Breast Augmentation (Augmentation Mammaplasty)
Breast augmentation is a very popular procedure for women and among the most commonly performed cosmetic surgery procedures. Plastic surgeons in the United States can perform this procedure by placing a saline or silicone gel filled implant under the crease in the breast, around the nipple, through the armpit, or through the belly button. The implant can be placed under the breast tissue or beneath the chest wall muscle. After surgery, breasts will appear “fuller” with an increase in volume, enhanced projection, and more shapely contour. Incision scars eventually fade over time but are permanent and can thicken in a small percentage of people.
Which incision should I use for breast augmentation?
The most common incision used for breast augmentation is the inframammary (under the breast) incision. Approximately 70% of women across the country have breast augmentation performed using this incision. It is usually well-hidden and has a low complication rate. The periareolar incision (scar around the colored part of the nipple) is also very popular. This incision typically heals well, but is located on the front of the breast. The transaxillary (armpit) incision is also used, but primarily with saline implants. Some plastic surgeons place small silicone implants through the armpit as well, but this is not very common. The belly button technique (trans-umbilical breast augmentation, or TUBA) is used by a handful of plastic surgeons nationwide. It is more controversial due to the limited control and visualization the surgeon has. I am not an advocate of the transumbilical technique and do not practice it.
What is the history of silicone breast implants?
Silicone implants were used nearly exclusively in the United States in the 1980′s and early 1990′s. Unfortunately, these older silicone gel implants had many concerning factors associated with them. The outer silicone rubber shells were not very strong, and therefore the implants had a high breakage rate. In addition, the silicone on the inside of these implants was a thinner liquid. Therefore, when these implants would break, the liquid silicone would ooze out of them, causing many women to fear that the silicone would escape the breast pocket and course through their body causing various diseases, such as breast cancer, lupus, and arthritis. In reaction to these concerns, the FDA imposed a ban on silicone implants in 1992, allowing them only to be used in an FDA-approved study. For the next fourteen years, the vast majority of patients in the United States underwent their breast augmentation using saline implants. While these patients were typically very happy with their results, there was always the desire for the choice of silicone, since they are undoubtedly more natural looking and feeling. Finally, in November 2006, in reaction to the scientific studies demonstrating NO connection between silicone gel implants and any of the diseases people worried about (such as breast cancer, arthritis, and lupus), the FDA lifted the ban on silicone gel implants. We are now able to use them again.
The new silicone gel implants by the two major manufacturers (Mentor and Allergan) are much better than they were twenty years ago. The outer shell of the implant is extremely strong and resistant to breakage AND the silicone inside the implants is no longer a liquid but a cohesive gel. It’s a gel that sticks together. Now we are no longer so concerned with silicone leaking from the implant.
What is the difference between a silicone gel and saline breast implant?
There are benefits and drawbacks with each of these implant types. Saline implants are simple, less expensive, and there is never a question of whether they are broken or not. These implants are filled with sterile salt water, the same fluid that is given to a person who is in the ER being treated for dehydration. If the implant outer shell develops a break or tear, the implant will quickly deflate, often within a couple hours. The saline that leaks out of the implant is safely absorbed by the body. Because it’s typically very obvious when a saline implant breaks, there is no need for expensive tests to follow these implants. The drawback of a saline implant is the fact that it is not as natural looking or feeling as a silicone implant. Some patients complain of wrinkles and ripples, mainly on the bootom or the sides of the implants.
A silicone implant looks and feels more natural than a saline implant but is more expensive and, even though studies have shown their safety, more controversial than saline. In general, the question now is not whether or not silicone implants make people sick, but How Can We Tell If A Silicone Implant Is Broken? Because the silicone inside the new silicone implants is no longer a liquid, but a cohesive gel, it may be very difficult to tell whether an implant may have a break or tear in the outside shell. The FDA therefore recommends that all patients who undergo cosmetic breast augmentation with silicone implants undergo an MRI of the breasts 3 years after the original surgery and every other year thereafter. This is not a requirement, however. Make sure to discuss this with your board-certified plastic surgeon prior to undergoing a silicone gel breast augmentation.
Should I have my implants placed above or under the muscle?
Breast implants can be placed in a pocket either above the chest (pectoralis) muscle or below it. Traditionally implants were placed above the muscle. This allowed the implants to move with the rest of the breast tissue and provided for the shortest recovery. Unfortunately, there does appear to be a higher risk of capsular contracture (excessive scar tissue around the implant) with implants placed above the muscle. Because of this, many plastic surgeons now place the breast implants in a pocket below the pectoralis muscle. This creates a lower risk of capsular contracture and arguably allows better visualization on a mammogram.
