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Breast Augmentation

Technically known as augmentation mammaplasty, breast augmentation is used to enhance the size, shape and appearance of a woman’s breast.
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 upon all of these conditions. Saline or silicone implants are FDA approved for breast augmentation and we use them both. Dr. Brown will achieve visually beautiful results with either device, the silicone implants do feel more natural than saline implants. 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 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. 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

Who is a Candidate?

  • Women who want to increase the size or improve the shape and appearance of their breasts
  • A person with breast asymmetry or congenital deformity of the chest
  • Women with decreased breast size and loss of fullness after child bearing
  • Women with a mild degree of sagging

Goal of Surgery:

  • 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 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 sizes are in CCs. Think of 200cc equals about one cup size. Try not to get caught up with decisions regarding less than 50cc, as these small volumes end up being relatively insignificant in the overall appearance or size. 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

Postoperative Course:

  • The patient goes home with a sports bra in place. In 24hrs, this is changed to a shapely underwire bra, 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
  • 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 in about 8 weeks, 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 Options:

  • A breast lift (mastopexy) 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. 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.

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.

Breast augmentation Las Vegas surgeon Dr. 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 Las Vegas procedure to deliver the best result.

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.