What is breast augmentation surgery?
A breast enlargement or augmentation is a personal decision. However there has to be a good communication and knowledge between the patient and the cosmetic surgeon to enhance the size, shape and fullness of the breast to achieve the patient’s realistic expectations as much possible
One of the defining representations of beauty, vitality, and sexuality in the human form is the female breast. It is therefore understandable that many women desire a bust line that is larger, fuller, and shapelier breasts. In a Breast Enlargement, or Augmentation Mammaplasty, an implant is placed behind the breast or the chest wall muscle in order to enhance the size, shape and fullness of the breast.
Breast Augmentations have been performed for over 30 years in over 3 million women. Throughout this time, the surgical techniques and breast implants themselves have been continuously refined to increase the safety and reliability of the procedure. The primary factors that contribute to a successful Breast Augmentation procedure should be thorough attention to detail during the pre-operative planning stage, meticulous attention to technique and implant positioning in surgery, and careful patient compliance is very important as well during the recovery process. It is also of utmost importance that the procedure by performed by a highly trained experienced cosmetic plastic surgeon.
Am I a candidate?
You are a good candidate for cosmetic Breast Augmentation surgery if you have at least one of the following conditions or similar characteristics:
You have consider your breasts to be too small or under-developed
You feel that your figure is out of proportion because your small breasts make your hips appear wider
You feel that your small breasts limit your choices of flattering clothing or swim wear styles and wish to achieve these.
Your breasts have lost volume, or size after pregnancy, weight loss, or with aging
The upper part of the breast appears “empty” and wishes to have to achieve that upper fullness.
Your breasts have a different size or shape from one another and wish to achieve better asymmetry.
You have previously had breast implants and are experiencing problems with them
One or both breasts failed to develop normally, or have an unnatural, elongated shape.
Only you can decide if Breast Augmentation surgery is a good option for you, no one else can decide for you and each patient has their own preferences regarding what is “normal” “too big, too small” and “beautiful” in a breast. Your individual wishes regarding the change you seek in the shape and size of your breast should be discussed with your cosmetic surgeon. At the end of the your consultation he will then have a plan and know what surgical approach to incorporate and needs to be performed to achieve your desires and expectations.
Prior to making the decision to perform your breast augmentation surgery, your surgeon will thoroughly evaluate your general health status and any pre-existing health conditions or risk factors, which could compromise your surgical outcome or jeopardize your health. Detailed measurements of multiple physical parameters of your breasts are obtained in order to define all pre-existing breast asymmetry, and noted photographs are taken as well before and after surgery. It is recommended as a baseline precaution, most women older than 30 will be required to have had a normal mammogram within 6 months prior to the procedure.
Incision Placement Options
There are many factors to be taken into consideration when choosing the incision you wish to approach, such as the degree of enlargement desired, your existing breast anatomy, and the type of breast implant desired. Your surgeon will work with you to determine which incision approach is right for you. The four most common incision options are transaxillary, periareolar, inframammary and transumbilica
- For extremely discreet scars, the transaxillary approach utilizes a small incision in the armpit. Both saline and silicone gel implants can be placed using this approach, although silicone implants require a larger scar because they are pre-filled and cannot be rolled tightly for insertion.
The periareolar incision is made around either the top, or bottom half of the areola, which is the dark circle of skin surrounding the nipple. This incision allows very direct access to the interior chest wall, and leaves little noticeable scarring. This incision site will be used if a Crescent Lift is added to the augmentation to optimize nipple symmetry, or if a full Breast Lift needs to be performed. Both saline and silicone implants gel can be placed using this approach.
The inframammary approach utilizes a small incision along the underside of the breast where it meets the chest wall, and is typically hidden in the fold beneath the breast. This incision method allows for the best access to the interior breast anatomy for optimal implant placement and adjustment. Both saline and silicone gel implants can be placed using this approach,but remember silicone implants require a larger scar because they are pre-filled and cannot be rolled tightly for insertion.
For NO breast scars, the transumbilical (TUBA) approach utilizes a very small incision concealed inside the belly button. This reqchnique requires a highly skilled surgeon to properly place the implant through the umbilicus. Only saline implants can be placed via the transumbilical approach due to the fact that they are not pre-filled and can be rolled tightly for insertion.
