Breast augmentation is one of the most common procedures in plastic surgery and it is one of my specialties which I perform in the Denver, Vail, and Aspen areas. I utilize an extensive pre-operative evaluation that relies heavily on imaging (2D and 3D). I take a team approach with the patients, finding the perfect implant size to exceed their expectations while staying within a natural aesthetic. In general, it takes less than 1 hour to complete the procedure. Per our method, only Intravenous (IV) sedation is required avoiding the need for general anesthesia. I utilize every brand of FDA approved implants on the market including those manufactured by Allergan, Mentor and Sientra. As each patient is different, the implant type is selected on a case by case basis. In more complicated cases, I often use anatomic shaped implants (cohesive gel). For cases where the breast are different sizes and shapes, implant sizers are used to ensure the best outcome. I use all incision types including the armpit, around the areola and at the lower fold of the breast. With use of our intra-operative field block, discomfort is limited immediately following surgery. Recovery time is around 7 days and patients are back to normal activities within 2 weeks. Overall we have consistently amazing results by focusing on matching the right size and style of implant to your body type.
Although this section is extensive, I have included all information needed for anyone considering augmentation of the breast. It is important to first understand which category you fall into by considering your age, your breast type and if there is loose skin present. In my practice, patients fall into four categories:
Group 1: Younger patients (20 to 50 years old) who are concerned with the small size of their breast.
Group 2: Patients with a change in breast shape and size following pregnancy and breast feeding.
Group 3: A patient of any age with a previous breast augmentation that requires replacement.
Group 4: Middle aged patients (35+ years old) with sagging, deflated breast.
A younger patient, with smaller breast and little pregnancy related changes, is an excellent candidate for a standard breast augmentation procedure. There are a few key points to understand about this procedure:
A common complaint for woman after pregnancy and breastfeeding is the changes that occur in the breast, especially with the size and the shape. These changes are due to the expansion of the milk ducts associated with pregnancy and the disruption of the normal anatomy of the breast (increased fat and the stretching of skin) with weight gain. In most cases, these problem areas can be fixed with a simple breast augmentation procedure. When the breast are droopy, a lifting procedure may have to be added. A few key points are listed below:
Breast augmentation is one of the most common procedures completed by plastic surgeons every year. As breast augmentation was introduced in the United States over 30 years ago, it is easy to understand why many of my cosmetic breast cases involve patients who have had a previous breast augmentation. The reasons for changing these implants can be varied but it is most commonly due to failure of the implant, scar tissue around the implant or a patients desire for a change in implant volume or plane (above or below the muscle). A few important points regarding these types of surgeries are listed below:
With age, the breast shape and size can drastically change. This is often seen in women with a fair complexion and who have breastfed. For these patients with droopy, deflated breast, a breast lift is often combined with a breast augmentation. The breast augmentation improves the size and shape of the breast and the lift repositions the breast back to a more youthful location. When considering these surgeries, a few key points must be considered:
Any woman that desires an improvement in their breast shape and size is a good candidate for breast augmentation. This is especially true for woman with small breast since puberty or after pregnancy. In the case of droopy, deflated breast, a lifting procedure is often combined with the breast augmentation.
Breast augmentation is not a permanent procedure. Per our current guidelines, the average duration of breast implant surgery is 10 years. Therefore, it is reasonable for a patient to assume that a replacement surgery will occur during that time frame. I do have many patients who have had breast implants for much longer than 10 years and who have not needed a replacement. Furthermore, the replacement surgery can be completed in less than 1 hour, without general anesthesia and with minimal recovery time.
Although the 1990’s were littered with large tort cases revolving around silicone breast implants, their safety record is now well established. Large patient studies have proven that that there is no apparent correlation between autoimmune disease and silicone implants. I utilize silicone implants preferentially in 95% of my breast cases. Even my patients with autoimmune disease are candidates for augmentation with silicone implants. The rheumatology literature has shown no correlation with worsened disease. Silicone gel implants are superior to saline filled breast implants from an appearance, feel and durability standpoint. It should be the first choice.
Breast implant construction has improved drastically in the past 20 years. This is especially true for silicone implants which now utilize cohesive silicone gel. This novel silicone gel has a tighter connection between the silicone molecules present in the gel. Why is this important? The gel in the cohesive silicone implants is less likely to leak and migrate to other areas. Furthermore, they can be manufactured with a more anatomically correct shape. Although these implants are the new frontier in breast surgery, the FDA approval has been slow to come. Specifically, Sientra has been approved for distribution of these shaped implants while Mentor and Allergan are close to being approved. So what is the real benefit of anatomic shaped implants? For select patients, a better match to the natural breast shape is achieved. This avoids a balled up un-natural augmented appearance that can occur. Unfortunately, there is a lot of misinformation regarding cohesive silicone implants in general. All current silicone implants utilize some form of cohesive gel but it is the ‘gummy bear’ types that utilize the strongly cohesive gel. Contrary to some websites, ‘gummy bear’ implants are not for every patient. A majority of patients would be well served by a standard cohesive silicone implant. ‘Gummy bear’ implants are harder, have the potential to rotate and can cause deformities. From my perspective, they are very beneficial, but only for a subset of patients I see on a daily basis.
Autologous fat transfer to the breast has become an en vogue procedure. It has the benefit of taking fat from one area of your body where it is not wanted (the belly) and transferring it to an area where it is needed (the breast). This has a big upside. An implant is avoided while the patient has the potential benefit of transplanting stem cells along with the fat. The safety profile is well established. I regularly use fat transfer to improve the breast appearance after breast cancer surgery and to fix patients who have had undesirable breast augmentation results with other physicians. As it pertains to patients who desire fat transfer primarily over breast augmentation with an implant, the tide is turning. The concerns that fat transfer to the breast may disrupt breast cancer surveillance with mammograms have not been supported by the literature. Therefore, even though patients with a family history of breast cancer or a known genetic breast cancer condition (BRCA) should avoid this procedure, most women are good candidates. I believe that this is the future and is becoming an excellent alternative to implant surgery.
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