Procedures

Breast Augmentation

QUICK FACTS
  • Breast augmentation surgery is the most common surgery I perform.
  • 60% of patients are ages 19 – 34 and have breastfed.
  • Breast augmentation surgery has one of the highest satisfaction rates of all cosmetic surgery.
  • Breast augmentation affects relationships more than other surgeries.
  • Most patients can return to work in about a week following surgery.
  • Breast implants will not correct severe sagging in the breast. A breast lift may be necessary to correct droopiness.
  • Breast implants do not reduce the ability to breast feed.
  • Most sensation in the breast is preserved following surgery.
  • The implant size used is a multi-factorial decision depending on the goals of the patient, the ability of the tissues to stretch, and the base width of the breast. The larger the band size the more volume is required to increase one bra cup size.
  • Breast implant manufacturers provide a warranty which includes life-time replacement of the implant(s) if implant deflates. If deflation occurs within 10 years of the original surgery the manufacturer will also provide financial reimbursement. Implant longevity of the thicker shelled implants, which began production in the mid-eighties is projected to be 25 years or longer.
  • Most common reasons for revision surgery include increasing the size of implants and adjusting the position of implants. Complications such as infection and bleeding are not common complications.
  • Breast implant surgery and complications, if any, are not covered by medical insurance.
  • It is important to massage the implants to prevent scar tissue from shrinking around the implants; a condition called capsule contracture.
  • It is important to perform a breast lift if the nipple is pointing downwards or sagging below the inframammary fold.

There are different ways to perform breast augmentation surgery. Each has different results.

  • The advantages of placing the implants above the muscle include: larger implants can be placed, less gap between the implants, more fullness in the upper quadrants of the breast, less movement of the breast with muscle flexion
  • The advantages of placing the implants below the muscle layer include: a more natural shape, less shrinkage of scar tissue which causes the implant to round up and feel hard, more breast tissue can be seen in a mammogram, decreased ability to see or feel wrinkles in the implant shell, ligament attachments to the skin are preserved which slows breast sagginess with age.
  • Available incisions include armpit, under the areola, and in the skin crease below the skin.
  • Silicone gel implants have a more consistent dough feel and cost twice as much as saline implants. Because of difficulty in determining if silicone implants are broken, many surgeons recommend routine exchange of implants which is not covered by implant warranty. If injured implants leak into surrounding tissues complete removal of silicone can be complicated. Silicone gel filled implants do not cause cancer or other diseases.
  • Saline implants are inserted with smaller incisions and are then filled with IV fluid. The volume of saline implants is adjusted during surgery to equalize the breast size. They are similar in appearance to gel filled implants. They are jiggly at the minimum fill volume and firm at the upper fill volume. When aged saline implants deflate, it can be determined by physical examination.
  • In textured silicone shelled implants if the tissues adhere to the surface of the implant they have less problems with migration, have decreased capsule contracture above the muscle and are more apt to show winkles especially when the breast tissue is thin.
  • Smooth silicone shelled implants are less apt to show wrinkling compared to textured shell implants and have more problems staying in position.
  • Anatomic implants are supposed to result in a more natural shape compared to round implants; however, if they do not heal in perfect position, they can give the breasts unequal shapes. They cost more than round implants. Round implants result in equal or even better shape most of the time.
  • Higher profile implants result in more projection in the breast compared to flatter implants.
  • Projection also increases when a saline implant is filled to the upper fill range.