Doctor, what can you tell me about breast augmentation?
Breast augmentation is among the top procedures performed by cosmetic surgeons nationally. Patients request this procedure for multiple reasons. Some have never developed natural breast tissue of the size or the shape that is proportional to their body type. In others, contributing events such as pregnancy, breastfeeding or even weight loss have caused their breasts to flatten or droop. Even cases of asymmetry, where there is noticeable unevenness in breast size or shape, can be helped with breast augmentation.
The procedure can be simplified in a few surgical steps. However, it requires special planning, as each patient is built differently and has unique desires in what shape and size they find appealing. Therefore, there are many questions that need to be asked and discussed with your surgeon to help ensure that you are happy with your results.
Implants can be placed through several incision sites, including the inframammary (fold below the breast), peri-areolar (at the border of the areola), the axilla (armpit) or the umbilicus (belly button). I perform all of these approaches and choose the most appropriate option based on my patients’ choice and their anatomy.
Although I perform about 80 percent of the saline implants through the belly button, there are times when combining a breast lift with augmentation makes other incision sites more desirable. Silicone implants are primarily placed through an inframammary or peri-areolar incision.
In my opinion there are many advantages to the belly button approach in the appropriate candidate. The procedure is virtually scarless. Only one incision is needed, and it is well hidden deep in the depth of the belly button. Additionally, there is minimal sharp cutting involved, which lessens the risk of bleeding and numbness to the nipple. The procedure is not routinely performed by many surgeons, as there is a steep learning curve, but when mastered it offers a great alternative to the traditional ways.
Both saline and silicone implants are made of a silicone shell. The saline implants are inflated after placement with saline (saltwater), and the silicone implants come pre-filled with silicone gel.
Which is better really depends on your desires, priorities and your natural breast anatomy. The main advantage of silicone implants is their natural feel and smaller likelihood of visible rippling secondary to the foldings in the implant shell. The disadvantages include the need for a longer incision and difficulty in evaluating possible leakage. It is now recommended for patients with silicone implants to have an imaging study called an MRI to check for possible deflation of the implant. Additionally, there is an extra cost placed by the manufacturer for these implants.
The new FDA-approved silicone implants are of the cohesive gel technology, of similar consistency to a very soft gummy bear candy. This allows the implant to maintain its shape and for the silicone gel to be confined to the proximity of the implant in case of a leak.
The majority of breast implants are placed under the pectoralis major muscle. Placing an implant below the chest muscle can offer added padding to the implant on the top and toward the middle of the chest. This added benefit can vary depending on the shape and the level of drooping of the breast. It may also make the mammogram a bit easier to evaluate. That being said, there are times that placing an implant above the muscle is preferable. This decision should be made after an examination during your consultation.
There is absolutely no evidence that breast implants cause breast cancer. There are reports that at times implants may even make the self breast exam easier by providing a platform to feel any potentially worrisome areas. We recommend a routine screening mammogram before surgery for all patients and require it for those over 35 years old.
Breast augmentation is a popular procedure with a significantly high satisfaction rate among patients. The added level of confidence, femininity and proportionality that this procedure offers cannot be simplified as just having larger breasts. As with any other procedure, I encourage patients to come in for a complimentary consultation to evaluate their options and review some of the before and after photos, and together we make the best choice. All of our surgeries are performed at an accredited surgery center under the supervision of our full-time anesthesiologist, and my patients have access to me 24 hours a day to put their minds at ease knowing that we are always there for them.