Breast augmentation is a surgical procedure that is designed to increase the size of the breasts using either a saline filled or cohesive silicone gel filled breast implant. Below are some key points, but these need to be discussed further prior to proceeding with surgery.
The goals of breast augmentation include...
• Increasing the size of the breast while maintaining a natural, youthful appearance
• Achieve or improve symmetry of the breasts
• Obtain a well hidden, minimally noticeable scar
• Obtain a long lasting result
• Avoid complications
WHO IS A GOOD CANDIDATE FOR BREAST AUGMENTATION SURGERY:
Women frequently seek this operation after their breasts change following pregnancy and breast feeding. There are also many women who have never had children that seek this procedure because they are unhappy with the size of their breasts, and would like to feel more confident about their appearance.
DESCRIPTION OF SURGERY:
Under general anesthetic, an incision is made either at the inframammary fold, in the axilla (arm pit), or around the areola. I then go underneath the breast tissue until I encounter the lower border of the pectoralis major muscle. At this point I then create a pocket for the implant, either above or below this muscle. The implants are then placed, and the results are evaluated. Once I am happy with the appearance of the breasts, the incisions are closed, and the dressings applied.
A NOTE ABOUT BREAST IMPLANTS:
I spend a significant amount of time during your initial consultation discussing breast implants. Breast implants come in many different varieties, and this can be overwhelming when you are trying to choose the right implant for you.
A. Saline breast implants. These implants consist of a silicone elastomer shell that gets filled with saline (the same fluid that goes into your IV when you are asleep). These implants have a valve on the back side that I close once they are filled. Saline implants can be placed through a smaller incision than silicone implants, and they are also less expensive than silicone implants. These implants have a range of final volume, so I can correct some difference in size between the breasts by adding more to one than the other. The drawbacks of saline implants include a higher risk of visible rippling of the implant, a less natural feel, and a risk of deflation due to damage to the shell or failure of the valve.
B. Silicone gel filled breast implants. Silicone gel filled implants have improved significantly following the complications experienced in the 80’s and 90’s. Today’s silicone gel implants are cohesive (not filled with liquid silicone), and the shell minimizes the leaking of silicone into the pocket where the implant is placed. They have a more natural feel than saline implants. The drawbacks include needing a larger incision and being more costly than saline implants. Some women are also uncomfortable with the idea of these implants because of the failure of the previous generation of silicone implants.
C. Textured vs. Smooth implants. Breast implants are available with both a smooth surface, as well as a rough, textured surface. The primary benefit of a textured surface is a decrease in the rate of capsular contracture (the most common indication for implant removal). The primary benefits of a smooth surface are a less palpable implant shell, and less chance of visible rippling of the implant shell.
D. Form stable (tear drop shaped implants). Form stable, tear drop shaped implants are used almost exclusively in my practice in breast reconstruction following mastectomy. These implants provide a more natural shape to the reconstructed breast. I find that this shape is infrequently needed or requested in cosmetic breast augmentation surgery.
ABOVE OR BELOW THE MUSCLE:
In cosmetic breast augmentation surgery, the breast implant is placed either above or below the pectoralis major muscle. Placing the implant above the muscle provides more lift and projection to the breast. It can leave a visible upper border of the implant unless there is sufficient tissue in the upper portion of the breast. Placing the implant under the muscle provides a more gentle slope in the upper portion of the breast, blunts the upper border of the implant, and can decrease the risk of capsular contracture.
I offer three different incision placements for breast augmentation surgery. The majority of the time, I use an incision placed in the inframammary fold, where the breast takes off from the chest wall. This incision allows direct visualization of the surgical pocket, does not pass through breast tissue, and is placed at the point of least tension on the closure. The alternative is known as a periareolar incision. It is placed along the bottom of the junction between the areola and the breast skin. I typically reserve the use of this incision for cases where I am doing a breast lift as well as an augmentation, as I will be placing a scar around the areola for the lift. Lastly, some women may be a candidate for an incision placed in the axilla (arm pit) with the surgery performed with the aid of an endoscopic camera.
You will spend a couple of hours in the recovery room at the surgery center before you go home. You will need someone to pick you up from the center, and stay with you in your home. You may feel up to going for a walk later that evening or the following day. Over the next week to two weeks, you will feel better and better and slowly resume your usual activities. However, it could be a full 6 weeks before you feel completely recovered from your surgery.
This surgery is not a replacement for a breast lift, except in the cases where only a minimal lift is required. This surgery does not address differences within the breasts such as nipple position or rib / chest wall differences. This surgery does not halt the aging process of the breasts, and in fact can accelerate it. Over time, the weight of the implant can cause the skin of the breast to stretch, leading to the need / desire to undergo a breast lift. Larger implants accelerate these changes..
As with any surgery, there is a possibility of experiencing a complication. These include bleeding after the surgery (hematoma), decreased sensation in the breast or nipple, infection, asymmetry of the breasts, implant malposition, capsular contracture, re-operation and others. It is important to discuss these in detail prior to undergoing this surgery.
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