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Breast augmentation, or augmentation mammoplasty, is a surgical technique to increase the size of the breasts. Any woman that desires a larger breast may be a candidate for breast augmentation if she has realistic expectations. There are other techniques to increase the size of the breasts, but the most trusted technique is placement of an implant surgically. There are multiple options that are discussed and decided during a breast augmentation consulation.
Silicone versus saline breast augmentation
The implant is a silicone shell filled with sterile saline (salt water) or silicone gel. The silicone gel filled implants are now available for cosmetic use by FDA clearance after the highly publicized controversy regarding the long term health consequences of silicone gel implants. The findings of all research studies to date have not demonstrated any consistent relationship between silicone breast implants and systemic illness. The new generation of implants is less prone to the slow silicone leak (bleed) that was felt to be responsible for most of the local problems with silicone implants. Gel implants are more soft and natural, especially when there is less overlying breast tissue, but they do require larger incisions than their saline counterparts since they are prefilled.
Breast implant surface and shape types
Implant surface options are a smooth or textured silicone wall. Textured implants demonstrated less hardening (capsular contracture) around the implants, but smooth implants are less prone to rippling. A variety of implant shapes are available, but in most scenarios Dr. Park prefers round implants, which become thicker at the base when standing due to gravity. Anatomic implants attempt to replicate the breast shape with a tear drop pattern, larger at the bottom than at the top of the implant, but the disadvantage is the deformity that occurs if the implant turns. There are also options in projection. Low, moderate, moderate plus, and high profile implants have increasingly narrow bases and greater projections, which are useful in patients with thin, narrow chests desiring larger implants.
Different incisions for breast augmentation
The implant may be inserted by four alternate approaches. An inframammary incision is just above the breast fold in the central breast and provides the best exposure to place the implant and modify breast shape or position. This location is usually well hidden by bras and bikinis and can be difficult to see if it heals well or lies in the new inframammary fold. The peri-areolar incision is placed around the areola, the dark area surrounding the nipple. A higher risk of altered nipple sensation and impaired breast feeding would be expected with this technique, but most studies have failed to show a significant difference and this technique can provide adequate exposure with a nearly imperceptible scar if the areola is large enough and less breast modification is necessary. By removing an outer rim of areola and tightening with suture, the areola can be reduced in size or lifted, a mastopexy. In transaxillary breast augmentation, an incision is made in the armpit, keeping scars off the breasts, using a camera to expose and modify the breast. The technique cannot be used with large silicone implants or breasts needing significant changes in shape, but can be used for most saline implants. Using a remote incision in the belly button, a TUBA, Trans Umbilical Breast Augmentation, can be performed without visible scar but voids the warranty of the implant because of the trauma that can occur to the implant during placement from a distance.
Breast augmentation implant location
The implants may be placed either beneath the breast tissue (submammary breast augmentation), below the pectoralis major muscle (subpectoral breast augmentation), or under the pectoralis major fascia (subfascial breast augmentation). With saline implants, thin patients with small minimal breast tissue, and patients with a history of problems with previous implants, deeper placement is recommended with subpectoral the most common. Subpectoral and subfascial implants are less likely to develop capsular contracture, due to the constant “massage” that occurs with muscle motion. Submammary placement, especially with silicone implants, can have excellent cosmetic results in the right patients.
Breast implant size
Prior to consultation, a general idea of the desired breast size should be known. A simple and inexact trick that can be used at home is filling a sealable bag with different amounts of water or rice on top of the breast in a bra of the desired cup size and evaluating the result. Photographs from magazines can be a helpful guide for those patients unable to verbalize a desired size. Together with Dr. Park, a more exact plan will be made using implant samples and measured breast dimensions to determine a safe and effective size and the need for any supplemental surgery such as a breast lift (mastopexy) or change of the vertical or transverse position.
After the procedure
Breast augmentation can be done under general anesthesia or local anesthesia with sedation as an outpatient in 1 – 2 hours. A postoperative garment or tube top will be placed and should be worn for the first few weeks. Pain medication is usually necessary for 1 – 2 days and activities, including driving and lifting, should be limited for 4 to 5 days. Scars will begin to fade and soften at 3 months. Revisional surgery may be necessary for size change, implant type change, capsular contracture, bleeding, infection, asymmetry, rippling, leak, or rupture. Saline is absorbed by the body whereas silicone is permanent unless removed surgically. A breast implant does obscure some of the breast, reducing mammogram sensitivity, but less so with submuscular or subfascial augmentation.
All of the descriptions for the various procedures are condensed from the text of the upcoming textbook written by Dr. Christopher Park and Dr. Malcolm Marks and are copyrighted, "The Artistry of Plastic Surgery: Exploring the Experience” . |
