Breast augmentation surgery is performed to enlarge or restore the size of breasts using implants. Being one of the most popular cosmetic procedures performed, breast augmentation is a safe and effective solution to enhance, regain, and restore balance to a woman’s figure. Breast augmentation can be achieved using many different techniques to meet the needs of each individual patient.
Am I a good candidate for breast augmentation?
Candidates for breast augmentation surgery are those who are unhappy with their small breast size, have smaller or deflated-appearing breasts due to pregnancy or weight loss, have asymmetry of the breasts, or are self-conscious with their body due to their breasts. Ideal candidates are in good health and have realistic expectations of breast augmentation surgery.
It is important that patients understand all facets of breast augmentation surgery before making a decision. Augmentation is a long-term solution for achieving a desired figure, and will help you to look and feel better in clothing and swimwear. However, breast implants require monitoring and do not last forever. Implants commonly last for 10 years or longer before they need to be replaced. During a consultation with Dr. Hall, all of the pros and cons of this surgery will be discussed so that an educated and well-informed decision can be made.
Mastopexy/Breast Reduction – Patient 145
A mother of 3 in her mid 40’s who is bothered by the deflated look of her breasts after pregnancy and breast feeding. She would like to be fuller but still natural in appearance.
She is shown before and again, 6 weeks after augmentation/mastopexy. She is 5’3” and 111 lb and had 325 cc high profile cohesive silicone gel microtextured implants placed in a dual plane position through an inframammary incision (at the breast fold) combined with a periareolar mastopexy using a round-block Goretex suture.
Discussion: Her breasts are very atrophic (thinned) after her pregnancies and breast feeding. Her nipples prior to surgery are below the breast fold and so a mastopexy (lift) is needed. The distance from the bottom of her areola to the fold is not significantly increased however, it is 9 cm on stretch. So she is a candidate for a Vertical lift ( “lollipop scar”) which was our original plan. At the time of surgery, after placing her implants, I felt that we could accomplish her goals with a peri areolar Mastopexy (“circle lift” ). The peri areolar mastopexy is only possible in very few cases, because it does not give much of a lift and it flattens the breast. But in a case where the breasts are narrow / “pointy” as we have here, it improves the shape of the breast. In a breast that is already wider at the base it would tend to make the breast “boxy”. But in her case it was just right. This is also called a “concentric circle” mastopexy because a larger circle that reaches to the top of where we want the areola to go is drawn around a second circle that defines the new areola. A goretex suture that is permanent is used to prevent the areola from stretching out to the size of the larger circle. It “blocks” the areola from stretching out.
Although we could have placed her implants through the peri areolar incision and avoided the inframammary incision, her tissues are very thin, and I felt that is was safer to keep the space where her implant was placed separated from the incision around her nipple. This decreases the risk of the implant becoming exposed if the incision were to separate after surgery. It also avoids having to split the breast tissue which has breast ducts and bacteria, giving a higher risk of capsular contracture when the implant is placed through the peri areolar incision.
A high profile implant was used. In a tight breast it might appear overly “bulgy” on top, known as “superior pole convexity”. But in a loose breast that is deflated as we have here it is usually good to try and replace some of the lost volume with a higher profile implant. We are trying to “fill” the breast without overly stretching it.
A micro-textured implant was used. Smooth Implants tend to drop and fall off to the side with time, especially in a loose, stretchy breast. Texture may help to prevent this shifting of the implant. Texture can be controversial however because it could increase the risk of BIA-ALCL, which has only been reported in textured implants. It is felt to be an interaction of Biofilm when bacteria gets on the implant, with the texture. The risk of BIA-ALCL is very low however, is very treatable when recognized, and is more common in the aggressively textured implants. It is less common in the micro-textured implants, that have a less aggressive texture. So if we are going to use texture, I feel that the micro-texture is my choice, and of course we use our “14 steps” to avoid bacterial contamination of the implant.
The dimensions of the implant were carefully selected based on her tissue dimensions and confirmed by her in a bra with the Mentor sizing system in the office.
So, a lot of thought and planning to size the implant properly, pick the implant profile and texture and plan the surgical approach. There is no right or wrong way to do this surgery. But these are the tradeoffs that the patient and I together decided were best in her particular case.
This is an early result, and we can expect the breasts to settle and the scars to fade over the following months. But her case illustrates some of the tradeoffs that go into planning a mastopexy augmentation
A 3 year followup on a mother of 2 in her late 30’s. She wanted to be able to fill her swimsuit and bra without padding, but wanted to look natural. She also wanted to avoid an overly full “matronly” look. She is 5’5” and 144 lbs and has a 325 cc smooth round cohesive gel moderate profile plus implant placed through an inframammary incision below the pectoral muscle.
Discussion: She has had a nice result after surgery. I always tell my patients that the breasts are “sisters and not twins” . Her right breast is fuller and the nipple is lower, both before and after her surgery. In the photo she is seen to have a nipple piercing. She also had a tongue piercing prior to surgery. Both of these can increase the risk of capsular contracture if they are replaced after surgery. There is bacteria in the mouth and in the nipple area that can get into the blood stream with minor trauma and travel to the implant. It can attach to the implant (“biofilm”) and lead to a capsular contracture as the body tries to “fight” the bacteria. So I have recommended that she never put these piercings back. Her breasts have stayed soft. I also recommend that my breast implant patients take a single dose of antibiotics one hour before dental procedures, including a cleaning, for the same reason. Vaginal piercings can cause the same issue. This does not seem to be a problem with other piercings such as umbilicus (belly button) or the ear.
