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Breast Augmentation

Breast augmentation means using a saline or silicone implant to increase the size, volume, and contours of the breast, while providing cleavage. Other terms we use to describe this surgery include augmentation mammaplasty, breast implant surgery, and BAM for short.

Many types of women present for breast augmentation. Some have been flat chested or small breasted since puberty. Many women experience deflation of their breasts as a result of childbearing and breast-feeding. Others have asymmetries, unshapely breasts, or inadequate cleavage. A good percent of women in Las Vegas, simply want large breasts and a voluptuous and curvy silhouette.

Breast augmentation with implants can improve all of these conditions. Saline or silicone implants are FDA approved for breast augmentation and we use them both. There is three companies on the market providing FDA approved implants in the United States: Mentor, Allergan, and Sientra. Dr. Brown uses all of these companies, as all products are excellent. She will help you choose the various styles, fillers (saline vs. silicone), and shape or profile that will achieve visually beautiful results for your body type, while satisfying your personal goals.

The main decision to be made first is whether you want a saline or silicone device. The silicone implants feel more natural than saline implants. It is entirely normal to feel your implant once placed. It is not a breast and you will learn your new breast self exam and feel it move under your skin. After months, it becomes part of you, and you barely give it much thought. The palpability of a breast implant is closely related to an individual’s overlying tissues; patients with thicker tissues and more natural breast tissue potentially feel the implant less than thin, flat-chested women. Implants under the chest muscles may also feel softer because of the increased amount of natural soft tissue overlying the implant.

There are several “implant pockets” that are available. Submuscular positioning is advantageous in that it provides more natural soft tissue coverage and padding overlying the breast implant. Submuscular positioning involves making a pocket for the implant right above the rib cage and under the pectoralis major muscle. This muscle is fairly high on the chest wall, originating mostly from the sternum and inserting on to the shoulder. Because the submuscular implant fills the breast by a ‘push-forward’ type of fill, the best candidates for this surgical approach have breast positions somewhat high on their chest, and not very saggy. If you can support a pencil or pen under the fold of your breast, the tissue below the fold is considered low and saggy, and may not be filled out by a submuscular implant, where the bottom limit of the pocket dimension is the inferior breast fold. Tissues below the fold rather can be pushed forward and want to sag above and beyond the deeper submuscular implant. Based on pectoralis major muscle anatomy, there is always a portion of the implant not covered by muscle, located in the inferior and outer aspect of the breast. In patients who have very mild sagging or lowness of the breast, or alternatively, a high pectoralis major position, you hear the term ‘dual-plane’ implant positioning, which means that a portion of the implant is not covered by the muscle. It can range from one half to one third or so of the lower breast implant not being covered by muscle, and therefore the lower pole of the breast gland tends to be filled out more directly. Lastly, ‘over-the-muscle’ breast pockets can be utilized. This pocket is also termed subglandular (under the breast tissue) or subfascial (under the thick layer which encases the muscle). This pocket is preferred in women with thicker tissues, where muscle coverage simply is not necessary. The fuller breast tissue is filled out directly and predictably to a uniform ‘perkiness’. The implant and the breast gland act as a unit. Mild to moderately sagging breasts are best treated by an implant in this pocket, if a patient is not needing or desiring a breast lift. Patients who have thin tissues could experience increased perceptibility of their implant in this location, so in these cases a breast lift may be advised.

Las Vegas Patient Discuss Her Breast Augmentation

The Best Candidates for Breast Augmentation Surgery

  • Women who want to increase the size or improve the shape and appearance of their breasts. Women who desire closer cleavage.
  • A person with breast asymmetry or congenital deformity of the chest, such as tubular breast deformities or pointy shaped breasts.
  • Women with decreased breast size and loss of fullness after child bearing also called post-partum sub involution of breast tissue, a normal phenomenon after having children.
  • Women with a mild degree of sagging and thick tissue pinching at least 2 cm thick.

Surgical Goal:

  • Larger, well-contoured breasts of equal size. I strive for naturalness, pleasing shape and fullness (cleavage), and long-lasting stability in appearance.
  • Breast implants make you a larger version of yourself. They do not lift a sagging breast or change nipple position.
  • All individuals have a degree of asymmetry in breast appearance. Your preexisting subtle asymmetries will persist after breast augmentation.
  • Every size looks different in every patient. It depends on the patient’s frame, shoulder and chest width, thickness of breast tissue, and skin tone.
  • Bra cup size cannot be guaranteed, as there is no standardization of bra sizes, and all bras fit differently.

