Breast Augmentation

A woman’s sense of her own beauty is often expressed by a certain visible confidence, balance, and elegance, but it can be difficult to feel confident in your beauty when you are not satisfied with the appearance of your breasts. Women who are unhappy with the size, projection, appearance and/or symmetry of their breasts can choose to undergo a breast augmentation to help change the way their breasts look.

A breast augmentation procedure, also known as augmentation mammoplasty, is a surgical procedure that can be used to improve the dimensions, volume, proportions, and overall appearance of a woman’s breasts. Some women choose to undergo this procedure for a variety of reasons, including:

  • Small breast size
  • Diminished breast volume from natural aging, weight loss or after a pregnancy
  • Asymmetry

Why Consider a Breast Augmentation?

Inframammary (breast crease) Incision

Periareolar (around the areola) Incision

Transaxillary (underarm) Incision

Breast implants can be placed above or beneath the pectoral muscle.

The results of breast augmentation surgery are immediately visible. Over time, post-surgical swelling will resolve and incision lines will gradually fade.

The natural development of your breasts is determined by a number of factors. These factors include your genetics, age, and hormonal levels including estrogen and testosterone levels in your system. Your breasts may also change in appearance if you become pregnant, have just given birth, or you are currently breastfeeding, or even as a long-term result of aging and and/or previous pregnancies

Having larger and more symmetrical breasts can help some women improve their self-confidence and body image. The procedure can also make your body appear more proportionate and more aesthetically pleasing.

The Best Candidates for Breast Augmentation

You may be a good candidate for a cosmetic breast augmentation procedure if you are 18 or older and have breasts that do not fit your ideal self image and aesthetic goals, due to their insufficient size, fullness, firmness, projection, or conspicuous lack of symmetry.

Whatever your personal specific reasons may be, a breast augmentation performed by an experienced and qualified Plastic Surgeon is a safe and effective procedure that can help appropriate women in need of bodily improvements come closer to the look that they are imagining. Being physically and mentally reasonably healthy, and being generally realistic in your expectations are also important prerequisites before undergoing a breast augmentation.

Patients must adhere to strict age requirements before they undergo an elective cosmetic breast augmentation procedure. In order to qualify for augmentation with saline breast implants, you need to be at least 18 years old. For silicone implants, you must be at least 22 years old. Younger women with various unusual breast problems or abnormal appearing breasts may still qualify for breast implants, as the procedure in their case may be considered more reconstructive than just purely cosmetic in nature.

A successful breast augmentation always increases the apparent size and volume of your breasts,and can improve your appearance and your self-confidence. Before you decide to have the procedure, it is important for you to have realistic expectations and discuss them with your surgeon.

Saline vs. Silicone Implants

As part of your breast augmentation procedure, you will be able to choose between saline (salt water filled) and silicone (silicone gel filled) breast implants. Each type has its own set of pros and cons. Saline implants are heavier and firmer than silicone implants. They can be filled after being inserted empty into the breast pocket.

Silicone implants, on the other hand, are known to feel more natural to the touch, but they are pre-filled. This can limit your incision options. Patients who opt to use silicone implants have a lesser chance of experiencing visible or palpable rippling of the breasts.

The advantages of a saline implant generally revolve around possible implant failure or rupture. To begin with, it is often said that breast implants are not lifetime devices. This statement is somewhat misleading because although breast implants don’t last indefinitely, many do last for a given woman’s lifetime which may be 20, 30 or more years after receiving implants. Based upon currently available information, most breast implants generally have a documented failure rate of between ½ and 1% per year that is cumulative. In other words, after 10 years, 5-10% of implants will have failed, and similarly at 20 years, the failure rate would be 10-20%.

The advantages of a saline-filled breast implant include the easy diagnosis of an implant failure. The saline leaks out of the implant and the breast slowly or quickly deflates depending on the size of the leak. There is virtually no harm or risk of a saline leak because your body is 70% saline naturally and the saline from the implant is simply absorbed leaving the empty balloon shell behind. This benefit also means that there is usually no reason for any diagnostic testing to ascertain the status of your saline-filled breast implants, because failures are generally obvious

On the other hand, this same set of facts is the relative disadvantage of silicone gel filled breast implants. Leaks and ruptures are not always or even usually obvious and then there is the question of what happens if, and when the silicone gel filled implant leaks. To begin with, because gel leaks are not obvious the FDA has recommended that women with silicone gel implants after 3 years have breast MRI’s every 2 years. Many or most experienced Plastic Surgeons do not agree with that recommendation, and recommend instead return visits to a knowledgeable surgeon periodically or return visits in case of certain changes in the breast such as swelling, lumps, firmness, or changes in breast shape.