A mother of 2 in her early 40’s who is bothered by a deflated look of her breasts after pregnancy. She is 5’4” and 124 lbs and liked a 400 and a 375 cc implant in the office but wanted to look natural. At the time of surgery the 400 was tried and was simply too large for her frame so a 375 cc implant was chosen. She is shown before and again, 6 years after bilateral partial subpectoral placement of smooth, round, cohesive, high profile silicone gel implants placed through an inframammary incision.
A mother of 2 in her early 40’s who describes herself as a 34-36 A-B cup and would like to be a full b but still natural in appearance. Sh is 5’4: and 117 lbs. She was sized in the office using her tissue dimensions and liked a 275 cc implant. She is shown before and again, 2 years after bilateral subpectoral placement of a smooth, round 275 cc cohesive gel moderate profile plus implant placed through an inframammary incision.
A mother of 2 in her early 50’s who is bothered by a deflated appearance of her breasts after pregnancy, and is also bothered by inverted nipples. She wanted a full but still natural look and selected a 375 cc size. She is shown before and again, 6 weeks after bilateral partial sub-pectoral breast augmentation with a dual plane placement of 375 cc high profile textured silicone gel implants placed through an inframammary incision. High profile was chosen to restore some of her lost upper breast fullness. The pros and cons of texture were discussed and a textured implant with the least aggressive texture was chosen to decrease the potential lateral shifting of the implants with time. A Keller funnel was used to place her implants along with antibiotic irrigation and nipple shields to decrease her risk of biofilm contamination, subsequent capsular contracture and possible BIA-ALCL A micro-incision release of the inverted nipples was performed at the time of her breast augmentation. It has been just 6 weeks since her surgery and we can expect the breasts to “settle” and appear even more natural over the next 4-5 months.
There are many different options when it comes to breast augmentation techniques, as well as implant choices. The different techniques available often have to do with differences in incision placement, and include:
The inframammary incision, which is located underneath the breast
The periareolar incision, which is located along the border of the areola
The axillary incision, which is located in the armpit
Other techniques also include the transabdominal breast augmentation (TABA), in which breast implants are inserted through an incision in the abdomen, and the transumbilical breast augmentation (TUBA), in which implants are placed through an incision in the naval. Furthermore, patients have the option of having their implants placed on top of or underneath the pectoral muscle.
There are also many breast implant options available for each patient’s unique needs. The two most common types of breast implants used today are saline and silicone implants. Saline implants are filled with a saline solution, while silicone implants are filled with a silicone-gel. If a saline implant were to rupture, the breast would simply deflate and the solution would be absorbed into the body. If a silicone implant were to rupture the silicone is typically still contained within the layer of scar tissue that forms around the implant, as the body cannot absorb the silicone gel. Below is more information about breast implants:
How is breast augmentation performed?
During breast augmentation surgery using implants, Dr. Hall creates an incision, forms a pocket in the breast area, and then places the implant inside. The incisions are then closed in a manner that will reduce scarring and remain subtle. The number and placement of incisions will depend on which breast augmentation technique that you and Dr. Hall decide is best suited for your goals and unique anatomy. The type of implant used and whether the implant is placed underneath or on top of the muscle is also a decision that you will make with Dr. Hall during your consultation.
What should I expect during recovery?
After breast augmentation surgery, patients typically don’t need narcotics after 24 hours. They can typically return to office work after 5-7 days but should “rest the breasts” and avoid excessive activity for 6 weeks to allow adequate healing. Pain medication can be prescribed to help with a comfortable recovery. Patients are given a surgical bra to wear after surgery for support, and they should wear a comfortable bra throughout their recovery to ensure optimal results. Any sutures that are placed are typically self-absorbing and do not need to be removed. Dr. Hall will provide you with specific recovery instructions, which are imperative to follow for a quick and safe recovery. Learn more about proven methods to improve your recovery following a breast augmentation in Dr. Hall’s video blog, the Thoughtful Patient’s Guide!
How Long Will My Breast Augmentation Last?
With the proper preparation and aftercare, breast augmentation results are typically long-lasting. In the event that the breast implants become damaged, they usually need to be removed and replaced. For best results, scheduling a routine follow-up appointment with Dr. Hall is recommended to make sure the implants are healing properly. There are a few physical changes that can affect the integrity of breast augmentation results, which include:
Pregnancy, childbirth, and nursing
The natural aging process, and gradual breakdown of collagen and elastin in the skin
Drastic changes in weight, like gaining or losing
Gravity and the weight of an implant/breast on the skin
Year after year, the breast augmentation is the number one plastic surgery procedure performed throughout the nation. Many women seek to add volume and create a new breast profile, while some women seek to balance out uneven breasts. Augmentation techniques can also be combined with other breast procedures. Whatever your reason for choosing a breast augmentation, expect excellent results from board certified plastic surgeon, Dr. Jonathan Hall.
If you are located in the Boston, MA area and are interested in learning more about breast augmentation, contact our office today. We would be happy to schedule a consultation for you, as well as answer any questions you may have about the procedure.
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