Unfortunately, in certain patients with wide-spaced breasts it can result in a space between the breasts which some women don’t like, along with movement of the implants when the pectoralis muscle is flexed. It is also not ideal for patients whose breasts are a bit droopy. At your consultation, your board-certified plastic surgeon should explain the various risks and benefits of each type of implant pocket, and determine with you which is your best approach.
How long does it take to recover from breast augmentation?
Most patients will take a handful of pain pills and should take 1-2 weeks off of work. For my patients, exercise can resume after 3 weeks.
How long does the surgery take?
Most breast augmentation surgeries should take between one to two hours, and is performed under general anesthesia as an outpatient. I would exercise caution if your plastic surgeon takes less than an hour to do your breast augmentation. Speed does not necessarily equate to quality, and in fact, may be just the opposite.
How can I determine which size implant is best for me?
There are many methods to determining what breast implant size to use. First of all, all breast implants are measured in cc’s or milliliters. There is no standard A, B, C, or D size implant. Because everyone’s bodies are different and their starting breast sizes are different, an implant that could make one person a C could make another person a B. For example, a 350 cc implant may make a person who is 5’4″, and 110 lbs a C cup, whereas it may make a person who is 5’9″ and 160 lbs a B cup.
At home methods for determining breast implant size include the Rice Test (fill plastic bags with a measured amount of rice and place it in a sheer bra) and take-home inflatable sizers which can be purchased at your plastic surgeon’s office or www.MakeMeHeal.com. Allergan makes the Natrelle pre-consultation sizing kit which includes several sizing implants prefilled with mineral oil. You can order one here for $39.99 plus $5 shipping.
Some plastic surgeons prefer the “Trust Me, I’ll Make You Look Good” approach. I’m not a big fan of that, since people have different ideas of what size will make them happy and it doesn’t give the patient enough control over her outcome. The most common method of sizing patients for breast implants is to use preoperative sizers. These are premeasured silicone implants which are placed on top of the breast with a bra to simulate what size a person will be after surgery. I often do this with patients during the initial consultation. The newest method of determining what implant size is best for each individual patient is 3-D imaging. I currently utilize the Axis 3-D system for helping predict the outcome of breast augmentation surgery. By utilizing several digital cameras and a specialized computer imaging program, the Axis 3D system can help determine which breast implant size is best for each individual patient, all using three-dimensional images of the patient’s own body. The other company that has 3-D imaging systems is the Canfield Vectra.
Click here to view before and after images of Dr. Youn’s breast augmenation patients.
There is corrective breast surgery for all types of problems, such as softening up of a hard breast (or capsular contracture). There are many ways to treat capsular contracture. The simplest technique is a capsulotomy, where the scar tissue surrounding the implant is opened up. A capsulectomy involves removal of a portion or all (complete capsulectomy) of the scar tissue. Sometimes plastic surgeons will close off one breast pocket (such as a pocket under the muscle) and create a brand new, virgin breast pocket in a new location (such as above the muscle). A final technique is creation of a neopectoral pocket, where a new pocket is made above a current under-the-muscle breast pocket. Yeah, it’s pretty complicated, so I encourage you to talk it over in depth with your plastic surgeon. In most cases these corrective breast surgeries can result in a soft, realistic breast with no discomfort. There is, however, always a risk that the scar tissue will come back.
Other breast implant problems include implant displacement, malposition, deflation, leak, and asymmetry.
It’s also important to realize that any patient who has a complication or untoward result from previous breast surgery is at significantly higher risk than the average patient for a less-than-ideal result from revision surgery.
How long is the recovery time for corrective breast surgery?
It varies depending on what type of correction is needed. In most patients the recovery time is significantly less than with the first surgery. Your board-certified plastic surgeon should take extensive time during a consultation to inform you on your options available, as well as the recovery time that is necessary.
Click here to view before and after images of corrective breast surgery by Dr. Youn.
Large, pendulous breasts may cause a woman to potentially experience various medical problems caused by the excessive weight of the breast tissue. Problems with posture, skeletal deformities, back and neck pain, skin irritations and breathing problems are common with this condition. Bra straps often leave indentations in the shoulder area. Many women, especially teenage girls, are very self-conscious if they have unusually large breasts.
