Breast

Breast Augmentation

Increasing the volume and size of the breasts is called augmentation mammaplasty. Excessively small breasts may seem disproportional to your torso and hips; they may limit your choice of clothing; they may detract from your feelings about your figure. Current augmentation techniques can enhance your breast shape and size.

Small breasts either result from a developmental tendency or from involution of breast tissue (shrinkage) following pregnancy. Both types of small breasts can be enhanced with breast augmentation; however, these two breast types are fundamentally different: breasts that have never developed and been full tend to have tight skin envelopes whereas breasts that have shrunk after pregnancy usually have a looser skin envelope. A breast augmentation surgeon must consider and compensate for this fundamental difference.

As a leading Dallas plastic surgeon, my technique for all breast augmentation procedures involves precise electro-cautery dissection of the implant pocket with no blunt dissection. This minimizes bleeding, and therefore, postoperative swelling and bruising, and most importantly, postoperative pain. My efficient surgical technique and post-operative management allows my patients to recover from breast augmentation in 24 hours.

Video: 24 Hour Recovery

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Breast Augmentation Choices

I offer my patients a choice of implant incision (inframammary, periareolar and transaxillary), implant location (above or below the muscle) and implant type (smooth or textured, round or anatomic). Of course, I will make specific recommendations based on an individual patient’s tissue characteristics and preoperative measurements.

The goal of breast augmentation should be to achieve the best possible breast size and shape to meet your desires. At the same time, your procedure must be individualized to take into account your preoperative tissue characteristics and measurements. There is no procedure in plastic surgery that has a greater variety of options and combination of options; and, yet, many plastic surgeons will use a “one size fits all” approach more for this operation than any other.

Incision Approach

Precise dissection of a breast implant pocket can be achieved with three incisional approaches:

  1. Inframammary, the fold beneath the breast;
  2. Periareolar, the edge of the areola (the colored skin around the nipple);
  3. Transaxillary, the highest point in the axillary hollow (armpit).

The transumbilical (belly button incision) approach has been used for breast augmentation. However, with current technology, it is impossible to precisely create a pocket for the implant with the transumbilical approach. Even though this technique leaves no scarring on the breast, it offers by far the least predictability and control. Because of this, I do not offer this approach to breast augmentation.

The inframammary approach offers the most direct route to create the pocket for the implant. It also offers the most options for modifying the skin envelope or breast parenchyma (tissue). In most patients, the scar will remain hidden and camouflaged by the breast fold and breast after surgery. This approach is highly versatile and more suitable for the majority of my Dallas breast augmentation patients than other incisional techniques.

The periareolar approach conceals the scar in a natural border between the areola and the uncolored breast skin. However, this approach generally traverses more breast tissue than any other. Because the breast is a gland composed of ducts that converge to the nipple and open to the outside environment, it is exposed to the normal bacteria that covers the skin and lining of all living organisms (like people). Performing breast augmentation surgery through this tissue could potentially expose the implant to these bacteria. In addition, this tissue is highly vascular (contains blood vessels), resulting in more bruising and swelling after surgery.

The transaxillary approach is performed with an incision hidden at the highest point in the axillary (armpit) hollow. Patients may desire this approach because it leaves no visible scar on the breast mound. This surgery is performed with the assistance of an endoscope (small camera to visualize the operative site). The major disadvantage of this approach is that it allows the least amount of alterations of the breast parenchyma or skin envelope. This approach is suitable only for breast augmentation patients who are most concerned about minimizing any visible scars on the breast mound and who require no parenchymal modification or lift.  I do not generally recommend this approach for the placement of silicone gel implants.

Implant Location

Breast implants may be placed in front of, or partially behind the pectoralis major muscle. When “behind” the muscle, really only approximately the upper one-third to one-half of the implant is behind muscle. The benefits of placing the implant behind the muscle are multiple:

  1. The muscle adds cover to the implant, decreasing the possibility of implant visibility through the skin (in the upper and inner chest);
  2. Implants placed behind the muscle have a lower risk of developing capsular contracture (abnormal hardness and visibility of the normal capsule that forms around all implants);
  3. Possibly improved accuracy and sensitivity of mammograms compared to implants placed over the muscle.
  4. Placement over the muscle may result in a better result in some patients who have mild sagging of the breasts; however, adequacy of tissue cover is more important and this can be more assured by under the muscle placement.

Therefore, the vast majority of patients desiring breast augmentation will fare better with under the muscle placement.

