Breast augmentation is one of the most common plastic surgical procedures performed for women. This is because excellent results can be achieved predictably and safely. Breast enhancement can give women with small or unevenly sized breasts a fuller, better-proportioned look through the placement of breast implants. Women may elect to undergo breast augmentation for many different medical and aesthetic reasons, including balancing breast size and compensating for reduced breast mass after pregnancy, weight loss or surgery.
The procedure may be combined with other breast procedures such as a lift for more aesthetic results if the breast skin is very loose.
Questions to Ask
When considering breast enhancement, there are 3 general questions that need to be answered. Where are the incisions? Where are the implants placed? What implants are available and appropriate for you?
The incisions can be placed in the periareolar (lower areola border), inframammary (in the fold), axillary (under arm) or the umbilical (belly button) area. Each technique has advantages and disadvantages as well as an ideal breast type. Although augmentation can be performed with incisions under the arm or in the belly button, I have greater control and precision when I approach the breast from the periareolar or inframammary incisions. With accurate closure the periareolar and inframammary incisions can be almost imperceptible.
The incisions allow implants to be placed in one of three positions; subglandular (under the breast), subpectoral (under the muscle) or partially under the breast and muscle. Implants under the breast have a higher incidence of developing capsular contracture then when placed under the muscle. Complete submuscular placement can limit expression of an implant leaving a breast that looks like an implant. The dual plane placement which is partially under both the muscle and breast gives a natural look to the breast with all the advantages of being under the muscle. This technique divides the chest muscle low on the chest wall so that 50-75% of the implant is covered by muscle. This makes for a more natural upper pole of the breast and a soft rounded lower pole simulating the natural shape of the breast.
The implants available are silicone shells filled with saline (salt water) or silicone gel. The implants can be tear drop shaped or round smooth. Shaped implants must be textured to prevent them from moving in the breast pocket. I prefer the round smooth implants with the dual plane technique for the majority of woman. Round smooth implants also have the added choice of 3 profiles. The implants have names like moderate, midrange, moderate plus and high profile. Generally speaking as the projection or profile increases, visibility of the implant in the upper pole does too. Understanding your goals and desired appearance is a crucial part of the consultation process since the aesthetic choices available to you are numerous. The dimensions of your chest dictate an ideal implant volume range for you. The profiles create the volume range and the aesthetics to choose from.
The procedure lasts one and a half to two and a half hours and is typically performed with general anesthesia. I place local anesthesia into the breast at the time of surgery to minimize the discomfort on awakening.