Breast Augmentation: Making the Right Choice

Dr. Don Revis

by Dr. Don Revis | August 10, 2010 @ 03:00PM

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Augmentation mammoplasty, commonly known as breast augmentation, is a surgical procedure to enhance the size of a woman's breasts. There are many reasons a woman may pursue breast augmentation:

  • She may wish her breasts were larger
  • She may feel that her upper body is out of proportion to her lower body
  • She may have breasts of different sizes
  • She may have lost some of her natural breast volume as a result of pregnancy and breast feeding

Breast augmentation is among the plastic surgery procedures with the highest patient satisfaction ratings. Many women experience an immediate improvement in their self-esteem and discover a greater self-confidence. In addition, many women find greater access to different clothing styles and fashions.

If you think you might be a good candidate for breast augmentation, this article will provide you with a basic understanding of the issues involved. However, it is extremely important to individualize treatment to your specific circumstances and goals; therefore, it is recommended that you visit a board certified plastic surgeon for a personal consultation.

The Consultation

During your initial consultation, the plastic surgeon will inquire about your medical history, prior procedures, medications, allergies, and your motivations for seeking plastic surgery. It is very important that you be thorough when providing your medical history, as this information helps to prevent complications during your care. When asked about medications, be sure to include any vitamins or herbal preparations, as these can affect your blood pressure and clotting ability. Honesty regarding your use of tobacco and alcohol is also very important, as these may have a profound impact on your recovery period and your ability to heal following your procedure.

After reviewing your medical history, your physician should discuss your concerns, priorities, and motivations for pursuing plastic surgery, as well as your fears. After examining you, he or she will be able to offer advice and options to help you achieve the appearance you desire. He or she should also explain the advantages and disadvantages of the different options you have before you. You may be shown the different types of breast implants, and you may have the opportunity to "try on" different sized breast implants with a soft surgical bra. This will enable you to visualize how you will appear following your surgery and will assist you in selecting the proper size of implants to meet your expectations.

At the completion of your consultation, you will likely be given a written estimate of the cost of your procedure. At this time, you will also have the option to schedule your procedure if you so choose. The decision to undergo a procedure is a very important one, and the final decision should be given very careful consideration. At no time should you feel pressured to make a decision. You are also encouraged to bring your spouse, significant other, a family member, or friend to your consultation.

Breast implants come in many different types, may be placed through different incisions and in different locations. This can be quite confusing, and the following information is to help you understand the various issues involved in making your decision.

Types of Implants- Silicone Gel vs. Saline Filled Implants

There are two basic types of implants, silicone gel and saline filled. ALL implants consist of a silicone shell. Silicone gel implants are filled with liquid silicone. The FDA has restricted the use of silicone gel implants to only a select group of plastic surgeons and only certain patients. If you are interested in having silicone gel implants, be sure to ask if you might be eligible to participate in one of the approved protocols. To date, there have been numerous studies in the medical field demonstrating no link between silicone gel implants and any type of disease.

Saline filled implants consist of an outer shell of silicone that is filled with saline, or salt water. Most breast implants used for breast augmentation are of this type. In addition, there is a new type of saline implant called a "high profile" saline implant. It is designed to give better breast projection and volume because more of its volume is used in establishing projection rather than increasing the width of the implant. Please ask your plastic surgeon for further information regarding which implant might be right for your individual needs.

New High Profile Saline Implants Now Available

In our efforts to continually improve the products offered to our patients, we are now able to offer a new saline filled breast implant. The high profile implant, produced by the Mentor Corporation, provides yet another option for those women considering breast augmentation to enhance their appearance. The new implants allow a higher volume to be achieved with a smaller diameter implant. Depending on the shape of your chest, you may be a candidate for these new implants and may achieve an improved shape and more natural appearance.

Types of Implants- Smooth vs. Textured Surfaces

Breast implants may have a smooth or rough, textured surface. The textured implants were produced in the hopes that they would decrease the incidence of the patient forming a scar around the implant, also known as a capsular contracture. This does appear to be the case, but only when the implant is placed beneath the breast tissue but above the muscle of the chest wall (see Implant Placement Options, below).

Textured implants are not without their disadvantages, however. The texturing process makes the shell slightly thicker, which translates into an implant that might be more visible through the skin of the breast or might be more easily felt when the breast is touched.

Because of these disadvantages, most breast implants used today are of the smooth variety.

