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Breast Augmentation

Breast augmentation, “augmentation mammaplasty,” with the use of saline or silicone gel implants, is an effective way to improve the size and contour of your breast. My approach is comprehensive and relies on an extensive preoperative evaluation, including advanced imaging. The end result is empowering, giving you the freedom to embrace your body contour with confidence and making you feel more beautiful.

Who Can Benefit?

When considering a breast augmentation, you should first determine which of the following groups best describes your breast type.

Naturally Small Breasts

Naturally Small Breasts

Those with naturally small breasts and those without pregnancy-related changes fall into this category. These individuals are often younger (less than 30 years of age) and are excellent candidates for a standard breast augmentation procedure without a lift. Depending on their body type, these women are candidates for most implant types including moderate profile, high profile and anatomic shaped implants.

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Post-Pregnancy Breasts

Post-Pregnancy Breasts

This category includes women who have experienced a change in their breast shape and size following pregnancy and breastfeeding. For most of these women, only a standard breast augmentation is necessary to return their breasts to a pre-pregnancy appearance. In those women with both deflated and sagging breasts, a lift may be necessary.

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Breast Surgery Revision

Breast Surgery Revision

Although a breast augmentation will on average last at least 10 years, many women with a history of breast augmentation do require revisions. The most common reasons for a revision include an implant failure, palpable scar tissue around the implant (capsular contracture) and a woman’s desire to change the size or position (placement above or below the muscle) of the implant. For women in this category, I always encourage them to upgrade to a silicone gel implant if they were previously augmented with a saline implant.

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Sagging, Deflated Breasts

Sagging, Deflated Breasts

With age, your breast shape and size can dramatically change. Often, this occurs in women who have a fair complexion and have breastfed. For these patients, a breast lift often accompanies the breast augmentation procedure in order to address sagging skin.

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What do you desire?

Pre-baby breasts

Breast augmentation is an excellent way to improve the appearance of your breasts after pregnancy.

As the most common post-pregnancy complaint is deflation, an implant with an ample amount of volume is a good option for filling that void. However, if you do not desire more volume, a breast lift may be necessary if smaller implants are used. Breast augmentation also has the added benefit of improving the appearance of stretch marks on the breasts, which are common after pregnancy.

More perky breasts

A natural change

Larger & more symmetrical breast

Confidence

Concerns

Recovery

Recovery from breast augmentation is roughly two weeks.

Since I use twilight sedation, there is a lower incidence of surgery-related nausea, vomiting, and headaches following surgery. During the first four weeks of recovery, the patient should limit bending and heavy lifting to reduce the risk of implant displacement. Resting in a recliner or laying in a bed propped up with pillows will help provide comfort and reduce swelling. Massaging the breasts after surgery is also important to improve the overall results and ensure that the breasts remain soft.

Scars

Cost

Pain

FAQ

Who is the best candidate for this procedure?

Any woman that desires an improvement in her breast shape and size is a good candidate for breast augmentation. This is especially true for women who have had small breasts since puberty or after pregnancy. In the case of droopy, deflated breasts, a lifting procedure is often combined with this procedure.

Is breast augmentation permanent?

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 timeframe. 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 one hour, without general anesthesia and with minimal recovery time.

Are silicone implants safe?

Although the 1990’s were littered with large tort cases revolving around silicone breast implants, their safety record is now well established. Patient studies have proven that there is no apparent correlation between silicone breast implants and autoimmune disease. Even the rheumatology literature has shown no correlation with worsened disease. I use silicone implants preferentially in 95 percent of my breast cases, and that includes my patients with autoimmune disease. Silicone gel implants are superior to saline-filled breast implants from an appearance, feel, and durability standpoint. It should be the patient’s first choice.

What are "gummy bear" implants?

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. These implants are the new frontier in breast surgery and have recently achieved FDA approval. Specifically, Sientra® received approval in March of 2012 for its entire line of highly cohesive silicone gel implants that includes both round and anatomically shaped implants. Anatomically shaped implants supplied by Allergan, the Natrelle® 410, were FDA approved in February 2013. Finally, the most recently approved highly cohesive implants are the Mentor® MemoryShape™ implants, which were approved in June 2013. So, what is the real benefit of anatomically shaped implants? For select patients, a more natural breast shape is achieved. This avoids a balled-up, unnatural augmented appearance. However, “gummy bear” implants are not for every patient. The 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. I believe these implants are very beneficial, but only for a portion of the patients I see in my clinic.

Is it better to place an implant above or below the chest muscle (pectoralis)?

Placing implants below the muscle has a lower incidence of implant rippling and a lower development of scar tissue (capsular contracture) around the implant. Although certain cases have indications for above muscle placement, it should be avoided in small breasted woman due to implant show and a subsequent unnatural appearance.

Is there any alternative to breast enhancement surgery that does not involve breast implants?

Autologous fat transfer to the breast has become an accepted procedure in the field of plastic surgery over the past 5 years. This procedure has the benefit of taking fat from one area of your body where it is not wanted (e.g., the belly or hips) and transferring it to an area where it is needed (e.g., the breasts). 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 for this procedure is well established. I regularly use fat transfer to improve the breast appearance after breast cancer surgery and to improve 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 autologous fat transfer is the future of breast augmentation, and it is becoming an excellent alternative to implant surgery.

What size and shape implant should I use?

In order to determine the best size and shape of the implants for your breast, it important to have a good understanding of your body proportions. In our clinic, we take a team approach to implant selection and every factor is considered. This includes chest wall width, the amount of breast tissue available, the quality of your skin, the degree of sagging, your activity level and your overall body contour. We then use 2D and 3D imaging to further evaluate your physical dimensions and then assess how a specific size and shape of implant will affect your breast appearance.

Will breast implants interfere with my annual mammogram?

Although breast implants can affect the clarity of mammogram images, studies have shown that mammograms are still an effective way to screen for breast cancer in women with implants. It is recommended that you attain your screening test in centers that have experienced technicians and the newer imaging devices that accommodate implants

Will breast augmentation require future maintenance?

The FDA currently recommends a screening MRI of the breast every three years after breast augmentation for detection of any implant issues including rupture. These exams are helpful as our current experience has shown that breast augmentation lasts around 10 years

Is breastfeeding possible after breast augmentation surgery?

Breastfeeding may be limited after breast augmentation surgery depending on the technique used. Avoiding incisions around the areola and placing an implant below the pectoral muscle is the best way to protect future milk production.

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