BREAST AUGMENTATION INTRODUCTION
Breast augmentation is a cosmetic procedure that uses implants to enlarge and shape a woman's breasts. For many women, breast size is an important part of feeling normal, self-confident, and sexually desirable. Breast augmentation surgery can greatly improve a woman's self-image by improving the way she views herself. According to the American Society for Aesthetic Plastic Surgery (ASAPS), 399,440 breast augmentation procedures were performed in the US in 2007, making it the most common cosmetic surgical procedure. The popularity of breast augmentation not only reflects the increasing desire of women to have fuller breasts and a shapely figure, but also the safety of the procedure and the high satisfaction rate following surgery.
Women choose to have breast augmentation surgery because their breasts never developed to a size that meets their expectations, to bring balance to a breast that is somewhat smaller than the other, to improve the shape of underdeveloped or constricted breasts, to restore natural breast fullness which may have been lost as a result of pregnancy, weight loss or aging, or to improve self-confidence when wearing a swimsuit or form-fitting top.
During your consultation, we encourage you to discuss your goals and expectations for breast augmentation. The doctor will perform a thorough examination. Appropriate treatment options, risks and benefits, and the probable outcome of your procedure will be carefully reviewed during your consultation. Your surgeon may recommend that you have a baseline mammogram before surgery to assist in detecting any future changes in your breast tissue. If you breasts are sagging, your surgeon may suggest that a
breast lift procedure be performed in conjunction with your breast augmentation surgery.
IMPLANT FILL MATERIAL - SALINE vs. SILICONE
All breast implants available for use in the United States are approved by the FDA. The outer shell of all beast implants is made of a thin silicone elastomer, and its surface may be either smooth or textured. The implant shell is then filled with saline or silicone gel. Saline implants are filled with sterile injectable 0.9% saline at the time of the operation; silicone gel implants are pre-filled by the manufacturer.
The firmness of a saline-filled implant is directly related to the fill volume. As the fill volume of a saline implant increases, visible wrinkling decreases, but implant firmness also increases. All saline implants available today demonstrate more firmness than breast tissue when (over-) filled to a point of minimal wrinkling.
Silicone gel implants were approved for general use by the FDA in November 2006. The current implants are considered fourth generation devices and offer many features and advantages over previous devices. The moderately-cohesive and responsive nature of this silicone gel (compared to saline) creates a more natural feeling breast. Silicone gel-filled breast implants are the implant of choice in Europe, Canada, Latin America and Asia.
This difference in implant feel and consistency, between saline- and silicone gel-filled implants, becomes more obvious in thinner patients who have smaller breasts and less tissue covering the implant, and as implant size increases. In these women the implant fill material may play a very important role in breast aesthetics. Patients should understand the differences between saline- and silicone gel-filled breast implants so they can make an informed decision to select the type of implant they are comfortable living with.
IMPLANT SHAPE - ROUND vs. CONTOURED & IMPLANT PROFILE
One implant shape or style does not necessarily work well for every woman. Implant selection should be individualized for each patient, taking into account her desires, body size, breast size and shape, and tissue quality and characteristics. The choice of implant shape and style will ultimately contribute to the final shape of the augmented breast, but the degree to which it does depends on several factors and varies for each patient. The preference of an informed patient may be one reason for selecting a specific implant shape, but many times this decision is made by the surgeon based upon biodimensional planning.
Round - The anterior shape of this implant is round, while the profile is elliptical, making it symmetric when bisected in any plane. The actual volume in a saline-filled implant, with respect to the manufacturer's recommended fill volume, will play a role in breast shape. Breast shape following augmentation with a round implant also depends upon the size of the pocket in which the implant is located. In the United States, round implants are the most common; and for most patients, a smooth, round breast implant, either saline or silicone gel, will provide an adequate shape to the breast.
