Procedures

Breast Augmentation

Medical Term: Augmentation Mammaplasty

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 longer scar, usually underneath the breast, 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
• 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 4 weeks
• 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 6-8 weeks, but the time frame can be quite variable. Mild appearance changes can occur for 6 months after surgery as a result of gravitational forces
• Most patients take 1-2 weeks off work

Other Options:

• A breast lift (mastopexy) to treat sagging breasts. In this situation, an implant can be placed simultaneously underneath the muscle
• Liposuction, tummy-tucks, or other surgery may be done concurrently in healthy individuals

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