After implantation, the body forms an internal lining around the implant called a capsule. That capsule acts as a barrier to keep the silicone gel leaking from the implant from getting into the surrounding tissues. That protective process generally works with the exception of two things. In very very rare cases of especially traumatic implant rupture (e.g. a fall off a high ladder or a steering wheel trauma after an MVA), the implant may rupture coincident with a tear in the capsule resulting in migration of the gel into the surrounding tissue resulting in a lump.

Although the capsule retains the visible silicone gel in the vast majority of cases which are thus called “intracapsular ruptures,” very tiny microscopic amounts of silicone can sometimes still be detected in nearby tissues. These tiny amounts are not considered significant and are generally believed to be harmless.

While both saline-filled and silicone gel-filled implants are considered safe, the saline version provides a slight advantage in terms of peace of mind. On the other hand, when it comes to overall performance, the advantage clearly goes to silicone. Silicone gel implants are available in a wide number of styles, gel types, sizes and shapes. Whereas, the options with saline implants are much more limited.
Silicone gel-filled implants generally feel softer and look and feel more natural.
Many surgeons manage the “peace of mind” issue surrounding rupture of silicone implants by recommending routine replacement at some interval such as 10, 15 or 20 years

The incision location may vary depending on a variety of factors. Depending on your specific needs and your surgeon’s recommendation, you may get your incision around the areola, beneath the breast fold, or in the armpit. Generally speaking, an incision in or near the fold under the breast is the safest and most effective approach and is associated with the lowest revision or capsular contracture rate in published studies.

You may be a candidate for a transaxillary breast augmentation, where the incision is made in the armpit. The transaxillary incision is particularly appropriate for women with smaller breasts, poorly defined inframammary folds, and small areolas. It is commonly used in Asian women who often have small breasts with very small nipples, and who are concerned about the possibility of darker scars on or near their breasts. Although often associated with saline-filled breast implants, the axillary approach can be used with silicone implants as well.

An incision around the edge of the areola is a reasonable option particularly for women with larger areolas and modest amounts of their own breast tissue, It can hide the scar along the edge of the areola in many cases, but does risk placing a scar in plain sight on the breast if the scar is visible. It is thought to be associated with a slightly greater risk of altered nipple sensitivity and has been linked in some studies with a higher capsular contracture risk necessitating a revision.

The breast implant can be placed behind the breast tissue and in front of the Pectoralis Major (PM) muscle (“subglandular”), behind the breast tissue and behind the PM fascia but in front of the PM muscle (“subfascial”), or behind all three, behind the breast tissue, behind the PM fascia, and behind the PM muscle (“subpectoral” also referred to as “dual plane”). The pros and cons of each are somewhat complex, but currently the “Subpectoral” or “Dual-plane” technique is the most commonly recommended because of its advantages in lower capsular contracture rates and generally more natural contours. It comes with one specific notable downside, that being the risk of some unnatural breast movement when the PM muscle is flexed (referred to as an “animation deformity”).

Breast implants also come either with a smooth surface or a textured surface. Only the textured surface implants also come in various specific non-round shapes referred to as “anatomical.” The vast majority of implants placed for breast augmentation in the United States are referred to as smooth round silicone gel implants. In most cases, textured implants only are recommended when using non-round implants where avoiding rotation comes into play. Textured “anatomically” shaped implants may be an option for various specific indications such as unusually long and narrow or very short and wide breasts or chests; or in some major asymmetries and or skeletal abnormalities such as Pectus Excavatum, Scoliosis, or unilateral Thoracic Hypoplasia. Some patients and surgeons just prefer the anatomical shapes because they can create a less augmented look with accentuated fullness in the lower ½ of the breast and a more gradual or tapered upper pole.
Textured “anatomically” shaped breast implants make the most sense in women with less breast and soft tissue than the average patient. These implants are more expensive, feel somewhat firmer and come with the added risk of malrotation or malposition estimated at 5-25%. They are more commonly used in breast reconstruction than breast augmentation.

