Breast Augmentation

Breast Augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:
·         To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
·         Some other feature go right here
·         To restore breast volume lost due to weight loss or following pregnancy
·         To achieve better symmetry when breasts are moderately disproportionate in size and shape
·         To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
·         To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer
·         To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities
·         By inserting an implant behind each breast, surgeons are able to increase a woman’s bustline by one or more bra cup sizes.

A designer Operation

Breast Implant type

In the United States the two available and FDA approved breast implants are the silicone gel implants and the saline filled implants. The silicone gel breast implants are made with a silicone shell and a cohesive silicone elsatomer inside. The saline filled breast implants are still made with a silicone shell. Most people are not aware of this. In Europe there is another type of breast implant that has some merit: the polyurethane covered breast implant. The polyurethane implant is still a cohesive silicone implants but it is covered by a shell of silicone and polyurethane. The polyurethane implant was available in the US but was discontinued due to a fear of causing cancer. That was never proven in man but in mice.

I perform the breast augmentation operation in every way possible. The breast augmentation through the nipple-areolar margin has the advantage of camouflaging the incision well in most patients. The downside is that there is still a visible scar on the areola in most patients and there be a change in nipple sensation and perhaps breastfeeding.

The breast augmentation through a cut under the breast is called the inframammary approach. That is the preferred choice of incision for most patients. The incision is typically about 5cm or an inch and a quarter in length. The incision heals well there in most cases and being in the fold makes it less visible.

The transumbilical breast augmentation is also called TUBA. The TUBA is a great choice because the operation is done with no visible scars on the breasts. It is also the quickest procedure. Only saline breast implants can be done through the belly button.

The endoscopic breast augmentation is done through the armpit. This procedure also has the benefit of no visible scars on the breasts. The incision is in the armpit.

The breast implant positions can be over the muscle or under the muscle. There is another placement called “half over-half under” That means that the breast implant is partially under the muscle and partially under the breast tissue. In reality this half over half under procedure is essentially a breast augmentation where the implant is under the muscle. The muscle is called pectoralis major muscle. There is another type of breast augmentation that is called subfascial breast augmentation. I personally do not like that one. It means separating the fascia that encases the pectoralis muscle and putting the implant under the fascia but still above the pectoralis major muscle. The implant does not have complete coverage and the operation is messy and causes a prolonged recovery.

The breast implant location makes a difference in the shape. In the case of patient that has partially saggy breast and needs some lifting as well as a breast implant then placing the breast implant over the muscle and under the breast may be better to provide extra lift and better shape.

What size?

I spend a lot of time pre-operatively to have my patients try on different implant sizes so that they can participate in the decision as to what is the size they want. I do not think the plastic surgeon should select the breast implant size but the patient. In some cases my patients will tell me to use my judgment. In most cases I insist that they try on different implant sizes so that they seek and get a feel of how their body will look. This is a very valuable exercise before the breast augmentation surgery.

Moderate or high profile?

The term “profile’ in breast implant surgery refers to the projection of the implant or the perkiness. I tell my patients that this is a mater of personal preference. I show my patients both moderate profile and high profile and help them decide. Moderate profile implants will offer a more natural look compared to high profile implants.

In the United States there are three different profiles to choose from: High, moderate plus and moderate.

In Europe and South America there are five types according to implant profile: extra high profile, high, moderate plus, moderate and low profile.
Smooth surface or textured?

This refers to the surface of the breast implants. Both saline filled and silicone gel breast implants come in a smooth surface or textured surface variety. Making the surface textured may prevent or lower the incidence of capsular contracture. This however has not been proven. In general plastic surgeons in the US favor smooth surface breast implants and in Europe and South America and Asia they favor textured breast implants. The textured silicone implants are denser than the smooth surface ones and may require a larger incision for placement.

Round or Anatomic?

Most breast implants are round. Some come as anatomic. Anatomic breast implants means that they have a teardrop shape. The teardrop breast implants have a very limited application in my opinion. They should be considered only in cases of women who are flat chested with no visible inframammary crease and seek a very natural looking breast.

The main issue with tear drop shaped breast implants is that they can move while they a re inside the breast pocket and the part that is at the bottom and wider can rotate to the side or the top. This would affect the breast shape and cause new possibly uncomfortable feelings. That would take another operation to correct.

COMPLICATIONS

Breast Implant rupture

When Implants rupture it is recommended that they be removed and replaced with new ones.

When saline implants rupture the deflation is obvious and apparent.

When a silicone cohesive gel implant gets ruptured it may be hard to detect because the silicone implants maintain their shape even after rupture. In such cases of uncertainty getting an MRI will detect the leak even a small one.

Capsular contracture – the most dreaded complication

This is the most serious and common problem of breast implants. Capsular contracture is a response of the body to the silicone component of the implant. This means that capsular contracture occurs with both saline filled breast implants and silicone filled breast implants. Both implant types are made of silicone.

What is it? In short the body reacts against the silicone breast implant by creating and depositing extra collagen around the implant. This collagen is also called colloquially scar tissue. Capsular contracture is a frequent cause of breast pain in patients with breast implants.

Capsular contracture occurs in about 15% of women who get breast implants. WE CANNOT PREDICT AS PLASTIC SURGEONS WHO WILL GET CAPSULAR CONTRACTURE BEFOREHAND. This is why this remains still a problem as we do not know what exactly causes this [problem. There is some evidence that using a new generation cohesive silicone gel breast implants and placing it under the pectoralis major muscle may reduce the incidence or recurrence of capsular contracture.

There has been debate over the fact that textured silicone gel implants may lower the rate of capsular contracture. There have been studies that support that and others that do not. Textured surface means that the breast implant surface is rough instead of perfectly smooth. The patient does not feel this roughness. The rough surface causes a limited inflammation against the surface where it attaches inside the body. This small degree of inflammation is thought to reduce the chance of capsular contracture.

The fact is that the only breast implant ever to have the lowest rate of capsular contracture was the polyurethane covered silicone gel implant. Thos implants had also some great longevity.

Capsular contracture treatment options

They vary and depend on the history of the patient. There is no medicine that has been proven to effectively correct the problem.

Treatment options are therefore surgical and include removing the capsule or scar tissue or breaking it. Removing the scar tissue is called capsulectomy and breaking it is called capsulotomy.

Still these measures are not always therapeutic because the body may cause more scar tissue around the implants.