Contoured (Anatomic, Shaped, Tear Drop) - The 'anatomic' shape of this device is built into the implant. The profile of this implant resembles the shape of a normal breast; the implants taper from a lower profile in the upper pole (less volume) to greater projection (more volume) in the lower pole. Contoured implants are available in full-height and reduced-height designs. Contoured implants are often used in breast reconstruction following tissue expansion. The only contoured implants currently available in the United States are saline-filled. Contoured, form-stable silicone gel-filled breast implants are widely used in Europe, South America, and Asia; they are currently under investigation here in the United States, awaiting final approval by the FDA. In thinner patients, a contoured implant can create a more pleasing, less round upper pole with a more natural shape. In taller individuals with a longer torso the full-height contoured implant may fit the body better.
Implant Profile - Round implants are now available in low, moderate, and high profile projections. When comparing the shape of low, moderate, and high profile implants -- for a given volume, as the implant projection increases the base diameter decreases. Low profile implants are very flat and have a wide base diameter, while high profile implants have a more globular shape, combining a narrower base diameter with more projection. Implant profile is usually not something that patients need to be concerned about, but having a full selection of low, moderate, and high profile implants helps surgeons with biodimensional planning. Following the introduction of high profile implants in 2001, surgeons are now able to offer patients with smaller chest and breast sizes the option of having larger volume implants without having to exceed the patient's breast width. A high-profile implant provides more fullness in the superior portion of the breast, than a moderate or low profile implant.
Contoured, saline-filled implants are not offered in various profiles, but are available in various heights. In comparison to round implants, a contoured implant gives more projection in the lower portion of the breast.
INCISION LOCATION
The most important priority in selecting incision placement is that the surgeon has optimal control of the surgery; but a woman's preference would be considered the second priority. The best approach for breast augmentation may vary according to the physical characteristics of the breasts and chest, the type of implants used, and whether a breast lift is being performed at the same operation. The optimal incision provides the surgeon with good control of the operation, minimizes (breast) tissue trauma, minimizes the risk of bleeding and nerve injury, and does not affect the ability to breast feed. The incisions are as small and inconspicuously placed as possible.
The
inframammary incision is made in the skin fold beneath the breast. This affords a direct, efficient approach for dissection and implant placement, provides excellent exposure to all areas of the pocket, and does not traumatize breast tissue. There is a low incidence of alteration in nipple sensation or the ability to breast feed. The resulting scar is concealed within the skin crease under the breast and is covered by all types of clothing and swimwear. This faint incision is not visible when standing, but may be visible when you are lying down. This approach usually heals very well with minimal perceptibility. The inframammary approach is often used when re-operation is required.
The
periareolar approach involves a curved incision made along the edge of the areola. This approach allows equidistant access to all areas of the pocket compared with all other surgical approaches. The diameter of the existing areola must be large enough to permit the use of this incision. The periareolar incision is also covered by clothing and swimwear. Because the areolar skin is thin, this incision heals very favorably, but may be visible because of violation of the natural color transition between the areola and breast skin. There is a concern that the periareolar incision is associated with a higher incidence of alteration in nipple sensation and a slightly higher risk of interference with breast feeding. For women with minimal breast development and a tight skin envelope, the periareolar
IMPLANT PLACEMENT - POCKET LOCATION
Once the incision is made, the surgeon creates a pocket into which the implant is inserted. A subglandular pocket is created directly behind the breast tissue so the implant is positioned above the chest muscles. A submuscular (subpectoral) pocket is created beneath the pectoralis major muscle so the implant is positioned above the rib cage. In this subpectoral position, even though the implant is usually only partially covered by muscle, the muscle provides an extra tissue layer to help conceal the implant and its margins. Many women seeking augmentation require this muscle tissue coverage for a more satisfactory result. The submuscular space is felt to have a lower incidence of capsular contracture, and provides for better imaging of the breast during mammography.
Saline-filled breast implants should only be placed below the muscle to help conceal the unsatisfactory characteristics of saline as a fill material. Silicone gel-filled implants may be placed in a subglandular or submuscular position because of the softer more natural characteristics of silicone gel as a fill material.
IMPLANT SIZE & SELECTION
The enhanced breast should be natural looking and proportionate in size with the woman's height, weight and overall body build. The implant should provide the breast with a gently sloping appearance and should be reasonably soft allowing the breast to move naturally with normal body movements. There is no "one size fits all" rule, nor is there "one shape fits all" rule in breast augmentation. The reality is that a woman's individual anatomy will dictate her final appearance and result.