Implant Placement Options
- After deciding on the incision site, you then need to chose the appropriate implant placement for you. Breast implants can be placed either submuscular (beneath the chest muscle) or subglandular (over the chest muscle.) The choice of where to place the implant depends on a variety of factors, including the degree of augmentation desired, the type of implant selected, and your particular anatomy. Submuscular placement is the preferred and most commonly used method for implant placement due to its numerous important advantages. Both saline and silicone gel implants are regularly placed in the submuscular position, which provides optimal soft tissue coverage, tends to produce a more natural appearance for most body types, and reduces the appearance of implant rippling. In addition, recent studies suggest that submuscular placement decreases the risk of capsular contracture, a complication in which excess scar tissue tightens around the implants. Due to the stretching of the muscle tissue, submuscular placement results in mild-to-moderate muscle soreness in the early post-operative period
- The subglandular method places the implant behind the breast tissue, but above the chest muscle. This method is recommended for women who plan to continue strenuous weight training to build the chest muscle because implants placed submuscularly will become laterally displaced as the chest muscle contracts and grows. Subglandular implant placement may result in a more comfortable recovery (since the muscle is not stretched), but it may be more likely to interfere with mammograms. In addition, less tissue over the implant means that the implants will be more visible and may look less natural. Rippling of the implant tends to be more evident in the subglandular position, and the rate of capsular contracture is increased. Most of the time women with thin skin or very small breasts are not good candidates for this option.
Determining Implant Size & Shape
After deciding on the incision location and implant placement, patients will need to select the type and size of implant that best suits to achieve their goals.
The shape of your augmented breasts depends on three factors: 1) the amount of existing breast tissue; 2) the quality of the skin envelope of your breasts; and 3) the size and shape of the implant you choose. Implants come in Moderate Profile, Moderate Plus Profile, and High Profile shapes. The choice depends on the look you want to achieve, and not all patients are suitable candidates for certain types of implants. Additionally, it is possible that several different types of implants and surgical approaches can be appropriate, and therefore patients must retain a healthy degree of skepticism if a surgeon offers only one implant or one approach. Your surgeon will help you to determine the best style and size of implant to achieve the result you desire.
Choosing the Right Breast Implants
While saline implants have been used predominantly since 1992, silicone is regaining popularity since being re-introduced to the U.S. market in 2006. Each different type of implant has a unique set of characteristics and considerations, and my extensive experience with both saline and silicone implants will help your surgeon guide you in choosing the implant that will best achieve your breast enhancement goals.
Breast Augmentation can be an exciting process and along the way to your new look you w
ill face numerous decisions one decision will be perhaps the most important decision is what type of implant to use in order to achieve the results you are looking for.
Saline Breast Implants
From 1992 to 2006, saline-filled breast implants were the only option available for the majority of women seeking breast augmentation in the United States. There are no health risks associated with the medical-grade saltwater solution that fills these implants. The FDA, however, limits the use of saline implants in women under 18 years old.
Advantages: Saline implants cost less than silicone gel filled implants due to lower manufacturing costs they are filled during the surgery. Saline implants can be placed through very small incisions (even through the belly button), your surgeon can adjust the final fill of each implant during your procedure to correct for any breast size asymmetry and also customize the breast profile according to your preference. In the case of leakage or rupture, the saline is harmlessly absorbed by the body and eliminated.
Disadvantages: Some women report that saline-filled implants can look and feel less natural than silicone gel implants. For instance, saline implants may exhibit a wrinkled or rippled appearance, particularly in women with little existing breast tissue and when the implants are placed above the chest muscle. Also, if a saline implant leaks or ruptures, there is a rapid and conspicuous loss of volume, which makes replacement surgery more pressing for cosmetic purposes.
Silicone Gel Filled Implants
The new “fourth generation” silicone gel implants are a safe and effective option for many women considering breast enlargement in McAllen and Brownsville. These implants have undergone more than a decade of testing and clinical studies, and were found by the FDA to pose no significant health risks. In 2006, the FDA lifted its voluntary moratorium on the use of silicone implants, granting marketing approval for a new silicone gel implant type. However, there are some restrictions on their usage, including age restrictions – these implants may not be used for women under 22 years old.
