduce the implant, and in most cases whether the implant is placed over or under the chest wall muscle.  In our practice, we customize the augmentation process as much as possible to the desires and needs of each individual patient.


What Types of Breast Implant Are There?

There are two basic types of breast implants offered today, those made of silicone gel, and those that consist of silicone shell which is then filled during the operation with a variable amount of sterile saline (salt water).  Silicone gel implants are thought to ripple less than saline (show visible wrinkles through the breast skin), may feel more natural, and are twice as expensive as the saline implants.   If the silicone shell leaks, a small amount of silicone gel inside the implant can extrude and cause local thickening of the natural wall formed by the body around the implant called the capsule. Such leaks are often undetectable both on physical examination and mammography.  Therefore, the manufacturers of silicone implants recommend MR scans at regular intervals.  Saline implants are less expensive, very durable and certainly have both a nice feel and look.  They are slightly heavier than the same size silicone implants.  If a saline implant leaks it quickly deflates and is immediately noticeable.  Both a slowly leaking silicone gel implant and a deflated saline implant must be surgically replaced.

Both saline and silicone implants can come textured or smooth, round or tear drop shaped.  Textured implants are thought to reduce the incidence of capsular contracture (when the capsule surrounding the implant becomes thick, hard and painful, see complications of breast implants below) but are associated with more visible rippling.  It is for this reason we use smooth surfaced implants.  Round implants form a natural teardrop shape after they are implanted and unlike the tear drop implants do not distort the shape of the breast if they inadvertently rotate.  Round implants are therefore preferred in our practice.

Implants have three different profiles (how far they project away from the chest): moderate, moderate plus, and high.  High profile implants, those that project the farthest from the chest are usually more suitable for the smaller woman, one who wears a 32 bra or less.  They can also help women whose breasts sag and who desire augmentation without an additional breast lift procedure.  Moderate plus implants have a wider base and don’t project as far as a high profile implant of the same volume.  They are more suitable for women who have a wider rib cage and larger breast width.  The moderate or low profile implant is rarely used in our practice.

 Breast Augmentation: Before

Breast Augmentation:
Before

 Breast Augmentation: After

Breast Augmentation:
After


Where Are The Incisions Made To Introduce The Implants?

There are four common places to make the incisions to introduce the implants:  in the crease under the breast (inframammary), through the armpit skin (transaxillary), through the darker circle of skin that surrounds the nipple (periareolar), and through the belly button (umbilical).  Though the most common incision used is the inframammary, for most women any of the approaches can work equally well.   If the surgery is properly performed, the incisions heal with unnoticeable scars no matter where they are made. Each approach has its advantages and disadvantages.  Most surgeons have an individual preference but should be able to offer a choice of approaches.  In certain situations, a particular approach is better than the others.   Silicone implants cannot be placed through the belly button incision.


Where Do The Breast Implants Sit In Relation To The Chest Wall Muscle?  Under The Muscle? Over The Muscle? Or Under The Muscle Covering?

In this country, the majority of implants are placed under the chest wall muscle (subpectoral).  On the contrary, in Europe, most implants are placed over the muscle (subglandular).  Placing the implant under the muscle reduces the tendency for ripples in the implant to show through the skin.  This is particularly important for very thin women.  Placing the implants under the muscle is more painful postoperatively than above the muscle. An implant under the muscle can move quite noticeably during exercise when the chest wall muscles are flexed. 

In our practice, we often place the implants in a space or pocket created under the coating of the muscle or fascia above the muscle and under the breast itself. This is a subfascial placement and has the advantages of both the subpectoral and subglandular pockets.  Placing the implant under the fascia but not under the muscle results in the same degree of protection against rippling as the subpectoral implant but without the movement, bottoming out and other problems of the subpectoral placement.  There is far less postoperative pain after a subfascial augmentation than a subpectoral one.

 Breast Augmentation: Before

Breast Augmentation:
Before

 Breast Augmentation: After

Breast Augmentation:
After


What Type of Anesthesia is Used For Breast Augmentation?

Many surgeons prefer general anesthesia for breast augmentation.  We use local tumescent anesthesia with conscious sedation.  Prior to the surgery we infiltrate the breasts with a dilute solution of local anesthetic with epinephrine.  The local anesthesia largely eliminates the pain associated with surgery and the epinephrine in the solution substantially reduces bleeding and bruising during and after the procedure.  The conscious sedation we use in conjunction with the local anesthesia is exceedingly safe, makes for a quick recovery from the anesthesia with very little post operative nausea and vomiting and for most patients almost no memory of the procedure.


How Long Does It Take To Recover From Breast Augmentation Surgery? When Can I Resume Normal Activities?

Our patients are up and about the day following surgery.  The swelling, bruising and discomfort (usually a tightness in the breasts) following breast augmentation are largely gone within five to seven days after surgery.  It is prudent to take a week off of work following this procedure.  For the most part you can resume the activities of daily living and light sports or cardiovascular workouts when you feel like you are able within a week or two.  More vigorous sports may require several weeks to a month to resume.

 Breast Augmentation: Before

Breast Augmentation:
Before

 Breast Augmentation: After

Breast Augmentation:
After

What Are The Complications Of Breast Augmentation?

