Breast Augmentation

What is Breast Augmentation?

Breast augmentation surgery uses implants to enlarge and shape a woman’s breast.  Women choose to have breast augmentation for several reasons: Because their breasts never developed to the size they wanted, to improve the shape of underdeveloped breasts, to balance and correct breast asymmetries, and to restore breast fullness which has been lost as a result of pregnancy, nursing, aging, and/or weight loss.  For most women, having adequate breast volume and a pleasing breast shape is an important part of feeling like a normal woman, having a good self-image, being self-confident, and feeling sexually desirable.  Breast augmentation surgery can really make a tremendous difference in how woman feels about herself.

The American Society for Aesthetic Plastic Surgery (ASAPS) Cosmetic Surgery National Databank states that 333,392 breast augmentation surgeries were performed in 2017 – making it the most common cosmetic surgical procedure overall.

 

The Importance of the Consultation

The consultation is designed to understand your expectations for breast augmentation, to discuss pertinent information regarding breast implant types, to review appropriate treatment options, and to discuss the anticipated results of your procedure.  Dr. Dembny will perform a thorough examination so the surgery can be individualized for your body and your needs.  If your breasts are drooping, a breast lift procedure may be recommended to provide a better result.

 

What is the Difference Between Saline & Silicone Gel Breast Implants?

It is important for women to understanding the differences between a saline-filled and a silicone-gel-filled breast implant so they are comfortable with their decision.  The primary differences relate to the fill material, the subsequent consistency of the implant, and what happens when the implant fails.

The shell of every breast implant is made of a thin silicone elastomer.  This shell is then filled with a saline solution or silicone gel material.

Saline implants are initially empty; they are filled in the operating room with a sterile saline solution.  Each saline implant has a specified range to which it can be filled; this allows some variability in the final volume which may be helpful in compensating for some minor differences in breast volume, or just adding a small amount of extra volume.

The feel (or firmness) of a saline implant will therefore be determined by the final implant volume.  Saline implants that are filled to the minimum recommended fill volume will have a softer feel, while those that are filled to the maximum recommended fill volume will have a firmer feel.

Silicone gel implants are filled by the manufacturer, so there is no ability to change/vary volume of a specific implant.  However, there are several different types of silicone gels with varying consistencies that can be used to fill a breast implant.  The standard ‘classic’ round silicone gel implants that have been available for many years, and were approved by the FDA in November 2006, are filled with a moderately-cohesive (also called, responsive) silicone gel.  These implants are fairly soft and pliable.  The anatomically-shaped silicone gel implants, that were approved by the FDA in 2012, are filled with a highly-cohesive (also called, form-stable) silicone gel.  These breast implants have a much firmer consistency, and completely maintain their shape, because it is the silicone gel filling that actually maintains the anatomic shape of the implant.  And now for the last several years, two manufacturer’s have offered a third type of silicone gel that has a cohesivity between moderate and high.  These implants have a better ability to maintain their shape, without having complete form stability.

It is not possible to look at a breast and be able to determine whether a saline or silicone gel implant is present.  However, these two types of implants do have different consistencies.  The differences in feel will be more obvious in women who have less breast tissue and subcutaneous tissue to cover the implant.

When a saline breast implant fails – the saline solution leeks out of the implant, is absorbed by the capsule around the implant, and the breast decreases in size fairly quickly.  This deflated breast can be easily seen by standing in front of a mirror.  When a silicone gel breast implant fails – the silicone gel leeks out of the implant, is contained within the capsule around the implant but is not absorbed, so the breast does not decrease in size or look deflated.  As a result, the failure of a silicone gel breast implant is often referred to as a “silent” failure.  Since the patient or the surgeon can’t determine if a silicone gel breast implant is failed by merely looking at the breast, a MRI study must be performed to assess the integrity of the implant to determine if it has failed.  The FDA recommends that women who have silicone gel-filled breast implants obtain an MRI study 3 years after surgery, and then every 2 years after that, to monitor implant integrity.

 

The Difference Between Round and Anatomically Shaped Breast Implants

The size and shape of a breast implant should be individualized for each woman based upon her preference, body size, breast shape, and skin quality.  The degree to which breast implant size and shape contributes to the final shape of the augmented breast depends upon multiple factors that will vary for each patient.  Implant shape is often chosen by the patient in conjunction with surgeon input.

Round breast implants have a circular shape when viewed from the front.  The posterior surface is rather flat, while the anterior surface is dome shaped.  Round breast implants are the most common  and will provide an adequate shape for most individuals.  Round breast implants are available with varying projections.  This projection is referred to as ‘profile’ and is described below.

Anatomically-shaped breast implants have more of an oval shape when viewed from the front.  The profile view of this implant resembles normal breast shape with less profile in the upper part of the implant and the majority of the projection in the lower part of the implant.  Anatomically shaped implants are available in designs with varying heights and projections. Because the shape of this implant tends to resemble the shape of a normal breast it creates a more pleasing and natural augmented shape with a natural sloping upper contour and less upper pole roundness/fullness.

 

Breast Implant Profile

The implant ‘profile ‘refers to the implant projection – how far forward the implant projects.

Round implant just implants are available with the following profiles: low, moderate, moderate plus, high (full), and extra high (extra full).  For a round implant the profile refers to the projection in the central part of the implant.  Low-profile implants tended to be rather flat, and have very little projection, while high profile implants have a very curved and projecting dome shape. For a constant volume, as the implant projection increases, the implant diameter decreases.  The width of the breast implant should never exceed the width of the pocket.  Therefore, slender patients with narrow chests tend to require high profile implants, while patient’s with wider chests can accommodate moderate or low-profile implants.

