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.
Breast Augmentation/Ideal Implants – Patient 304
A mother of one in her early 30’s who is bothered by a deflated appearance of her breasts after breast feeding. She describes herself as a 36 B but wanted to be a full C. She is 5’4” and 158 lbs and is shown before and again, 4 ½ months after bilateral subglandular breast augmentation with Ideal Structured Saline implants filled to 410 cc.
Discussion: She has pseudoptosis with her nipples being located just at to above her breast fold. Caliper pinch of her breasts shows a thickness of 4.5 cm. A subglandular placement was chosen because she has enough breast tissue thickness to hide the implant and a subpectoral placement puts her more at risk for a “waterfall effect” with her somewhat loose breast falling off of the breast mound. With a subglandular placement, the implant drops with the breast, avoiding the potential for a waterfall effect. She has the Ideal 370-410 cc implant. The empty implant volume is 56 cc and the inner lumen is filled to 214 cc. The outer lumen is filled to 145 cc to give a total implant volume of 410 cc. This higher fill volume is similar in profile to a high profile silicone implant and gives a little more fill to the upper breast. She is pleased with the soft feel of the Ideal Implants which are nearly as soft to the touch as silicone implants. She is also happy to not have to worry about silent rupture.
An Asian woman in her early 20’s who wished to have fuller breasts. She described herself as a 32-34 A cup and wanted to be a C cup is possible but still natural in appearance.
She is shown before and again, 6 weeks after breast augmentation with 5 th generation smooth round cohesive silicone gel implants placed below the pectoralis muscle through an infra mammary ( at the breast fold) incision. Implants used were Sientra Opus 255 ml moderate profile cohesive silicone gel implants. She is petite at 5’3” and 116 lbs. This was the largest implant that would fit the dimensions of her breast and still maintain a natural appearance, without an overly round “implant” look. Her inframammary fold was reinforced at the time of her surgery by anchoring it to the rib periosteum with long lasting but dissolving sutures to prevent “bottoming out” and dropping of the breast fold.
A woman in her early 20’s who described herself as a 34 A cup and wanted to be a full C cup if possible but still natural in appearance. She is 5’4” and 135 lbs. and is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with the Sientra Opus 5 th generation cohesive gel round smooth moderate plus 325 cc implant placed through an inframammary incision (at the breast fold).
Discussion: Her breast width is 12.5 cm and the fold to nipple distance is just 5.5 cm but increases to 8 cm on manual stretch. The Sientra 325 moderate plus implant is 11.8 cm at the base. This fits within her measured base width so the breasts will not look overly round after augmentation. The nipple to fold distance on stretch of 8 cm would theoretically allow an implant base of up to 12 cm without being overly full on top. She is still at some risk of “bottoming out” if the inframammary fold ligament were to detach from the extra pressure of the implant so I reinforced the fold at the time of surgery with slowly dissolving but strong anchoring sutures. This allows us to use the largest possible implant that will fit her measurements without appearing unnatural. On close observation you may notice nipple piercings before surgery. I ask patients to remove these at the time of surgery and never replace them because I think it can increase the risk of capsular contracture. The nipple ducts, like the mouth and vagina have bacteria and a piercing in these areas may allow bacteria to enter the blood stream, travel to the implant and lead to bacterial contamination of the implant with biofilm and a subsequent capsular contracture. Piercings in other areas without bacteria such as the umbilicus, do not seem to have the same issue.
A mother of 1 in her early 30’s who is bothered by a deflated appearance of her breasts after pregnancy and breast feeding. She describes herself as a 36 B and would like to be a full C. She is 5’4” and 158 lbs and is shown before and again, 6 weeks after bilateral subglandular placement of Ideal Structured Saline implants 370 filled to “100%” fill of 410 cc.
Discussion: Our patient wanted a natural but fuller appearance and wanted to restore some volume to her upper breasts. Her breast width is 13.97 on her right and 14.3 on her her left. Her nipple to breast fold distance on stretch is 9 cm. The diameter of the Ideal Implant she selected and filled to 410 is 11.7 I usually add 3 mm to the base width of the Ideal because is it designed to sit on a curved surface. So 12 cm is less than her breast width, so it will not “look like an implant”. Her nipple to breast fold on stretch is 9cm. Any more and she may be a candidate for a lift. If her implants were placed below the muscle the implant would move separately from the breast and the breast which is slightly lax would have a tendency to drop off of the implant- this is sometimes called the “waterfall effect”. In a case like hers where the breast is lax, a subglandular placement allows the implant to move with the breast and settle with the breast, giving a more natural look. The tradeoff for a subglandular placement is a slightly higher risk of capsular contracture.
The 370 implant has an empty implant volume of 56 cc. The inner lumen is always filled to 214 cc. The outer lumen is filled to 145 cc, giving her a total implant volume of 410 cc. This gives a higher profile, which helps to add some volume back to her deflated upper breast.
A 39 year old woman who described herself as a 34B but wished to be a full C to D but still relatively natural in appearance. She was concerned about capsular contracture because of a friend who has breast augmentation elsewhere and wished to do everything to avoid this. She wanted to have some superior pole fullness as long as it would look relatively natural. After discussing the different implant choices she elected for an Ideal Structured Saline implant because she did not want to have to worry about a silent rupture. She is 5’5” and 137 lbs and elected for a 455 cc implant placed through an inframammary fold incision and below the pectoralis muscle.
She is shown before and again, 10 months after her surgery.
Details: We used the 405 cc Ideal Structured saline implant with the empty implant volume of 60 c. The inner lumen was filled to 235 cc and the outer lumen was filled to the maximum recommended volume of 160 cc to give a total volume of 455cc. ( “100% fill “) Because of the relatively large size of the implant that she selected, I reinforced her inframammary folds by anchoring her inframammary fold ligament to the rib periosteum at the time of surgery with a strong dissolvable suture to decrease the risk of “bottoming out”. This can be an issue with a larger implant when additional force is placed on the fold, causing it to “give way” and allow the implant to drop excessively. She is thrilled with her very full but still natural appearance, and her inframammary folds have been stable.
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:
At our office we also offer the IDEAL implant. The IDEAL implant structured breast implant is a new type of implant designed by a plastic surgeon. It combines the safety of a saline implant with the realistic look and natural feel of silicone gel implants. The IDEAL implant offers next-generation technology that offers you the benefits of each type of implant, so you can feel both beautiful and secure.
Learn more about the IDEAL implant in Dr. Hall’s video blog below:
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.
“I saw 3 surgeons before meeting with Dr. Hall and by far
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professional and helpful. Can’t say how pleased and
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