Breast reduction removes fat, glandular tissue, and excessive skin, resulting in smaller, lighter and firmer breasts that are better-shaped in proportion to the rest of the body. A breast reduction always combines removal of excess skin and breast tissue with a breast lift. Traditionally, this has been performed with a scar around the areola, and then in an upside-down T-shape. The scar fades with time, over approximately 6 months to 1 year. The scar may be nearly invisible in many patients after about 1-2 years, although is still permanent.
During your consultation, your board-certified plastic surgeon should discuss your treatment options for breast reduction surgery. It can often be a covered benefit under certain insurance plans. These insurance plans typically require a combination of factors, including back, neck, and/or shoulder pain, dermatitis or rashes underneath the breasts, a large bra size, and a history of medical treatments such as physical therapy. Most insurance plans also require a minimum weight of tissue to be removed, traditionally over 500 grams per breast (just over a pound). Each individual insurance company and policy may have their own specific requirements. Be sure to check your insurance plan coverages to find out whether your breast reduction will be covered.
What scars are there with breast reduction surgery?
There are two major scar techniques for breast reduction surgery: The traditional inverted T (or anchor) scar and the vertical scar. The inverted T technique has the benefit of a low revision rate and a predictable result. Drawbacks of the inverted T technique include more scarring and higher incidence of ‘bottoming out.’ The vertical scar technique is used more in Europe than the U.S., and has the benefits of less scar and potentially less ‘bottoming out.’ Drawbacks include a higher revision rate and risk of contour abnormalities in the lower part of the breast. Many plastic surgeons who perform the vertical technique limit it to smaller breasts.
How long does the surgery take and what is the recovery like?
The surgery time is usually 3-4 hours, with general anesthesia. Many patients spend the night in the hospital, although going home after a few hours is usually fine. Recovery time is about 2 weeks before going back to work, 3 weeks before going back to the gym.
Click here to view before and after images of Dr. Youn’s breast reduction patients.
Over time, the effects of gravity along with the loss of the skin’s natural elasticity begins to have an effect on the appearance of a woman’s breasts. These factors, combined with pregnancies and nursing will often cause the breasts to lose their youthful shape and firmness.
A breast lift, or mastopexy, is a surgical procedure to raise and reshape sagging breasts. The procedure can also reduce the size of the areola (the darker skin surrounding the nipple). Breast implants inserted in conjunction with a mastopexy procedure can increase both firmness and size.
It is impossible to have a breast lift without scars. It is also important to realize that a breast augmentation alone will not lift the breasts. It will only make them larger. The only way to lift the breasts is with a mastopexy (breast lift).
What scars are associated with a mastopexy (breast lift)?
There are three main types of mastopexy scars. Patients who need a minimal lift or just a reduction in their areolar diameter may be good candidates for a donut mastopexy. This involves a scar around the areola only. Patients who need a moderate lift often undergo a variation of the lollipop lift, with a scar around the areola and vertically downward. Patients who need a maximal lift often undergo a lift with scars that extend around the areola, vertically, and horizontally under the breast (inverted T). After examining you and taking your measurements, your board-certified plastic surgeon should explain why one of these techniques is best for you. Most patients have their scars fade significantly within 6 months to 1 year.
What is the recovery from mastopexy like?
It all depends on if breast implants are used. If the breast lift is performed in conjunction with breast implant placement, the recovery time is similar to a breast augmentation (about 1.5-2 weeks). If no implants are used, the recovery can be closer to a week, although this varies per individual. Most patients wear a special support bra for 3 weeks after surgery.
Unfortunately, insurance plans do not typically pay for cosmetic breast lift surgery.
Click here to view before and after images of Dr. Youn’s mastopexy patients.
Over 60% of males will experience enlarged breasts over their lifetime. Usually this is temporary during childhood or puberty, but occasionally it can persist into adulthood. In addition, some medicines can cause gynecomastia. There are many techniques that your board-certified plastic surgeon uses to reduce male breasts, usually leaving minimal scars. Often, this can be performed using liposuction. Occasionally a small scar underneath the areola is needed to remove thicker breast tissue. The appropriate surgery can be determined during a consultation. Recovery time for gynecomastia surgery is usually quite short, often only a week or so. It has been our experience that insurance providers rarely pay for gynecomastia surgery.
Click here to view before and after images of Dr. Youn’s patients with gynecomastia.
The size of a patient’s nipples can be reduced using a fast and safe procedure. Inverted nipples can also be improved through minor surgery.