Breast augmentation is cosmetic breast surgery that can increase the size of the female breast. Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the world. A breast augmentation can give women with small or unevenly-sized breasts a fuller, firmer, better-proportioned look. In some situations, the placement of a breast implant can also provide a small breast lift. Dr. Haddock is an expert in breast implant surgery performing hundreds of implant placements per year.
A breast augmentation can be performed using a variety of different techniques. One of the primary decisions to make is what incision to use. There are three common access incisions for breast augmentation:
Underneath the breast (inframammary)
Around the areola (periaerolar)
In the armpit (transaxillary)
Each of these different access incisions have their own advantages and disadvantages. Women with breasts that were previously larger but which have atrophied following childbirth and breast-feeding are often best served with an incision either under the breast or at the edge of the areola. The incision underneath the breast is very versatile. It allows accurate placement of an implant via an incision location that is well concealed. Saline or Silicone implants can be placed using this approach. The periaerolar approach has the distinct advantage that the incision is located at the junction of the darker areola skin and the lighter breast skin, producing a well-concealed scar. The periaerolar approach is also advantageous if breast augmentation is performed in conjunction with a breast lift. Silicone implants can only be placed using this approach if the areola is of adequate size. One of the biggest advantages of the transaxillary approach is that the incision is remote from the breast. This approach can be used for women who have very little breast tissue and a small areolae, who select to undergo a breast augmentation with saline implants. During your consultation Dr. Haddock will discuss which incision is appropriate for your anatomy and overall goals.
Via cosmetic breast surgery breast implants can be placed either in front of or behind the pectoral muscle. The decision is influenced both by individual physical characteristics and safety concerns. Thin women with small breasts look better when the implants are placed behind the muscle. The extra padding from the muscle helps prevent rippling or a visible implant edge. Heavier women with larger breasts that sag may look better with implants that are placed in front of the muscle. Mammograms are easier to read if the implants are located behind the muscle and studies have also suggested that capsular contracture is less frequent when implants are placed behind the muscle. Regardless of the location of the implants, self-examination is not impaired.
There is a large range of implant sizes used within breast augmentation. Breast size increases approximately one cup size for each 150 to 200 cc of implant volume. Size selection will be guided by Dr. Haddock and influenced by your anatomy and goals. For most patients a natural appearance is an important goal of any cosmetic procedure. The greater the implant size, the more difficult it is to maintain a natural look. Dr. Haddock believes that choosing the correct implant size for a patient is one of the most important portions of any breast augmentation. He will offer a simulation with a 3D camera to help in this decision making. Some patients also choose a temporary saline injection to help them confirm their desire for a breast augmentation (see Temporary Saline Augmentation below).
Both saline and silicone implants are approved by the FDA for breast augmentation. Modern silicone implants are filled with cohesive gel that has a consistency that more closely resembles jello than water. This gel is believed to better prevent silicone migration once the outer plastic cover (shell) has worn out many years after implantation. Both saline and silicone gel implants have the same outer cover (shell), which is made of solid silicone.
Breast Augmentation with Fat Grafting
Breast augmentation can be accomplished without the use of an implant but with the transfer of fat from a different part of the body via fat grafting. This involves liposuction of an area of unwanted fat, processing this fat to remove any extra tissue, and then injecting the fat into the breast to provide a breast augmentation. This method offers a natural augmentation of moderate size. This method cannot give as dramatic a result as an implant but avoids the downsides of a silicone or saline implant. The fat that is injected will give an immediate breast augmentation but only 50-80% of this result will remain long-term. Some of this injected fat will resorb over the first few months following surgery. What remains will be present indefinitely.
Temporary Saline Augmentation
Some patients wish to see how they will look with augmented breast. While Dr. Haddock will use Vectra, a 3D camera, to simulate the anticipated result for many patients this is not sufficient to get an idea of the size they desire. An alternative option is to perform a temporary breast augmentation with saline. This is an in office procedure that involves careful injection of fluid into the breast using a small needle. The patient will immediately have the appearance of a breast augmentation in the range of the desired implant. For some patients they choose to do this temporary breast augmentation to look better for a specific event. While the results only last for a few days and do not feel the same as a breast augmentation with an implant it does allow patients to experience augmented breast prior to undergoing surgery.
Risks Associated With Breast Augmentation
The body normally forms a thin layer of pliable scar tissue around any foreign substance that is placed beneath the skin. This occurs whether the device is a breast implant, a pacemaker, or an artificial joint. This process is beneficial because it maintains implant position. Sometimes this scar layer, or capsule, will contract around a breast implant following augmentation and can render the breast hard in consistency. This is a biological, as opposed to surgical, cause of breast hardening and essentially represents an over-reaction by the immune system. The shape of the breast may change if this process becomes more advanced. In extreme cases the condition may be painful enough to require surgical correction by complete removal of the scar capsule and replacement of the implant. This treatment is usually successful although recurrence of dense scar tissue around the implant can occur in some women, particularly those who experience scar layers in both breasts. The cause of excessive capsule formation, or capsular contracture, is not known. Fortunately, capsular contracture requiring additional surgery only occurs in approximately 5 percent of women.
Complications from breast augmentation are rare. Infection or bleeding problems can occur and may require additional surgery. Potential aesthetic problems include implant asymmetry and a palpable implant edge, the latter of which most often occurs in very thin women with saline implants. Most asymmetry problems are minor and do not require correction. A palpable implant edge is not a health hazard and does not require treatment.
Post-Operative Care and Recovery
Minimal postoperative care is required following breast augmentation. A surgical bra is usually placed at the time of surgery. The amount of discomfort is variable but is generally greater in patients that have implants that are positioned behind the muscle. In the majority of cases the discomfort subsides within 48 hours. Skin stitches do not require removal. It is often possible to return to sedentary work after one week or sooner. Range of motion and some movement is encouraged the night of surgery. Most normal activities can resume within two weeks. Strenuous physical exercise involving the upper body must be avoided for at least six weeks. Eventually there are no restrictions of any type.
For fuller and shapelier breasts, consider breast augmentation with Dr. Haddock. Contact us now for further information or to book a consultation.