Breast Augmentation
Breast Augmentation is now one of the most frequently performed Plastic Surgery procedures. The goal of surgery is to enhance and improve your existing contours. Therefore, the procedure must be individualized for your anatomy. An implant is utilized to increase the breast volume. The artistry lies in creation of an anatomic space for the implant with minimal bleeding and choosing the right shape and size of implant to achieve an optimal result.
Frequently Asked Questions:
Q: What type of implant is best for me?
A: There are 2 basic implant fillers, saline and silicone gel. Similar shapes can be created with either implant but there is a difference in the palpability or “feel” of the implanted breast. For most patients the gel implant feels more like natural tissue. There is no significant difference in the complication rate with either type of implant. There are various base diameters and projections for either type of implant and this must be individualized for your anatomy.
Q: What about the “silicone controversy”?
A: In 1991, the FDA removed silicone implants from use in breast augmentation in order to study potential relationships between silicone and disease processes, primarily autoimmune disease. After 16 years of extensive study, no relationship between silicone and these diseases could be found. Silicone is once again available. Our doctors have been clinical investigators and have helped to supply much of the data that has made breast implants one of the most studied devices in medical history. At this time, we feel silicone implants are absolutely safe and the best choice for a majority of patients.
Q: Where is the incision made?
A: Either type of implant can be placed through a relatively small (1-1½ inches) incision beneath the breast, or at the junction of the areola and chest wall skin, or occasionally in the armpit. It is possible to place saline implants through the umbilicus but there is less ability to accurately define the pocket and no ability to make individual changes in breast shape as required for some individuals. For the vast majority of patients, any of these incisions are minimally visible and scars are, therefore, not a significant trade off.
Q: Are the implants placed on top of the muscle or underneath?
A: If there is minimal breast or subcutaneous fat in the upper portion of the chest, it is usually preferable to have additional coverage, which can be provided by utilizing the pectoralis major muscle of the upper chest to cover the upper portion of the implant. For patients with adequate soft tissue coverage, above the muscle or prepectoral can provide a very natural appearing result and may be a little less invasive.
Q: What about sensation?
A: Normal sensation is maintained in the vast majority of patients. However, no guarantee can be made as stretching of the sensory nerves to the breast skin always occurs to some degree. The potential for sensation loss is not related to the location of the incision. We try to see all of our patients at 1-year postoperative and it is very unusual to have complaint of significant sensation change at that point in time. In the early weeks after surgery, hypersensitivity may or may not be present, but this usually resolves within weeks.
Q: What about breast-feeding?
A: Anatomically, the ability to breast-feed is maintained after implants. However, some patients are unable to breast-feed even without implants and this certainly cannot be guaranteed.
Q: What about mammograms?
A: Mammograms, as well as frequent self-examination of the breast should be undertaken by all patients including those with implants. We recommend that our younger patients have a baseline mammogram shortly after placement of the implants so that if it is several years until mammograms are instituted, we will know what the breast look like after placement. For those patients 40 years or older, mammograms should be obtained prior to surgery.
Q: Is there any relationship between implants and breast cancer or breast masses?
A: There is no relationship between implants and cancer. Rarely a leaking silicone implant can result in a lump which could be confused for breast mass. This should always be assumed that any masses are in the breast and workup undertaken accordingly. Studies have shown that patients who developed breast cancer with implants usually present at an earlier stage because they are used to frequent examinations and mammograms.
Q: What is recovery like?
A: Surgery itself takes about 1½ hours. Most patients can leave the surgical facility within an hour. Due to meticulous way in which we perform the surgery, it is usually possible to resume normal activities of daily living the day following surgery. Most patients can resume work in 2-5 days with gradual resumption of exercise at 7 10 days. We generally recommend follow up at 1 week, 1 month, and 1year.
Q: What size of implant should I have?
A: Obviously, there is a lot of room for subjective variations in implant size. The most important thing is to choose an implant in a size range that can be tolerated by your tissue characteristics. A patient with paper-thin skin and no soft tissue coverage cannot tolerate the same-size implants as someone with a C-cup breast and elastic skin. In general, we ask you to consider your preferred cup size and we will discuss how this is converted to an implant volume. Often perusing multiple before and after pictures is a good way to be sure we have the same expectations. It is not unusual for patients to say, “I wish I had gone a little larger” and later be glad they did not. We will take the time to help you choose what is right for you.
Q: What is the most common potential problem after breast implant?
A: Every elective procedure has one major “trade off” that must be considered. With the breast implants, this is the tendency of the body to form scar tissue around the implant, which it recognizes as a foreign material. We call this scar tissue a capsule, and the process by which it may thicken, a capsular contracture. There is no way to predict the exact potential for this problem in a given individual. Statistics with modern implants indicate that greater than 90% of patients maintain softness following implantation. Even those who develop some capsular contracture do not require re-operation in most cases. However, somewhere around 3-5% of patients will develop significant firmness. The vast majority of these can be corrected by secondary operation, which removes the scar tissue and replaces the implants.
Q: How often the implants rupture?
A: Modern implants are very durable. They will not break or leak with any type of normal activity. There is no definite life span of an implant. However, after 10 years the chance of an implant leaking probably begins to increase at 1or 2% per year. However, if there is no evidence of leakage, there is no need to replace it, as it has been proven this will not result in harm.
Q: Is it possible to have other procedures at the same time as implants?
A: It is very common to perform minor reshaping procedures at the time of implant surgery. This could include nipple or areolar reduction, limited or full breast lift with implants, or combination with other body contour procedures such as liposuction or tummy tuck. Obviously, we wish to create the best overall body shape, not just to make the breasts larger.
For further details on how the surgery is performed, please visit our 3D Education Center.