Breast Augmentation

Breast implants are performed to enlarge small breasts, underdeveloped breasts, or breasts that have decreased in size after childbearing. We will help you determine the most effective surgical approach following a thorough examination of your breasts. They will discuss with you the various alternatives of anesthesia available for your case, they will describe the surgical procedure, what results as expected, and the possible risks and complications.

Screening for Breast cancer using mammography and other tests such as ultrasound or MRI are required prior to surgery. Preoperative instructions include the discontinuation of certain drugs in order to decrease the possibilities of bleeding. Prophylactic antibiotics are routinely prescribed to prevent postoperative infection. Breast implant surgery does not generally interfere with the ability to breast feed.

Site of Incision

The options for site of incision are underneath your breasts (inframammary), around the nipple (periareolar), in the armpit (transaxillary) or through the belly button (TUBA or trans-umbilical breast augmentation). All these approaches have advantages and disadvantages.Diagram of breast augmentation incision sites

The incision around the nipple can lead to numbness, and can be quite visible because it is the focal point of the breast, it may also result in difficulties with breastfeeding.

The inframammary incision under the breast is placed within or near the crease beneath the breast, the scar is usually hidden under the breast. This incision can sometimes become lumpy and could become very visible.

When the incision is placed through the belly button (TUBA), the incision is hidden inside the belly button. The technique requires an experienced surgeon in order to avoid breast implant rupture during placement, undercorrection of certain breast asymmetries, incomplete control of shape, and bleeding. When properly performed, it is an excellent scarless alternative to the other type of incisions.

The transaxillary approach is extremely popular with many patients because the incisions can be made smaller and they are almost invisible (they are hidden in the skin crease in the top of the armpit.)

The Endoscopic Transaxillary Augmentation Approach

The standard placement of breast implants, regardless of the incision site, is essentially a blind operation that makes intraoperative visualization of the surgical area difficult for purposes of dissection of tissue planes, for the accurate division of muscle fibers, and the control of bleeding. The use of illuminated surgical retractors has offered only a partial visualization solution

The introduction of the endoscope has substantially improved the accuracy and predictability of breast enlargement with breast implant surgery. The addition of the endoscope has been is a major breakthrough in the area of cosmetic surgery including breast augmentation.

The ideal incision site to perform breast endoscopic augmentation is the armpit. The endoscopic transaxillary augmentation allows the cosmetic surgeon to create crease symmetry, muscle division, implant positioning and bleeding control under total endoscopic visualization with great control and ease.

The performance of a safe and effective endoscopic transaxillary augmentation procedure requires expertise with the use of the endoscope.

Although we consider the armpit the best approach for the endoscopic breast augmentation, at a patient’s request, they are also able to perform the endoscopic surgery using the inframammary and the belly button incisions.

Implant position (Above or Below the Muscle)

breast_aug_diagram2_sm

Above the Muscle (Subglandular Implant)

The breast implant is placed over the pectoralis muscle and below the breast tissue

Advantages

  • Less postoperative discomfort and swelling
  • Lower chance that the breast will appear to move when the patient exercises the upper body

Disadvantages:

  • Greater risk of visible rippling appearance of the breast
  • Worst cosmetic results are seen in women with small breasts

Beneath the Muscle (Subpectoral Implant)

The breast implant is placed under the pectoralis muscle.

Advantages:

  • Less interference with a mammogram
  • Less rippling appearance in the upper half of the breasts
  • More cushion between the implant and the skin
  • Ideal for thin and small-breasted women

Disadvantages:

  • Not well suitable for large breasted women
  • Worse cosmetic result are seen in athletic women

Implant Shape: Round or Teardrop

Round implants are shaped like jelly donuts. They are not affected by rotation and cost less than teardrop implants. There are no disadvantages to round implants. It is favored by most cosmetic breast surgeons. Teardrop implants are shaped more like the breast. The teardrop implant may rotate, creating a distorted breast shape. It also requires a textured surface to prevent rotation.

Implant Surface: Smooth or Textured

Textured implants are rough, similar to sandpaper. They were developed to decrease the risk of capsular contracture. However, studies have not shown a consistent advantage over smooth implants regarding capsular contracture. They have an increased risk of rippling, have a higher deflation rate and are firmer than smooth implants. They are also more expensive. Most breast cosmetic surgeons favor smooth implants.

Implant size and volume

Breast implants are available in various sizes ranging from 200 – 600 ml. The range 300 – 450 ml is the most common. Choosing your desired size can be a difficult decision – it is highly personal.

You can determine the size you want by placing breast implant sizers in your bra and then putting on a sweater, blouse or a t-shirt. You’ll want to decide your cup size and that will determine how large your implant will be. A 400 ml implant placed in a woman with an A cup will produce a C cup. The same implant placed in a woman with a B cup will produce a D cup. Bring the pictures of your desired size (take a look at a lingerie catalog or swimsuit pictures) to your consultation. Take the time to decide what you will be happy with so you don’t feel the need to undergo a second surgery.

Each saline implant must be overfilled by an additional 25-30 ml. This technique decreases the risk of deflation, rippling, and sloshing. There are no disadvantages to overfilling. Implants are meant to be overfilled, and the implant manufacturers recommend surgeons to overfill them.