The new silicone implants are vastly improved over the earlier generations of silicone, and are filled with a cohesive silicone gel which is much less likely to leak or migrate if punctured, torn, or cut. To ensure ongoing safety, the FDA continues to monitor silicone implants as part of a post-approval study
Advantages: Silicone gel-filled implants are the most popular choice worldwide by a significant margin. This is because women find that silicone can produce more natural looking and feeling results. They ripple and wrinkle less and do not slosh like saline implants sometimes initially can as the air inside the implant is absorbed
Disadvantages: Silicone implants cost twice as much as saline implants, and also have additional associated costs. In the United States, the FDA recommends surveillance MRIs to check for implant rupture starting 3 years after surgery. This is because unlike with saline implants where rupture results in rapid and obvious implant deflation, silicone implant rupture can only be detected with MRI. Insurance does not cover these surveillance MRIs. Since silicone implants arrive pre-filled from the manufacturer, they require larger incisions for placement, and they cannot be placed through the belly button.
As with any type of surgery, there are potential risks and complications, such as adverse reactions to anesthesia, bleeding, infection, poor healing of the surgical scar, and pain. Post-operative bleeding or formation of a seroma (a collection of the watery fluid around the implant,) may require re-operation and drainage, and may be associated with an increased incidence of infection or capsular contracture.
Infection of a breast implant is extremely rare, but may require removal of the implant for up to several months until the infection can be completely cleared and the implant can be re-inserted.
Postoperative formation of a fibrous tissue capsule around the breast implant is a normal bodily response when a foreign object is placed in soft tissue. Capsular contracture, however, is a persistent and aggressive shrinkage of this tissue capsule surrounding the implant, causing the implant and breast to feel unnaturally firm and sometimes painful. Capsular contracture is usually progressive, worsening with time, over the course of several months to years. This may result in asymmetry, making the breasts appear misshapen or out of position. The occurrence or severity of this condition varies with each individual, and there are no reliable data as to why it occurs in some people. Submuscular implant placement has been shown to decreases the incidence of capsular contracture compared with subglandular placement.
Deflation of a saline breast implant may occur when the saline solution leaks either through the valve, or through a puncture or defect of the outer shell of the implant. This requires surgical replacement. Rupture of a silicone implant is more difficult to diagnose, since the implant does not deflate. Special MRI studies are required to identify a ruptured silicone implant, and the FDA recommends an MRI study be performed every 3 years for surveillance after silicone implants. Insurance does not typically cover surveillance MRI for silicon implant rupture. Both saline and silicone implants are covered by a manufacturer’s warranty against rupture and deflation.
Sensory changes may occur in the nipples or outer breasts, and scars may be unsightly. Patients with very small breast volume or thin skin pre-operatively may note visible wrinkling or rippling of the implants, especially in the subglandular position, and more commonly when larger size implants are chosen. Delayed wound healing may occur in persons with diabetes, history of radiation, autoimmune disease, or in smokers
Breast Augmentation surgery may not be a one-time surgery. It is very likely that additional surgeries and doctor visits will be necessary over the course of your lifetime to maintain the appearance of the breasts after Breast Augmentation, either because of problems related to the implants themselves (deflation, capsular contracture, rupture, etc.) or because of changes affecting the appearance of the breasts over time (pregnancies, weight gain, loss of breast tissue as a function of age, etc.)
There is no evidence that breast implants affect fertility, pregnancy, or a woman’s ability to breast-feed. Even without implants, not all women may be able to breast-feed. Although there may be a slightly increased risk for scarring within the breast and a decreased ability to breast feed when the peri-areolar (nipple) incision is used as compared to the inframammary (breast fold), axillary (under-arm), or transumbilical (belly-button) incisions, this has not been scientifically proven.
A Word About Breast Implants & the Risk of Cancer
There is no evidence that implants either cause or play a role in the development of breast cancer, and there is no statistical difference in the occurrence of breast cancer in women with implants as compared to women without implants. Similarly, if or when breast cancer is detected, there is no statistical difference in the stage of disease when comparing women with implants to those without implants. Women must be knowledgeable about their risk factors, such as family history of breast cancer in first-degree relatives before menopause. Women must be diligent about self-examination of the breast, as well as scheduling regular breast examinations by your gynecologist or plastic surgeon. However, regardless of the type of implant or or whether the implant is placed above or below the muscle, breast implants may make mammography somewhat more difficult and less reliable, especially in cases where capsular contracture develops. Approximately one in eight of all women will develop breast cancer, and breast implants may make cancer more difficult to detect by mammography in women with implants. However, modern mammography centers are equipped with the latest equipment and trained technologists and physicians who are accustomed to imaging the breasts of women with implants.