Breast enlargement, also referred to as breast augmentation, is one of the most popular cosmetic surgery procedures performed in the Dallas and Plano areas. As a result, many women wonder if they are a candidate for breast enlargement. There are typically three types of patients who are good candidates for this procedure:
- Women who feel that the volume of their breasts is not sufficient to create a shapely feminine physique.
- Women who have a significant asymmetry secondary to inadequate development of one breast.
- Women who have lost volume and develop ptosis or sagging after pregnancy or weight loss.
The American Society of Plastic Surgeons recommends that women wait until the age of 18 before undergoing augmentation. We concur with this limitation as this is generally the age at which a woman’s breasts have finished developing and the woman has reached a maturity level to make a decision such as this. Additionally, we would recommend women who have immediate plans for children wait until they have completed this prior to being augmented. If these plans are more in the distant future, then it is reasonable for the patient to proceed with augmentation.
Knowing your choices
TYPE OF IMPLANTS
There are many choices to be made in augmentation surgery. The first is the type of implant that the patient would like to have placed. Silicone and gel-filled implants have recently been approved by the FDA with conditions. What this means is that the FDA has asked the two manufacturers of implants, Mentor and Inamed, to provide the public with more education on these implants which they are working on at this time. Currently these implants are available to patients who had a lack of development of the breasts or who will require a breast lift in addition to augmentation. Silicone gel-filled implants are the preference of a large majority of plastic surgeons. This is because of the more natural feel and appearance of this type of implant. A large number of studies have been performed to evaluate the safety of silicone gel-filled implants and none have shown silicone gel-filled implants to be related to any disease process. The second choice for type of implant is a saline filled implant. Saline implants are a reasonable choice for breast augmentation, however, they do not have as natural a feel and appearances as silicone gel-filled implants do. More can be learned about each of these two types of implants at a site created by the American Society of Plastic Surgery www.breastimplantsafety.org.
POSITION OF THE IMPLANTS
The next decision a woman undergoing breast enlargement must make is the decision of what position she would like the implant placed. There are two basic positions in which an implant may be placed. The first is submuscular, meaning behind the pectoralis or chest wall muscle. The advantage of this position is that it helps “hide” the implant creating a more natural feel and appearance. This is especially important in women who will have a saline implant placed, which at this time is the only type of implant available for women who are undergoing a breast augmentation for a simple increase in volume. The second advantage to this position is that it decreases the rate of capsular contracture or scar tissue that forms around the implant. The second choice for position is submammary which means behind the breast tissue but on top of the pectoralis or chest wall muscle. Typically when choosing this position a patient needs to have an adequate volume of breast tissue to begin with to help “hide” the implant. Typically patients choose this position when they want to create a more unnatural, obviously augmented look to the breast.
TYPE OF INCISION
The final decision that a patient must make for their breast augmentation procedure is the type of incision to be made for placement of the implant. The most traditional type of incision made is one on the lower aspect of the breast. The advantages of this incision are that it is well hidden in the fold of the breast, it provides the surgeon with direct access to the area in which he will be working, and finally it provides the surgeon with the ability to make adjustments to asymmetries or differences in size or shape of the breast. The next incision that is commonly used is the periareolar incision. This is an incision that is made on the inferior aspect of the areola or colored part of the nipple. This incision can be more conspicuous than the incision on the lower portion of the breast if it is not made very precisely. It too provides direct access to the area in which the physician is working and it also allows for adjustments of breast asymmetry to be made. Another reasonable incision for placement of a breast implant is the axillary or underarm incision. The patients who are candidates for this are patients with relatively symmetrical breasts with minimal or no ptosis or sagging. This incision is not as well hidden as the incisions on the breast and is sometimes noticeable when the patient is in clothing that exposes her underarm. The other disadvantage to this incision is that it does not provide the ready access for adjustments to differences in breast symmetry. The final type of incision is the periumbilical incision. This is an incision made around the navel. This incision is not a good choice for augmentation. It makes no sense to make an incision this far away from the breast when there are so many other good approaches. This too is an incision that can be exposed when the patient is in clothing that reveals her abdomen.
In determining implant size, there are many variables. The first is the size or width of the patient’s breasts. The implant that matches the patient’s breast width is typically chosen to prevent an implant that slides over into the patient’s underarm. As an implant increases in size the diameter of it increases also. Therefore this can limit the size of the implant that can be placed in some women. There is an implant available that is called a high profile implant that allows women with narrow chest walls to receive a larger implant without it increasing so much in diameter. The patients desire to have a more natural result versus a more augmented appearing result also plays a role in the determination of implant size. It is helpful for patients to bring pictures of breast size that they find desirable. They must keep in mind that this is simply a tool for the physician to determine the size that they desire and not a guarantee that their breasts will have the same appearance as the picture after the surgery.
BREAST IMPLANTS AND BREAST LIFT
Patients who have ptosis or sagging after pregnancy or weight loss may require a breast lift in addition to augmentation. Patients with ptotic or sagging breasts must realize that a large amount of what they place in a bra cup is skin. Lifting the breast will remove some of this skin which will affect the volume of the breast. The placement of an implant simultaneously at the time of a lift allows the volume that has been removed in performing the lift to be replaced and also allows for more fullness at the upper portion of the breast. Patients who undergo an augmentation in conjunction with a lift need to realize that there are limitations in the size of implant that can be placed. The reason for this is that a large implant can create difficulty closing the incisions made for the lift. As a result, patients can have problems with wound healing and worse scarring. Additionally an important consideration is that the larger the implant placed regardless of whether a mastopexy is performed or not will result in ptosis or sagging in the future because of the weight of the augmented breasts.
Patients who are longing to undergo augmentation should be well versed on the possible complications associated with placement of an implant. Patients who have plans for children in the future have the possibility of not being able to breast feed. It is difficult to place a percentage on this, because a large number of women would not have been able to breast feed regardless of whether they had undergone breast augmentation. There is some risk of a decrease in nipple sensation after breast enlargement. Breast implants can deflate or leak over time. The typical life of an implant is about ten to twelve years. Both Mentor and Inamed have lifetime warranties on their implants. They also provide funding to assist the patient in the replacement of their implants. Other possible complication of implants is the formation of a capsular contracture or scar around the implant. A patient forms some degree of scar but sometimes this scar can progress to the point that it deforms the breast or causes the patient pain. In this case the scar can be removed and the implant replaced. It is difficult to predict who this will happen to, however there has been shown to be a decrease in occurrence with placement of the implant behind the pectoralis muscle. There can sometimes be bleeding around an implant after surgery which necessitates removing the blood that collects around the implant. Also an implant can sometimes become infected as it is a foreign body. A majority of the time this requires the implant to be removed and a period of time allowed to pass prior to replacement of the implant.
BREAST CANCER SCREENING
Many patients ask how the placement of an implant affects breast cancer screening. Breast implants placed behind the muscle make it easier for an adequate physical examination of the breasts. Additional mammographic views of the breasts are performed by the radiologist to allow a greater amount of the breast tissue to be seen. Studies show that patients who have implants placed behind the muscle and who undergo yearly mammogram and physical examination by a physician have no difference in the detection of breast cancers when compared to the population who does not have implants.
Schedule an Appointment
Overall, when performed by a plastic surgeon certified by the American Board of Plastic Surgery, breast augmentation is a very safe procedure. It helps provide women with a more confident body image. Dr. Perry would be glad to answer any other questions you might have about breast augmentation. Make an appointment for a consultation today.
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