Questions to Ask Yourself Before Your Consultation

Before you schedule your consultation, it will be extremely helpful to analyze your needs and goals. There are several questions that you should ask yourself before you commit to the procedure, including:

  • What is my ideal cup size?
  • What sort of look do I want,” augmented” or more “natural?”
  • Do I have specific “looks” that I don’t want, or prefer?
  • Do I have a specific implant size in mind (e.g. 250cc, 325cc, or 400cc?)
  • What kind of implants am I interested in, silicone or saline?
  • Do I want or need a breast lift?
  • What other procedures can I take advantage of to fully realize my aesthetic goals?

Taking the time to answer these basic questions for yourself can help you determine which procedure is right for you.

Planning Your Surgery

During your initial consultation, be sure to discuss your expectations. Your surgeon should evaluate your health and explain which surgical techniques are most appropriate for you based on the condition of your breasts, your skin elasticity, and what you expect to get out of the procedure. If your breasts are sagging, you may need to combine the procedure with a breast lift to further enhance your final results.

How to Prepare for Your Surgery

You will be given instructions on how to prepare for surgery, including guidelines on eating, drinking, smoking, and taking or avoiding certain vitamins and medications. Smoking significantly increases the risks of surgery. A mammogram may be recommended prior to your procedure to ensure breast health and serve as a baseline for future comparison. Plastic surgeons generally require an up to date routine medical exam by your primary care doctor within 30 days of surgery. If you don’t have a physician, we can arrange an exam for you

While making preparations, you must arrange for someone to drive you home and spend the 1st night with you after your surgery. In the best hands, most patients recover fairly quickly after surgery and have only mild to moderate discomfort usually easily managed with mostly Motrin/Advil and/or Tylenol. You will be given a few prescriptions either prior to your surgery or on the day of the operation. Most patients after breast augmentation have little or no significant discomfort at all after 7-10 days.

The Day of The Procedure

On the day of surgery, you should have nothing by mouth after midnight unless otherwise instructed. You should wear comfortable clothes including a loose fitting top that buttons or zips in front. You should have showered as instructed with an antibacterial soap and of course not smoked for the prior 2 weeks. Be sure to arrive as directed at least 60 minutes prior to your scheduled surgery time.

At the conclusion of the operation, some surgeons will apply a waterproof dressing over your incisions to help with healing and to allow you to shower the next day without worry. The surgery usually takes 45 minutes or a little longer to complete, but the total time in the operating room is usually somewhat longer than that because of the other steps involved.such as getting you off to sleep and waking you up.

You will need to stay in a recovery room for another hour or so until you are fully awake, but then you will be discharged home in the hands of your designated care-giver. You will be given a number to call in case of any questions and will be usually be contacted later that day. Most patients come back for a quick check-up within 24-72 hours, and periodically after that.

After the Procedure

We encourage you to resume your normal daily non-strenuous activities within 24 hours of surgery. That includes returning to work within a few days unless your job is very physical and involves heavy lifting for example. Mild to moderate exercise is also encouraged after the first few days which may include some cardio and mild stretching. Upper body arm and chest muscle exercises and other weight lifting or exercises involving straining are strongly discouraged for 3 weeks while things are busy healing. If you are traveling in from out of town, we recommend that you spend the 1st night or 2 nearby before returning home by car, train or plane. All forms of travel are safe but we recommend moving around as much as possible to avoid the risk of blood clots. For out of town patients, a number of options for follow-up visits are possible.

We generally recommend leaving the waterproof dressing on your incisions for about 7 days. We rarely use stitches that need removal so you don’t have to worry about that. A surgical bra is usually provided right after surgery mostly to help keep your clothes tidy and provide some early support, compression, and sense of security. We generally prefer that you get into an underwire bra as soon as possible which we believe does a better job of defining and supporting the desired borders of your breasts while things heal. This is in contradistinction to the common recommendations on the internet recommending sports bras. Applying an ice cold compress to the breasts intermittently for the 1st few days may be helpful for limiting swelling, bruising, and some of the discomfort. The obvious visible swelling in your breasts takes a minimum of 4 to 6 weeks to disappear. By that time, all vestiges of pain and tightness are also gone and your augmented breasts should begin to feel like an integral part of you.

Your New Look

The results you’ll experience from a breast augmentation can be satisfying and even exhilarating. As you recover, you will appreciate the fuller and more proportional appearance of your breasts.

It is important that you follow up as directed with your surgeon to assess the condition of your breast implants. In addition, whether you choose to have breast implants or not, it is essential to your health that you do a monthly self-examination of your breasts and schedule regular diagnostic breast screenings.