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What is breast augmentation?

Breast augmentation is one of the most common plastic surgical procedures performed. The basic principle involves insertion of an implant underneath the breast gland or pectoralis muscle. The results of this simple process can change one’s appearance and confidence dramatically. It is no wonder this is one of the most commonly requested procedures in plastic surgery. New techniques are now available that can utilize one’s own fat to help contour and augment breasts in select patients.

Presently available breast implants include silicone and saline varieties. Silicone implants are composed of a gelatinous substance contained within a rubberized silicone shell. In the past, this included the more liquid form of the implant which did pose issues related to rupture and leakage. Modern silicone implants are referred to as “cohesive.” In other words, the issues with spread of liquid within a breast pocket are avoided since the substance tends to coalesce with itself in the event of leakage or rupture. The newest iteration of silicone implants includes the highly intriguing “gummy bear implant.” These implants are termed “form-stable” and tend to hold their original post-manufacturing shapes. They resemble the natural teardrop shape of an ideal breast and come in numerous sizes.

Saline implants are composed of a rubberized silicone shell which is filled inside the breast cavity with saline fluid. Fewer options exist for implant shapes. However, the ability to size the implant accurately once in the breast pocket can be much more adjustable. Also, in the event of a rupture, saline fluid leaks into the surrounding tissues and is harmless. The end result in this circumstance is a “deflated” breast, whereas this will be less obvious with a cohesive silicone gel implant.

Most surgeons will agree that a silicone breast implant offers more realistic results in terms of both shape and consistency. Past concerns regarding silicone toxicity have not been substantiated by scientific data. In the end, patients have more choices these days than they ever did with regards to breast augmentation.  

Although the decision to pursue breast enhancement must come from patients, an effective plastic surgeon will guide the patient into choosing the right option given body type and goals. Patients frequently choose implants that are too large to be supported by their frame. Various factors will determine whether or not the patient’s choice is suitable. An experienced plastic surgeon will take these into account and formulate the best surgical approach.

How is breast augmentation performed?

In the case of implant augmentation, several options exist in both surgical approach and implant choice, as described. With regards to surgical approach, much of the decision is based on the surgeon’s experience and choice of incision. Incision options include inframammary (under the breast fold), periareolar (around the nipple), transaxillary (from the armpit), and transumbilical (through the belly button). In addition, choice of placement of the implant beneath the breast gland versus the pectoralis muscle is made. Each option has its pros and cons. The plastic surgeon will need to take into account the patient’s preference for the incision with the positioning and style of implant to be used. Certain incisions will not support a particular type of implant. Also, placement of the implant underneath or over the pectoralis muscle is dependent on body habitus. Dr. Panossian has extensive experience in all options and will guide each patient to the most appropriate option during an extensive consultation.

Fat augmentation is a more recent trend. In appropriate patients, fat is harvested from the lower abdomen through a small incision inside the umbilicus (belly button) and injected into each breast. Additional fat is harvested from the thighs, buttocks and love handles as needed. The process of fat augmentation may need to be repeated due to some resorption that occurs of the transferred fat. Recent studies have shown this to be effective in conjunction with use of a vacuum device (BRAVA) applied to the breast for several weeks prior to official fat augmentation. 

What is the recovery?

Breast augmentation is an outpatient procedure which can take between 1 and 3 hours to perform. A family member or friend should accompany the patient for transportation and assistance during the first 24 hours after surgery.

Although most patients may feel only mild discomfort, it is important to avoid strenuous activities including sports, heavy lifting, exercise, and running after children. Having someone at home who can assist with daily activities is highly recommended. Keeping activity level at a minimum during the first week is imperative for healing and return to usual activities. At 2 weeks following surgery, patients are allowed to exercise gradually, beginning with walking and low impact activities. Upper body exercises, weightlifting, and running are avoided for 4 weeks. A noncompressive bra without underwiring is worn for support. Dr. Panossian’s staff is available at all times to answer any questions regarding symptoms or postoperative care instructions.

What are the risks and complications?

Complications following breast augmentation are rare. Nonetheless, several noteworthy outcomes are possible in the lifespan of an augmented breast. It is important to understand these issues ahead of time in the decision to proceed with breast enlargement surgery.

Bleeding is a risk with any surgery. In the setting of breast augmentation, a large pocket is opened along the chest wall. This is a relatively avascular plane with very little bleeding; however, there may be small blood vessels that can rupture after surgery and create a blood collection known as a hematoma. This may require a surgical decompression. In rare circumstances, the implant may need to be removed or replaced.

Infection following surgery is rare. If this occurs, it usually manifests within the first week following surgery. This can sometimes be controlled with oral or intravenous antibiotics. In some cases, the implant will need to be removed to allow for clearing of the infection. A new implant can then be reinserted several months later.

Nipple sensitivity issues can also arise. Some people complain of oversensitivity, undersensitivity, or complete loss of sensation. The incision itself can have areas of numbness. Patience and time will usually resolve these symptoms. However, in some patients, this may be permanent.

Capsular contracture is a known response of the human body to a foreign object such as a breast implant. This involves a natural inflammatory process resulting in scar formation and creation of a lining (i.e., capsule formation) that can, at times, result in distortion of the implanted breast or pain. The texture of the implant underneath will also go from supple to firm during this process. It may take several months to years to develop and may require surgical revision in some patients.

Implants can rupture occasionally. This can result from an injury or even from normal compressive forces. In the event of a rupture, both saline and silicone breast implants are safe and unlikely to cause anything more than a misshapen breast. If a rupture or leak does occur, then a second operation will be required to replace the damaged implant.

There is currently no conclusive scientific study to suggest an increased risk of breast cancer in the setting of breast augmentation. However, routine mammography will need to be adjusted to account for the implant located beneath the breast gland. Additional x-rays or ultrasound studies may be required to evaluate lumps or the implant itself. In some instances, an MRI may be necessary.

The typical lifespan of a breast implant is difficult to estimate. There is currently no requirement to replace implants that are not problematic. 

Dr. Panossian is highly skilled in identifying potential problems and will assist you throughout every phase of this very gratifying procedure.