Anatomically-shaped implants resemble the profile of a natural breast.  They are narrow in the upper part of the implant, and the majority of the projection is in the lower part of the implant.  For an anatomically-shaped implant the ‘profile’ refers to the amount of projection in the lower part of the implant.  Anatomically-shaped silicone gel breast implants are available with the following profiles: low, moderate, full, and extra full.

 

Where is the Incision Placed?

A woman’s preference is important in deciding where to place the incision, but primary consideration is given to having adequate control of the operation. The best location for the incision is determined by the physical attributes of the breast, the type of implants used, and whether a breast lift is required at the same operation. The two most common incision locations are the crease under the breast and the border of the areola. Less commonly used locations are the underarm and the belly button. An emphasis is always placed on making all incisions as small and inconspicuously placed as possible.

The inframammary incision is made in the skin fold beneath the breast. This incision is not visible when standing but may be visible when you are lying down; it is covered by all types of clothing and swimwear. This incision allows control of the inframammary fold position, a direct approach for dissection and implant placement, provides excellent exposure to all areas of the pocket, and does not traumatize breast tissue. The inframammary approach is often used when re-operation is required.

The periareolar is made along the border of the areola. It allows equal access to all areas of the pocket compared with the other approaches. The diameter of the areola must be large enough to permit the use of this incision, otherwise the incision length would be too small to accommodate insertion of a breast implant. This incision requires a bit of extra care when closing to avoid widening of the scar, but it can also be visible because it can alter the natural color transition between the areola and breast skin. The periareolar incision may be associated with a higher incidence of alteration in nipple sensation. The periareolar incision may be preferred when a small breast lift is also required.

 

Breast Implant Pocket Location

The breast implant is placed into a space that is either above or below the muscle.

A ‘subglandular’ pocket is created directly behind the breast tissue – so the implant is positioned in the space below the breast tissue and above the pectoralis muscle. The implant is covered by skin, subcutaneous fat, and breast tissue; in slender patients this is not a very substantial tissue covering and the implant can be felt quite easily. Because this pocket does not involve cutting any muscle fibers the procedure is less painful than when the implant is placed under the muscle.

A ‘submuscular’ (subpectoral) pocket is created beneath the pectoralis major muscle – so the implant is positioned in a space below the pectoralis muscle and above the rib cage. The implant is covered by skin, subcutaneous fat, breast tissue, and muscle. In this position the muscle provides an extra layer of tissue to help conceal the implant and its margins. Many women seeking breast augmentation achieve a better result when the implant is placed under the muscle. The submuscular space is felt to have a lower incidence of capsular contracture, and probably provides for better imaging of the breast tissue during mammography.

 

How Does My Doctor Select the Correct Breast Implant Size?

The augmented breast should have a natural shape, a size that is proportionate with the overall body habitus, and a soft consistency to allow natural movement. To achieve this a “dimensional” planning approach is necessary. The physical examination is focused on assessing and quantifying the characteristics of the breast and overlying skin and subcutaneous tissue. This information is invaluable for selecting a breast implant with the proper size and volume. This information is also helpful for explaining to the patient how her specific desires could be affected or limited by the characteristics of the breast, and how that relates to anticipated breast size. This knowledge improves patient understanding and expectations.

Excessively large breast implants are one of the primary causes for unsatisfactory results, complications, and reoperations following breast augmentation surgery. It is important that women understand the longer-term effects of larger breast implants and how the weight and force of these implants might impact their future risk for complications. Large breast implants can cause stretching and thinning of the skin and subcutaneous tissue, as well as breast tissue atrophy.  This in turn can lead to greater implant visibility, greater edge palpability, more rippling, inferior malposition, and certainly more drooping and sagging. It is for these reasons that a detailed pre-operative tissue evaluation be performed, that consideration be given to the long-term interactions between the breast implant and the surrounding tissue, and that breast implant selection be based upon each the woman’s tissue characteristics.

 

What Kind of Result can I Expect from Breast Augmentation?

The decision to undergo breast augmentation is a very personal and that should be made with as much information as possible.  Breast augmentation has a 95% patient satisfaction rate because of the improved self-image, the enhanced self-conference, and greater freedom with fashion that women experience following this surgery.

For the most part, it is a woman’s individual breast anatomy and tissue characteristics that will determine her final appearance and result. Thus, the simplistic saying, “Breast implants will make your breasts larger”…in the vast majority of situations the post-operative breast shape very much resembles the pre-operative shape.

 

What is the Recovery Following Breast Implant Surgery ?

Recovery from submuscular breast augmentation is generally not too difficult for most patients.  Adequate pain control is achieved with a combination of oral medications, and most women will require narcotic medication for only 3-5 days following surgery.  There is usually at least a moderate amount of swelling following surgery which will take several months to completely subside.  Patients are required to wear a compression/support bra were about 8 weeks following surgery.  Patients who have desk jobs may be able to return to work in less than a week.  Activities are usually limited to a 10-15 pound restriction for the first 2 weeks following surgery.  The gradual return to more strenuous activities will be guided by your surgeon.  Patients whose work requires significant physical exertion may need 3-4 weeks of recovery before returning to work.  Scar management will also be dictated by your surgeon over the first several months.

 

Call us today (414) 443 0033 to schedule your breast augmentation consultation with Dr. Dembny, at our offices that serve both Milwaukee, Glendale & Waukesha, WI.