Saline vs. Silicone Gel Implant

The FDA has recently approved silicone gel breast implants for use in primary breast augmentation for any woman over the age of 22. The main disadvantages include a possible higher rate of capsular contracture, the incision to place the implant is larger than the one needed for placement of a saline implant, and the cost is substantially higher then saline breast implants. On the other hand, they provide the most natural look and feel ideally suited for women with a modest amount of breast volume.

Breast implant projection (Standard vs High Profile)

With a high profile implant, the liquid volume is the same as a standard implant but its diameter (footprint) is narrower and the projection (the amount it protrudes out and away from your body) is greater.

Most women are better candidates for standard implants. If the diameter of the implant size (standard implant) you selected is about the same as, or smaller than, your measured breast diameter, then a standard implant is your best choice. If the diameter of the desired breast implant size is larger than your breast diameter, then a high profile breast implant is best.

Frequently Asked Questions

  • What are the limitations of breast enlargement with implants?
  • What are the possible risks and complications of breast enlargement with implants?
  • What are the patient instructions after breast implant surgery?
  • What kind of anesthesia is used?
  • Explain breast augmentation with fat injections (microfat grafting).
  • What are the advantages of breast augmentation by fat transfer versus breast implants?

Q. What are the limitations of breast enlargement with implants?

A. Breast augmentation with implants will not improve nipple asymmetry, move your breasts closer together, lift droopy breasts, or remove stretch marks. Also, breast implants are not completely free of problems.

Q. What are the possible risks and complications of breast enlargement with implants?

A. Anesthesia reaction, asymmetry, bleeding, breast droop, capsular contracture (hardening of scar tissue around implant), deflation (approximately 7%), displacement, hematoma (pooling of clotted blood, risk is 3-4%), implant leak, infection (risk is less then 1% and always involves removal of the implant), interference with mammography, keloid (heavy scar), nerve damage, nipple numbness, pain, permanent numbness (risk is 15%), reactions to medications, rippling, rupture of the implant (often due to injury), seroma (pooling of watery blood), skin irregularities, sloshing, slow healing, swelling, symmastia (breasts merge into one mass), and visible scars.

Q. What are the patient instructions after breast implant surgery?

A.

Above the muscle Below the Muscle
Pain Level Mild to moderate discomfort; 1-2
weeks of pain medication
Moderate discomfort; 1-2 weeks of pain medication
Swelling 4 days to 2 weeks 2 to 12 weeks
Bruising Up to 2 weeks Up to 2 weeks
Numbness 1 to 2 weeks Up to 2 weeks
Work Return to work in 1 week Return to work in 1 to 2 weeks. If job is strenuous or requires lifting, wait 1 month
Exercise Wait 2 to 4 weeks Wait 2 to 4 weeks
Final Result 1 month 4 months

On the day of surgery you will feel sleepy and may feel pain or be nauseated. Your chest may feel tight and uncomfortable. Your arms and back may also be sore. Pain medication will be prescribed to minimize your discomfort.

After surgery your breasts will be very firm, high, and swollen. After about a month, the swelling will be gone and they will be lower, smaller, and softer. It may take several months for the implants to settle into a permanent position.

Q. What kind of anesthesia is used?

A. We perform the majority of the breast implant procedures, including the endoscopic transaxillary approach, totally under local anesthesia using a modified tumescent technique.

If the patient requests general anesthesia or breast augmentation under sedation anesthesia, the surgery is performed at Bayonne Medical Center Same Day Surgery Cosmetic Suite. The actual surgical procedure takes 1-1½ hours. However, you will be in the operating room a little longer. In most cases, patients are allowed to go home 2-3 hours following surgery.

Q. Explain breast augmentation with fat injections (microfat grafting).

A. Patients who desire breast augmentation but are wary of implants are candidates for breast enlargement using their own fat. We transfer the fat to the breast utilizing the microfat grafting technique.

We remove the fat from selected areas of the body, purified the fat, then re-inject the donor fat cells into the breasts. The process of fat injection involves scores or hundreds of injections with very tiny syringes
into the breasts.

The procedure is designed to fill the breasts so that they appear lifted and perky. The fat is injected into different areas of the breast and at various depths so that the patient will get the highest permanent absorption rate. Surgeon experience with the technique is important to achieve a uniform, smooth, normal appearance on the breasts.

Q. What are the advantages of breast augmentation by fat transfer versus breast implants?

  • Less expensive
  • Minimally invasive with less trauma to the breast
  • No visible scars
  • Can be done as an office procedure totally under local anesthesia
  • Avoids tissue or foreign material (implants) rejection because the fat is an autologous graft
  • Fewer postoperative complications
  • Touch up procedures are easily performed
  • Fat transfer does not make the performance on a future breast implant placement more difficult

In the past breast augmentation using fat injections was frowned upon by breast surgeons because of the pressure of fat necrosis (a frequent benign breast tissue change resulting from the fat transfer) would interfere with breast cancer detection. But MRI technology changed that because the MRI can determine the difference between fat necrosis and cancerous tissue.