Breast augmentation is the enhancement and enlargement of the breasts with implants. The implants are either round or tear-drop shaped, and consist of a silicone envelope filled with either sterile saline (salt water) or silicone gel. The implants are placed either under the chest muscle (pectoralis), or between the muscle and the breast tissue. Implants can be either textured (rough surfaced), or smooth.
The most common surgery is using smooth, round implants in the submuscular position. I will provide a complete explanation of all options during your consultation. The size of the implants is best chosen by taking measurements of your breast diameter, and picking the implants from this measurement. I use many computer photographs of my previous patients to demonstrate the different breast sizes (cups A,B,C,D) before and after surgery. I also will show you with patient pictures, the difference between the round and tear-drop implant, and the difference between above or below the muscle implant placement.
In the photograph, the distance A to B is the breast diameter. If you choose an implant significantly less than this measurement, you will go up one cup size (from an A cup to a B cup in this patient). If you select an implant that is the same as the breast diameter, this will make you go up two cup sizes (from an A cup to a C cup in this patient). An implant wider than the breast diameter will result in a D cup.
This patient chose a 270 cc saline-filled smooth implant under her muscle (incision at the areola) which measured less than her breast diameter, and her final result is a B cup. I find this measuring to be a much more accurate way to select implants, as compared to wearing the implant in a bra, which always appears larger than when it is surgically placed under the breast and muscle. Wearing an implant in a bra could cause you to think the right implant is too large, and you might then select an implant that is too small.
My second patient demonstrates the effect of selecting an implant which is the same width as her breast diameter. She chose a 390 cc saline-filled implant (incision at the areola), which increased her bra size two cups, to a full C cup. This implant is wider, and gives her more fullness and cleavage, without being too large for her frame. A D cup could be created by using an implant wider than her breast diameter.
Incision sites can be either through the bottom of the areola, the crease of the breast, or the armpit. The incisions are short (~1 inch), and fade well with time. The "belly-button" approach is not used by most plastic surgeons because of the increased likelihood of implant malposition, the "blind" nature of the procedure, and the possible trauma to the implant as it is passed through a metal tube.
I place all implants "visually", that is, I always see the entire pocket where the implant will reside. If the incision is in the armpit, I use an endoscope that projects an image of the pocket onto a computer screen. If the incision is along the areola, or in the crease of the breast, I use a specially adapted lighted retractor to completely see the pocket. Why is this important? Because this allows more exact formation of the pocket, more exact positioning of the implants, and I can make sure that there is absolutely no bleeding. Many plastic surgeons believe that bleeding, even a small amount, can contribute to the occurrence of capsular contracture, or tightening around the breast implant.
Silicone-gel implants are very popular. There are some definite advantages and disadvantages to these implants when compared to saline-filled implants. In general, silicone gel implants feel softer, more "natural", and may have less wrinkling. The less breast tissue you have to start with, the more you will feel the difference between silicone and saline implants. However, silicone gel implants may require more follow-up in the future (MRI scans are recommended every 2 years to evaluate the implants), and will need a longer scar for placement. The choice between saline and silicone is influenced by your anatomy and your desires. I will explain this during your consultation.
Surgery: Breast augmentation requires general anesthesia, takes appx. 1 1/2 to 2 hours, and you go home that day. Before the surgery is over, but while you are still asleep, I like to administer a local anesthetic around the pocket where the implant sits. This will drastically reduce the pain that patients may experience. This medicine also precludes the need for a “pain pump”. If drains or pain pumps are used, this may increase your chance of bacteria entering the site and contaminating the implant and could possibly increase your risk for capsular contracture.
The incisions are all closed with dissolvable stitches, under your skin, so there are no stitch marks or stitches that need to be removed, and the scar usually fades nicely. A dressing is then wrapped around your chest, and no drains or tubes are used.
Healing time: Walking is started immediately, limited exercise at 1 week, but no heavy lifting or upper body exercise for 2 weeks. Most people take 5-7 days off from work. Soreness of the chest, especially when trying to sleep, may last for 4-6 weeks. Breasts continue to soften for 6 months.
Pain level: Most people take pain pills for 2-4 days, then switch to Tylenol®. Rank=6-8 Pain information
Risks: You will get a scar along the incision site (either areola, crease of breast, or armpit), but this fades well, especially if it is placed where the color changes on the breast (areola). Numbness may be persistent, but lessens with time. Initially, there is a low risk of bleeding or implant malposition which could require return to the operating room. Infection is extremely rare. The most important risk is that of capsular contracture, or firmness around the implant. Other risks.Risk information
Costs: $6,500 to $7,000 for saline implants, $7,000 to $7,500 for silicone gel implants. Cost information