Procedure Description:

  • The surgery is done as an outpatient under general anesthesia.
  • Incision site is chosen based on patient anatomy and preference, with a direct approach to the pocket preferred by utilizing an inframammary (under the breast) or periareolar (around the nipple) approach. The scars are typically 3 cm in length for saline implants and slightly longer for silicone implants, but fade nicely and are relatively inconspicuous.
  • A breast implant is then inserted under the breast tissue itself or under the chest muscle (pectoralis major muscle). Submuscular placement is recommended in non-sagging breasts. The muscle provides more natural soft tissue coverage over implants in thin or small-breasted patients, so that the implants look and feel more natural, stay softer, and facilitate breast self-exam and mammography. Patients with fuller or mildly sagging breasts may get better contours with over the muscle placement.
  • Silicone, high strength firm cohesive silicone implants, or saline implants can be used. Silicone implants feel softer and more natural than saline implants. Patients who are thinner, smaller, with less breast tissue, or patients with implants over the muscle do feel the implant more, and may benefit from silicone implants. You must be 22 years old to receive silicone implants. Placement of silicone implants requires a slightly longer scar and they are slightly more expensive than saline implants.
  • Implant style can vary as well. Moderate profile implants are standard and may provide the most natural look. Higher profile implants are designed narrower with more outward projection, providing a slightly rounder appearance. Higher profile implants work well for women with smaller or narrow frames desiring larger cup sizes than their frame would otherwise allow. Round implants are preferred, as they look natural in all body positions, and rotational issues within the pocket are not problematic.
  • Implant size is determined by both by patient cup size desires and the width of the their breast. The wider you are, the bigger the dimensional space, and the larger you may need to go to fill the periphery of the breast. Central and upper pole fullness is desired in Las Vegas, so it is important to get the dimensions of the breast implant consistent with the measurements of your breast. Most patients are not familiar with CC’s and you don’t need to be. Trust your doctor’s judgment, we size patients all day and every day. 5cc is a teaspoon, so if you put say 5 teaspoons or 25 cc in a cereal bowl, you can visualize how small differences in implant size end up being quite irrelevant in the overall breast appearance and size. It is not about a number here. It is about a beautiful shape, cleavage and size that enhances your figure. Saline implants are meant to be overfilled and have a range of appropriate fill volume; only final fill volumes are listed in the before and after pictures. It is true that most women wish they had gone bigger, so keep that in the back of your mind.

After Surgery:

  • I send all my patients home with a surgical bra that I provide. As soon as 24 hours after surgery, patients are welcome to change into a shapely underwire bra that I specify, which is worn day and night for 6-8 weeks. The underwire stabilizes the lower and outer breast pocket dimensions, leading to predictable implant position and central cleavage as the implants drop and settle with gravitational forces.
  • Bra support is encouraged long-term to decrease risks for sagging, which naturally occur. The larger you go, the more potential gravitational effect.
  • Oral pain medication and muscle relaxers are prescribed to relieve discomfort
  • Sutures are dissolvable
  • No upper body activity, heavy lifting or fitness activities for 3-4 weeks
  • The implants soften, settle, and drop starting at 2 month, but the time frame can be quite variable, depending on an individual’s tissue tightness and skin tone. Mild appearance changes can occur for 6 months after surgery as a result of gravitational forces
  • Most patients take 1-2 weeks off work
  • Exercise is allowed gradually and as tolerated in 4 weeks.

Other ideas for optimal breast contouring:

  • A breast lift (mastopexy) is used to treat sagging breasts. In this situation, an implant is placed simultaneously underneath the muscle, as the breast gland and tissue have been brought to a higher location with a nipple that is smaller if desired, centrally placed and pointing straight ahead instead of to the floor. The muscle protects the implant under the healing incisions.
  • Liposuction, tummy-tucks, or other surgery may be done concurrently in healthy individuals. It is very common to perform all truncal surgeries in one setting. For example, breast surgery with tummy tuck and liposuction. In this situation, it is one 2-week recovery, important for busy moms or busy jobs. Also termed “Mommy Makeover”, one of our specialties.

Breast implants do not treat sagging per se. They improve breast shape, size, and contour. Breast lift surgery treats sagging, and is often combined with implants. Dr. Brown will advise you on what you are a candidate for, providing you with a straightforward and logical explanation for why a particular choice may be recommended. Alternatives and other options will always be considered. We understand that it gets confusing for mildly sagging patients in particular, where there can be various recommendations given for surgical treatment and pocket site choice. There certainly is an artistic element of plastic surgery, combined with a surgeon’s technical skills and training which can affect surgical plan. The key is to admire a surgeon’s results and aesthetic sense, while logically following your intuition. Surgical plans are logically based, and need to make sense.

Las Vegas and Henderson based surgeon, Dr. Hayley Brown will discuss some of the other decisions involved in planning your breast enlargement procedure, including implant sizing, styles, and incision location, during the consultation. In some cases, women may need to combine a breast lift with their breast augmentation procedure to deliver the best result. Dr. Brown has performed thousands of breast augmentation surgeries and her experience is vast. She is also highly skilled at treating breast implant remove and replacement surgeries.

If you’re like most women, safety and recovery following surgery are big concerns for you. Dr. Brown together with her staff at Desert Hills Plastic Surgery Center work to make each patient feel comfortable and educated about all aspects of breast surgery. Dr. Brown understands and respects that scheduling breast enhancement surgery in is a major decision. A safe procedure starts with a skilled Board Certified Plastic Surgeon.