SEMINAR 1: Breast Augmentation
There are several things to consider before having a breast augmentation:
Incision location. The three most common incision locations for breast implant patients are 1) under the breast, 2) under the areola (the pigmented circle that surrounds the nipple) or 3) in the armpit. An incision under the breast, or the inframammary fold (IMF), is an excellent option for any patient except those who also require a breast lift. Incisions under the areola are an excellent option for any patient undergoing a breast lift, or who has moderate to large-sized areolas. The incision is placed along the lower curve of the areola and can be well concealed between the color change occurring at the areola - breast skin interface. Individuals who have a relatively small areola and desire a moderate-sized or larger silicone implant are not candidates for this periareolar approach. The armpit, or transaxillary approach, uses a short scar concealed in the armpit. We typically reserve this approach for patients who have not had previous breast augmentation, do not require a breast lift and want a saline implant.
Implant positioning above or below the chest muscle. Breast implants can be placed above or below the chest or pectoralis muscle. In general, implants are placed under the pectoralis muscle if the patient has only a modest amount of tissue thickness above the nipple, to achieve a more natural slope to the upper breast and to reduce premature hardening of the pocket surrounding the implants, also known as capsular contracture. Patients may choose to put breast implants above the muscle if they are extremely athletic, have more pre-existing breast tissue above the nipple to help camouflage the implant, or intentionally wish to have a more discrete, implanted-look in the upper chest.
Implant size. It is always helpful to have a sense of the size of breast implant you want when meeting with your surgeon. We have photos of patients who have undergone placement of breast implants of several sizes in our photo gallery and many more in books available for viewing in our office. Another online resource to help you determine breast implant size is www.implantinfo.com.
When choosing the size of your breast implants, it is always best to review “before and after photos” of patients taken using standardized poses. It is also advisable to review pictures of patients that looked like you before surgery to get the best idea of what you can expect. Print pictures of results that you liked and didn’t like and bring them with you. Show us the photos of imperfections you didn’t like. Sometimes, these imperfections can be avoided, but sometimes they are unavoidable. Reviewing these types of photos with your plastic surgeon helps to make sure you have realistic expectations.
Saline versus silicone implants. Breast implants are filled with either saline or silicone gel. Over 60% of our bodies are made up of saline, or salt water solution. So, if a saline implant ruptures, the implant rapidly deflates and your body easily reabsorbs the saline solution. Silicone implants are filled with a cohesive silicone gel that helps these implants maintain their shape and have a more natural feel than saline implants. Silicone implants were reapproved by the FDA in November 2006 in patients 22 years of age or older. Since silicone implants do not rapidly deflate if there is a leak, the FDA recommends that patients with silicone implants have periodic MRI exams to confirm the integrity of their implants. The shells of both saline and silicone implants are made from an elastomer consisting of polydimethylsiloxane, which is made more durable or vulcanized at room temperature. These implants can be smooth or textured. Click here to join our blog discussion on silicone versus saline breast implants.
Breast implants and breast cancer. Breast implants do not increase or decrease your risk of getting breast cancer. Breast implants do affect how mammograms are taken. In general, if you do not have a first degree relative (parent or sibling) with breast cancer, you should have a screening mammogram or breast X-ray when you are 35 years of age, and if it is normal proceed to annual screening mammograms starting at 40 years of age. In general, two pictures of each breast are taken during screening mammography. However, if you have breast implants, additional displacement views are taken in which the X-rays show the implants displaced or pushed out of the way. If you have breast implants, you should have your mammograms taken at a facility familiar with this technique, sometimes referred to as Eklund maneuvers. Alternatively, an MRI can be used to evaluate the breasts. Breast tissue is easier to see with mammography if implants are placed under the pectoral muscle (subpectoral or bi-planar) compared with implants placed above the muscle (subglandular).
When do you need to replace breast implants? Breast implants are not perfect and will eventually fail. The two main reasons are a leak or rupture, or capsular contracture causing the pockets surrounding the implants to become hard and painful. The average lifespan of a breast implant – saline or silicone – is 10 to 15 years. So, although breast implants are very safe medical devices, they will eventually need to be replaced. In some cases, because of the natural process of aging, gravity and the weight of the breasts, replacement of breast implants may be accompanied by a breast lift procedure.
It is also important to know that the major breast implant companies – Allergan and Mentor – provide excellent warranties with their breast implants that will cover the replacement of the devices as well as some of the subsequent surgical fees.
Deciding between a breast augmentation, lift or both. A breast augmentation will add volume and size to the breast. Larger breast implants can also raise nipple position by 1 to 2 cm, thus effectively providing a modest breast lift. Women who only want their breasts to appear more “perky” and raise their nipples, but not necessarily have larger breasts, are better candidates for a breast lift or mastopexy. A combination breast lift and breast augmentation, or augmentation mastopexy, is best suited for women who want their breasts to be perkier, but with more fullness in the upper pole of the breast and more volume. In these cases, a breast lift alone cannot achieve as much upper pole fullness as augmentation mastopexy, and so an implant is used not just to gain size, but to achieve a certain shape.
Click here to view a video on breast augmentation.
A breast augmentation is often combined with other procedures that may include:
Breast lift (mastopexy). Patients with excess breast skin and downward-pointing nipples may wish to consider a breast lift or mastopexy to raise the breast tissue and nipples to a more youthful position. This is particularly common in individuals who may be candidates for an extended abdominoplasty because weight fluctuations in these individuals often leads to redundant skin of the breasts, abdomen and flanks.
Simultaneous breast augmentation and breast lift (augmentation mastopexy). Some patients may benefit from additional breast volume, tightening of the breast skin, and repositioning of the nipples to a more youthful position. This may be best achieved with both a breast lift and a breast augmentation at the same time, or an augmentation mastopexy. This combination is also particularly common in individuals who may be candidates for an extended abdominoplasty because weight fluctuations in these individuals often leads to volume loss and redundant skin of the breasts, abdomen and flanks.
Liposuction. Removal of fat from the sides, thighs, back and buttocks with standard tumescent liposuction, VASER LipoSelection or SMART laser-assisted liposuction provides a nice complement to refinement of the abdomen with an abdominoplasty.
Abdominoplasty (tummy tuck). Frequently, patients wishing to improve the contour of their abdomen debate between an abdominoplasty or tummy tuck and liposuction. Some individuals can be candidates for either procedure depending on their goals. An abdominoplasty is best for people with loose skin and lack of abdominal muscle tone who have undergone significant weight loss or for women who are dissatisfied with their shape after having had children and are looking for a so-called “mommy makeover.”
Combining breast augmentation with other procedures can be performed efficiently and safely. Click here to read Dr. Tenenbaum’s article on combining breast surgery and abdominoplasty, or here to view a television clip from KMOV of an actual patient who underwent the mommy makeover procedure including breast augmentation with Dr. Myckatyn.
Anesthesia: A breast augmentation is usually performed with the patient under general anesthesia.
Length of procedure: 45 to 60 minutes.
Estimated recovery time: You can return to work after 3 to 5 days and should avoid vigorous activities for 3 weeks. Visible bruising should clear up within 1 week and swelling begins to resolve within 3 weeks. To learn how to prepare for a breast augmentation and what to expect afterwards, click here to download our patient instructions.
Side effects: Common side effects include bruising and swelling. Click here to download a detailed consent form from the American Society of Plastic Surgeons that lists the risks and benefits of breast augmentation with saline implants or breast augmentation with silicone gel implants .
Before-and-after photos: Click here to view photos of breast augmentation.