The most common serious complications of breast augmentation are infection, bleeding, and capsular contracture. Infection occurs in about 1 percent of breast augmentations and usually requires that the implant in the infected breast be removed for at least three months in order to cure the infection.  Infection can occur in days to years after implant surgery.  If bleeding occurs, it will happen right after surgery and can require another operation in order to control it.  The body normally forms a soft pliable envelope of fibrous tissue around the implant within 72 hours of surgery.  In four to ten percent of patients, for unknown reasons, this capsule thickens and contracts causing the breast to distort and sometimes be painful.  This can occur within months to years after the surgery.  Severe capsular contracture requires surgery to excise the capsule and replace the implant.

There are other problems and potential risks associated with breast augmentation. For a more comprehensive description of these download the Informed Consent For Breast Enlargement With Implants that our patient’s must read and sign before breast augmentation surgery.  Chances are if you have a concern over breast augmentation, it is addressed in our consent.


What Size Of Implant Is Best For Me?

Choosing the right size implant is paramount to a happy patient.  Many women have a good idea of how big they want to be or how they want to look.  Ultimately, the size of implant is limited by the natural width of your breast and rib cage.  For smaller women choosing a high profile implant, one with more projection can augment the breast sufficiently while staying within their physical limitations.  We go to great lengths to see that you obtain the look that you want.  Try out suggestions in our Homework Sheet For Breast Augmentation. It will help you see what size implant will best suit you.


How Long Do Breast Implants Last?

No one knows for sure how long breast implants last. Many women enjoy their implants for decades without any problems. It is important to realize that breast augmentation with silicone or saline implants is not a permanent procedure. For a variety of reasons, additional surgery to replace the original implants is inevitable.


Useful Links For More Information On Breast Augmentation

The websites of the following organizations have very useful information on breast augmentation and are well worth a visit:

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Breast Augmentation Photo Gallery

Patient #1, Front View, BeforePatient #1, Front View, AfterPatient #1, Side View, BeforePatient #1, Side View, After
Patient #2, Front View, BeforePatient #2, Front View, AfterPatient #2, Side View, BeforePatient #2, Side View, After
Patient #3, Front View, BeforePatient #3, Front View, AfterPatient #3, Side View, BeforePatient #3, Side View, After
Patient #4, Front View, BeforePatient #4, Front View, AfterPatient #4, Side View, BeforePatient #4, Side View, After
Patient #5, Front View, BeforePatient #5, Front View, AfterPatient #5, Side View, BeforePatient #5, Side View, After
Patient #6, Front View, BeforePatient #6, Front View, AfterPatient #6, Side View, BeforePatient #6, Side View, After
Patient #7, Front View, BeforePatient #7, Front View, AfterPatient #7, Side View, BeforePatient #7, Side View, After
Patient #8, Front View, BeforePatient #8, Front View, AfterPatient #8, Side View, BeforePatient #8, Side View, After
Patient #9, Front View, BeforePatient #9, Front View, AfterPatient #9, Side View, BeforePatient #9, Side View, After
Patient #10, Front View, BeforePatient #10, Front View, AfterPatient #10, Side View, BeforePatient #10, Side View, After
Patient #11, Front View, BeforePatient #11, Front View, AfterPatient #11, Side View, BeforePatient #11, Side View, After
Patient #12, Front View, BeforePatient #12, Front View, AfterPatient #12, Side View, BeforePatient #12, Side View, After
Patient #13, Front View, BeforePatient #13, Front View, AfterPatient #13, Side View, BeforePatient #13, Side View, After

 

Breast Reductions, Lifts & Lifts
with Augmentation Photo Gallery

Patient #1, Breast Reduction,
 Front View, BeforePatient #1,
 Breast Reduction,
 Front View, 2 Months After,
 Scars will greatly diminish in time.Patient #1, Breast Reduction, SideView, BeforePatient #1, Breast Reduction,
 Side View, 2 Months After,
 Scars will greatly
 diminish in time.
Patient #2, Breast Lift
 with Simultaneous Augmentation,
 Front View, BeforePatient #2, Breast Lift
 with Simultaneous Augmentation, 
Front View, AfterPatient #2, Breast Lift
 with Simultaneous Augmentation,
 Side View, BeforePatient #2, Breast Lift
 with Simultaneous Augmentation,
 Side View, After
Patient #3,
 Breast Reduction, Front View, BeforePatient #3,
 Breast Reduction,
 Front View, AfterPatient #3,
 Breast Reduction,
 Side View, BeforePatient #3,
 Breast Reduction, Side View, After
Patient #4, Breast Lift Followed by Augmentation 4 Months Later, Front View, BeforePatient #4, Breast Lift Followed by Augmentation 4 Months Later, Front View, AfterPatient #4, Breast Lift Followed by Augmentation 4 Months Later, Side View, BeforePatient #4, Breast Lift Followed by Augmentation 4 Months Later, Side View, After
Patient #5, Malpositioned implant on the right, deflated implant on the left, Front View, BeforePatient #5, Breast lift with removal of both implants, Front View, AfterPatient #5, Malpositioned implant on the right, deflated implant on the left, Side View, BeforePatient #5, Breast lift with removal
 of both implants, Front View, After

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