The pre-operative consultation should include a physical examination which focuses on the woman's breast size, shape, and tissue characteristics. This biodimensional approach to surgical planning can dramatically reduce risks for undesirable results and complications following breast augmentation. After evaluating and quantifying a woman's breast and tissue characteristics, it is important to explain how her specific desires could be affected or limited by those characteristics. Appropriate pre-operative sizing allows the surgeon and patient to communicate more effectively about the anticipated breast size. This improves a woman's expectations for the result she will obtain, and minimizes complaints about improper sizing post-operatively.
Excessively large implants are arguably the single greatest cause of compromised results, morbidity, complications, and reoperations following breast augmentation. Women should understand the potential long-term effects of larger breast implants, and how that might impact their future risk for undesirable results, complications, and/or reoperations. For most women, limiting implant volume to less than or equal to 350cc would in all likelihood reduce the incidence of future complications and reoperations. Excessive enlargement by breast augmentation can cause stretching and thinning of the breast skin and subcutaneous tissue, implant edge visibility, palpability, or rippling, breast tissue atrophy, breast drooping, and excessive 'bottoming out' of the breast. Improved results in breast augmentation can be achieved by appropriate patient selection, detailed tissue evaluation, consideration of long-term implant-soft tissue interactions, and (optimal) implant selection based upon the woman's tissue characteristics.
Breast implant size and shape may be more important in thin individuals with small breasts, where the implant accounts for the major portion of the volume of the augmented breast. And it is in these individuals that the implant fill material may play a very important role in breast aesthetics; silicone gel-filled implants may produce a softer breast with less chance for implant visibility and rippling. Patients should understand the differences between saline- and silicone gel-filled breast implants so they can make an informed decision to select the type of implant they are comfortable living with.
RESULTS
Your new look will bring you greater freedom with fashion, and an improved self-image. Breast augmentation is a procedure with very high patient satisfaction. When asked if they were glad they had breast augmentation surgery, over 95% of women answered "yes", and stated they would recommended it if it was desired by someone else. Whatever your personal reasons are for seeking breast augmentation, there have never been as many options available as there are today. Choosing breast augmentation to enhance your appearance is a very personal decision and one that should be made with as much information as possible.
If you would like to schedule a consult to discuss whether breast augmentation is right for you please call our office at 414-443-0033.
Post Operative Instructions and Information for Breast Augmentation:
• Breast augmentation is performed under a local anesthetic with intravenous sedation, or a general anesthetic, as an outpatient procedure.
• At discharge you will be given instructions regarding incision care, and how you may bathe. Within a day or two patients should be up and around. Most of the discomfort can be controlled with medication prescribed by your plastic surgeon.
• Patients will wear a support bra or other support wrap for two weeks following surgery. After that, a sports bra or other comfortable bra may be worn. Avoid under wire bras for 3 months following surgery. Generally, a patient should wait until 6 weeks following the operation before buying bras that she intends to fit well and continue to wear.
• Patients return to the doctor's office at 1 and 2 weeks, as well as approximately 1 and 3 months, after surgery. Your surgeon may ask you to return for periodic checkups thereafter.
• Some sutures may be removed 1-2 weeks after surgery. The majority of sutures are dissolvable
• Initially the breasts may be quite swollen after surgery. The majority of swelling resolves within 2 weeks after surgery. Residual swelling will remain for 6-8 weeks.
• Lubrication and massage of the scar lines can begin approximately 3 weeks following augmentation surgery. Scars will soften, flatten, and fade over the next 9-12 months.
• It is important to avoid any strenuous activities for approximately 3-4 weeks after surgery. Your doctor will instruct you when you may begin a gradual return to activities. Patients usually return to an unrestricted activity level by 4-6 weeks after surgery.
• Patients should plan on remaining off work for 1-2 weeks after surgery.
• Patients are likely to be happy with their breast augmentation for years. However, keep in mind that your breasts are not immune to the effects of weight fluctuations or aging.
• To avoid complications and assure your safety, we recommend that you examine yourself regularly (monthly breast self-exam) and visit your surgeon for a yearly assessment.
• Women over forty years of age should continue to have routine annual screening mammograms.