Implant Type

Silicone and Saline Breast Implants

I offer breast augmentation surgery with both silicone and saline breast implants.  Silicone breast implants are made of silicone gel and encased in a silicone rubber shell. In November 2006, the FDA approved silicone breast implants for use in the United States. Previously, silicone implants had been suspected of causing systemic health problems; however, multiple studies and expert-review panels have shown that these claims were false. Silicone implants have been safely used by plastic surgeons in Europe for years, and now American patients can once again take advantage of the natural look and feel of silicone breast implants.

TYPES OF IMPLANTS

Silicone vs Saline

 

Implant Type SiliconeImplant Type Saline

Some women still opt for saline breast implants, but, these implants are still encased in a silicone rubber shell.  Saline implants will generally look and feel less natural than silicone implants.  The thinner the patient and/or tissue cover, the greater the disparity between how natural silicone looks and how comparatively unnatural saline will appear. If you are uncertain about the type of implants you want, it is best to discuss your concerns with a board-certified plastic surgeon with extensive experience in breast augmentation.

Breast implants are available with a smooth or textured surface and are either round or anatomically shaped. Some older data suggests that Textured implants may decrease the risk of capsular contracture, an abnormal hardening of a capsule around breast implants. However, these implants tend to form an adherent capsule, making them look more “stuck-on.”  In a select few patients, this may be an advantage in trying to minimize bottoming out; however, one downside of textured breast implants is that they have a thicker shell, increasing their visibility and palpability through the skin.  The vast majority of patients will achieve the softest, most natural appearing and feeling breasts with smooth round silicone implants.

The majority of breast augmentation procedures performed in the United States today are down with smooth round implants.  There are also tear drop shaped or anatomic breast implants. Many patients assume that tear drop shaped or anatomic implants will look more natural; in fact, with well performed breast augmentation surgery, both types of implants can look very natural; also, because all anatomic implants are textured, some people may think they look more stuck-on and less natural.

Every woman’s body is different, so it is important to have an experienced plastic surgeon advise you personally on which breast implants can achieve the look you want.

Mentor Referral Program

Breast Augmentation with Lift

Patients with more than minimal sag to their breasts may not achieve the best possible result with a breast augmentation alone. Patients falling into this category frequently include those who have had significant changes in the breast volume and shape in the past. This includes patients that have normal involution (volume loss) after breast-feeding or after a large weight loss. These breast augmentation patients have a corresponding significantly larger skin envelope for any given preoperative breast size than a patient who has not breast-fed or lost weight.

There are three approaches to this patient:

  1. Fill the breast skin envelope adequately – this usually requires a very large implant;
  2. Shrink the breast envelope to the ideal size for the present amount of breast volume;
  3. Shrink the envelope somewhat with a breast lift procedure (mastopexy) and fill the envelope somewhat with an implant.

The first option really makes no sense at all. A very large implant will add at least as much weight to the skin envelope as must have been there during breast-feeding. It is this weight that stretched the envelope out and made the breast sag. Therefore, a large implant will almost always lead to progressively more sagging of the breast and a worse long term appearance. A pure mastopexy, shrinking the envelope adequately to the current breast volume will minimize the chance of further breast sag, but it will frequently leave a smaller breast volume than a patient desires or than is in proportion to their frame. A combination of a breast lift with a small implant will frequently leave the best possible shape and overall balance. This may require a two-stage approach (two operations separated by several months) to achieve.

Your Initial Consultation

During your breast augmentation consultation at my Dallas office, I will review with you your goals and desires regarding your desired breast shape and size.  I will then make a series of detailed measurements of your breasts.  After examining you, I will be able to discuss what incision approaches are available, what implant location is ideal and what size or size range is appropriate for you.

If you decide to undergo breast augmentation surgery, photographs will be taken prior to surgery.  These photographs assist me in planning, performing, and following-up on your procedure.

The cost of breast augmentation depends on the nature of the procedure. Incision location and implant choices may affect the overall fees.  My staff will provide you with detailed estimates of the costs involved with surgery, including the surgical fee, anesthesia fee, implant cost and facility fee.

Fees for cosmetic surgery such as breast augmentation are payable in advance of surgery.  The surgical fees include the cost of surgery and all post-operative follow-up care and visits.  Financing may be available through third-party finance companies for a portion of the surgical fees.

My office staff can also help you with special requests including travel and accommodation arrangements for out-of-town patients, limousine service and special nursing or companion care arrangements.

The Day of Your Breast Augmentation Procedure

Most of my patients undergo breast augmentation surgery at Lemmon Avenue Surgery Center, my on-site, state-certified and fully accredited day surgery center.  This facility has been optimized to provide patients with an improved, more controlled, and private experience than they can get from a public hospital. I can perform surgery at a public hospital if the patient feels more comfortable with that option.

