Breast Augmentation

Breast augmentation serves to help women desiring to balance their figure in order to improve how they look in clothes, to augment their self-confidence, and in some cases to reverse the changes associated with pregnancy and weight-loss.
In addition, some women suffer from uneven breasts, or just feel that their body is out of proportion due to small breast size.

Breast implants alone may be used to lessen the breast drooping (ptosis) that occurs with age, although only in mild cases. More significant drooping may also require more incisions on the breast in addition to implants (see Breast Lift)

Options for incisions

  • Under the breast – Typically a ~2 inch incision under each breast will deliver excellent access for the most predictable placement of the implants. The scar is well hidden under the breast, and usually heals quite well.
  • Around the areola – Making an incision around the colored skin of the areola affords a slightly more concealed scar. It does have the downside of altering nipple sensation and decreased potential for future breast feeding.
  • Underarm (axillary) and belly-button (transumbilical)- Although these access incisions have been described, Dr. Gordley feels that they are associated with higher risk of malpositioned implants due to poorer visualization, and therefore rarely recommends

Options for placement of the implants

  • Over the pectoralis muscle – Placement of the implant over the muscle is a good option for women who already have reasonable breast tissue higher up on the chest wall. It makes for a very natural breast shape and excellent cleavage. However, it is also associated with easier palpability or even visibility through the skin. In addition has been found to have higher rates of capsular contracture (or hardened scar formation around the implant). Additional XRAY views are also required during yearly mammograms to adequately visualize the breast.
  • Under the pectoralis muscle- When the implant is placed under the muscle, it is more well concealed, especially for women without much natural breast tissue. Although the recovery may be slightly more painful, it is associated with less capsular contracture and easier breast tissue visibility on mammograms.

Options for type of implant

  • Saline implants – “Salt water” filled implants have a track record of being very safe and predictable. If the external shell of the implants rupture, the saline is simply absorbed. They may not feel quite as natural as silicone, and there is also a higher chance of seeing “ripples” through the skin, especially if placed over the muscle
  • Silicone implants – Since coming back on the market, silicone implants have become quite popular. They maintain a more natural feel then saline implants. The “gummy bear” silicone inside of the new cohesive gel implants reduces chances of silicone leakage in the event of a rupture, drastically improving their safety. Concerns for rupture are usually evaluated with MRI, and ruptured implants typically replaced.

Additional information

  • Anesthesia – The procedure can be performed both under general anesthesia or under controlled IV sedation, and is day surgery.
  • Recovery time – After approximately 48 hours, most women feel well enough to perform most daily activities, and usually return to work. Some soreness may continue for several weeks.
  • Implant upkeep – Implants may need revisional surgery for several different reasons, including rupture, malposition, capsular contracture (as above), effects of gravity or patient request. Women who get implants should know that these are not lifelong devices, and may very well require surgery of some sort in the future.

Below is a fairly typical result of an appropriately sized implant creating a fuller, more attractive breast.

325cc subpectoral silicone implants, via inframammary incision

375 Saline Submuscular via periareolar incision

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

350cc Silicone Submuscular Implants via Inframammary Incision