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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.
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.
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.
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.
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.
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.
When you have sagging breasts, a breast lift with an augmentation is a great way to give you a more youthful breast shape.
Breast augmentation alone for these types of breasts is helpful but only addresses the deflation. A lift is often included to correct the sagging and is necessary to avoid a ‘double bubble’ deformity (where the implant sits higher than the sagging breast). With the advances in lifting procedures, the concerns regarding scars have been minimized. We use a vertical approach, also called the “lollipop” incision, that shortens the recovery time and scar length. Postoperatively, we then use a comprehensive scar treatment protocol to quicken scar maturation, allowing the scars to fade within a few months.
For those of you who desire a more natural improvement to your breast appearance, a few important points should be considered.
Placing the implants beneath the chest muscle and releasing the lower border of the muscle (dual plane) is necessary to give you a more natural postoperative contour. Silicone implants should be used preferentially as they have less rippling and a more natural feel when compared to saline implants. Also larger sized implants should be used selectively, and anatomically (“tear drop”) shaped implants should be considered as they are more effective at mirroring the natural breast shape.
The most common regret after breast augmentation is that the breasts were not adequately enlarged.
If larger breasts are what you desire, it is important that this be discussed in detail with your surgeon. In my practice, our patients play an integral role when selecting implants. Their input is then combined with a comprehensive preoperative evaluation that relies heavily on advanced imaging, allowing the selection to be fine tuned. For those of you who have different breast sizes, we often use implant sizers at the time of surgery to ensure the best outcome that maintains the most symmetry.
For women who have small, sagging, or asymmetrical breasts, a breast augmentation can be extremely rewarding.
So many of my patients have expressed their gratitude for the increased confidence and self-esteem they have gained as a result of this procedure. Studies have shown that an increase in self-confidence can have a ripple effect, positively impacting many areas of a person’s life.
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.
Your incisions will be located either in the armpit, around the areola, or at the lower fold of the breast. Any resulting scars will be easily hidden beneath a bra or swimsuit and are barely visible.
Many choose the incision around the areola as the scars are often difficult to detect in this location over time. Postoperatively, we use our comprehensive post-operative scar treatment protocol to quicken scar maturation (silicone sheeting, silicone gel, laser treatments, Dermapen®, Embrace® and LED light therapies) and to encourage the scar to fade.
The cost of breast augmentation varies depending on a number of factors, including the surgical technique and implant type chosen. I typically use silicone gel implants, which cost more than saline implants, but provide a more natural result that is well worth the investment.
You will find that the cost of breast augmentation also varies significantly depending on the geographic location of the surgeon. If you receive your surgery in a more populous area, it will often cost more. According to the 2012 statistics from the American Society of Plastic Surgeons, the national average surgeon fee for breast augmentation was $3,543. Patients should also note that breast augmentation is not a permanent procedure, and, on average, implants need to be either replaced or adjusted every ten years.
Although discomfort is part of the recovery process in breast augmentation, discomfort on average lasts for seven days and is manageable.
With the use of an intraoperative field block during surgery, the immediate postoperative time frame is fairly pain free. Postoperatively, with the use of pain medication and compression garments, the discomfort is further reduced. Most of my patients return to normal activities within 2 weeks and all are cleared for more aggressive upper body workouts at 4 weeks.
339cc moderate profile silicone implants
304cc moderate plus profile silicone implants
200cc high profile silicone implants combined with a short incision lift
371cc moderate plus profile silicone implants to improve deflation
286cc moderate plus profile silicone implants combined with a short incision lift
371cc moderate plus profile silicone implants combined with a short incision lift
339cc moderate plus profile silicone implants
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.
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.
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.
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.
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.
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.
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.
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
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
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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