Types of Implants- Round vs. Anatomical Shaped

Most breast implants used today are round. There are also implants that are teardrop shaped, called anatomical implants. These are in an attempt to better simulate the shape of the natural breast. In certain cases, these may be recommended, but ALL anatomical implants are textured, with the accompanying disadvantages of textured implants.

Incision Placement

The incision for breast augmentation may be placed underneath the breast, around the areola (the pigmented skin surrounding the nipple), in the armpit, or in the belly button. Not all plastic surgeons perform all of these approaches because it may not have been a part of their training. If you have a specific preference with regard to incision placement, make sure your plastic surgeon is experienced with that approach.

Implant Placement- Subglandular vs. Submuscular

Breast implants may be placed beneath the tissue of the breast (subglandular) or the muscle of the chest wall (submuscular). The decision is a very individual one, and it is determined by the natural shape of your breasts and chest wall muscles. Whenever possible, I prefer to place the implants in a submuscular position. This is for two main reasons. First, mammography is easier when the breast implant is separated from the breast tissue by the additional layer of muscle. Secondly, there is a lower incidence of capsular contracture when the implants are placed beneath the muscle. Capsular contracture occurs when the body produces scar tissue around the implant. This may change the shape of the implant and make the breasts asymmetric.

Hopefully the above information has helped to clarify some of the issues surrounding breast augmentation. The following information will help prepare you for your procedure.

Where Your Procedure Will Be Performed

Sometimes you have a choice in the location of your surgery, whether in a hospital, ambulatory surgery center, or office surgery setting. Some surgeons prefer to perform the majority of their procedures in their own office surgery suites as a convenience to themselves and to save money. Others prefer to do only minor procedures in the office and perform more major operations in a local hospital or ambulatory surgery center.

Any physician, regardless of his or her training, can open an office surgery suite and advertise as a plastic surgeon and perform plastic surgery on the unsuspecting public. Regulation of office surgery settings is currently voluntary and often substandard. New laws are being passed in an attempt to correct this potential problem. If you decide to have your surgery in an office surgery suite, choosing a physician who is board certified by the American Board of Plastic Surgery, who also has hospital privileges to perform the same procedure, and whose surgery suite is accredited adds an additional level of quality assurance.

To obtain hospital privileges to perform a procedure, surgeons must provide proof of education, training, and experience. This provides an added level of assurance that the surgeon has been properly educated and trained. Avoid a surgeon who operates in his or her office but does not have hospital privileges to perform the same operation.

Type(s) of Anesthesia

Anesthesia is an essential part of any surgical procedure and must be performed safely. General anesthesia is the deepest form of anesthesia. You are asleep, feel no pain, and will not remember the procedure.

Deep intravenous sedation, called "twilight sleep," is a combination of local anesthetic administered at the surgical site by your plastic surgeon and intravenous sedation administered by the anesthesiologist. You breathe for yourself, but you are in a deep sleep throughout the procedure. You should feel no pain, and you should not remember the procedure.

Your plastic surgeon should discuss these options with you more thoroughly at the time of your consultation, and please ask about anything you do not understand.

Details of the Procedure

Breast augmentation usually takes one to one and a half hours to perform. After you are properly anesthetized, incisions are made for placement of the implants. A pocket is then created by gently dissecting the tissues beneath the breasts. Once the pockets have been created, the breast implants are inserted and filled with saline. (Silicone gel implants come pre-filled and do not require filling in the operating room).

Afterwards, the incisions are carefully closed to minimize your scar. A sterile dressing is applied to the incisions, and a soft surgical bra is placed over your breasts.

After Your Procedure

Breast augmentation is performed as an outpatient procedure. After recovering in the recovery room for approximately one hour, you will be able to go home in the company of a friend or family member.

You should plan to take it easy following your surgery. No strenuous activities, heavy lifting (over 20 pounds), aerobic exercises, swimming, contact sports, tennis, or golf should be planned for the first several weeks. As your plastic surgeon monitors your recovery, he or she will advise you when it is safe to resume specific activities.

The Results You Can Expect

You will notice an improvement in your breast shape and size immediately. You may experience soreness in your chest, but this rapidly disappears. A very mild swelling usually takes several weeks to subside. You should be able to resume your normal daily activities the day after surgery, and you should be able to resume all of your physical activities within two weeks of surgery.

This article provided by Dr. Don Revis.

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