Before you are sent to the operating room, I will make marks on your breasts while you stand. These marks help me plan and perform your procedure.

I perform breast augmentation using state-of-the-art techniques.  To create the pocket for the implant, I use exclusively direct electro-cautery techniques.  This means all blood vessels are cauterized prior to cutting them, resulting in virtually no bleeding and minimal swelling after surgery. In stark contrast to how many plastic surgeons perform breast augmentation, there is no tearing of your tissue or blunt dissection to create the pocket. The benefit is virtually no bleeding, minimal swelling, and significantly reduced pain for my Dallas patients.

You will wake up in the recovery room and be discharged after a brief stay in a postoperative patient room.  The incisions are closed with absorbable sutures and steri-strips are applied to the incisions, which will stay in place for about 10 days.

Most patients experience mild discomfort or soreness after breast augmentation surgery.  We will provide pain medication in the surgery center and non-narcotic pain medication after discharge.

After Your Breast Augmentation

After your breast augmentation surgery, you will be given a very detailed instruction sheet, what we call a “Recipe for Recovery”.  This begins with a nap after you return home, followed by a warm shower (yes, you may shower almost immediately after this surgery).  You will then begin various non-strenuous exercises that will help prevent any stiffness and ensure your recovery is as rapid and easy as possible.

Because of the techniques I use in the operating room, you will have no need for narcotic pain medicine.  Because I perform a 24 hour recovery breast augmentation procedure, most of my patients resume normal activities within 24 hours after surgery.  I only ask that you restrict strenuous aerobic activities, exercise and heavy lifting for two weeks following breast augmentation surgery.

After breast augmentation surgery, you may have a loss of feeling in the breasts and they will feel swollen. These sensations are typical and will disappear in the weeks following surgery.  At first, the upper portion of the breasts will seem too full and the lower half will be tight and stiff.  Over the course of the next few months, your breasts will become softer, settle into position, and assume a beautiful shape.

Limitations, Risks and Possible Complications

Breast augmentation patients should be aware that the procedure will leave some scarring. In the first few months after surgery, the scar will more noticeable; with the passage of time if will become flat and slightly discolored.

Significant bleeding can develop in up to 2 percent of patients. If your breasts are excessively swollen, bruised, or painful after surgery, you may need to undergo an additional operation so blood and fluid can be removed.

Patients are given antibiotics to reduce their chances of developing an infection. Infection is extremely rare after breast augmentation; but if it occurs, it is a serious complication and may result in the need for the implant to be removed.

Saline filled breast implants do not feel like or look like natural living breast tissue.  You will be able to feel the implants and implant edges beneath your skin and breast tissue, including the possibility of feeling rippling, wrinkling and/or other irregularities.  These edges or irregularities may even be visible beneath the skin.  While there are ways to minimize this in most patients, it may be impossible to completely eliminate visibility and/or palpability.  This can be more severe in very thin patients, patients with very little of their own breast tissue, and/or patients with thin skin.

Breast implants are not considered lifetime devices.  This means you should not expect your implants to last your entire lifetime.  Saline implants may spontaneously deflate at any time, resulting in sudden asymmetry.  If this occurs, a secondary surgery is necessary to remove the deflated implant and replace it with a new one.  Implant manufacturers currently offer various levels of warranties for these situations.

All breast augmentation patients will develop a scar capsule around each implant.  This is the body’s normal reaction to the presence of the implant.  A small percentage of patients may develop excessive amounts of scar tissue that can become firm (capsular contracture).  If this is mild, no treatment may be recommended; however, if this capsular contracture becomes severe, breast disfigurement or even breast pain may occur.  In this case, surgery may be recommended to remove the scar tissue.  There is no guarantee that if capsular contracture develops, it can be permanently relieved with surgery.  Ultimately, for recurrent capsular contracture, implant removal may be recommended.

When the implant pocket is created, sensory nerves may be damaged, resulting in temporary or permanent sensation loss in the nipple.

Some degree of breast asymmetry will remain after surgery, though I will make every effort to make you as symmetric as possible.

Conclusion

Breast augmentation can be performed with minimal swelling, minimal pain, and rapid recovery.  My goal is to educate you before surgery to make the best possible decisions regarding implant type, implant size, implant positioning and incision location.  Decisions we make together before surgery and techniques I use during surgery combine to offer you the best possible short-term experience and long-term result.

If you have any questions regarding your decision about breast augmentation, please do not hesitate to contact my Dallas office for further information.

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