Overview of Breast
Breast augmentation is one of the most common procedures performed in Plastic Surgery. When performed by a competent plastic surgeon the results are dramatic with little scarring, and little down time. Many women want their breasts enlarged because they know it would make them feel more self-confident, more attractive, and will make them fit into clothes better. Often, they have thought about it for a long time. Others seek augmentation because their breasts have begun to sag, either due to age or childbirth. These women wish to regain that youthful “perkiness” and cleavage they once had. Some wish to return back to the shape they were in their early twenties. Others, when given the option, want a more dramatic enhancement. The effect of augmentation in the saggy breast is impressive as it raises the nipple, fills out the sagginess, and creates significant breast projection, as well as cleavage.
Incision for Breast Augmentation
There are three incisions that most plastic surgeons use for breast augmentation. For the majority of patients, the peri-areolar incision provides the best results. This incision allows for the most accurate implant placement, because it is located exactly where the implant needs to go. In addition, the scar is the least visible of the three incisions because the areola heals much more favorably than normal skin. This is especially true when the incision is made right at the margin of the areola.
The three incisions are:
Inframammary fold: Within the fold at the bottom of the breast.
Peri-areolar: Exactly at the margin of the areola where the lighter skin meets the darker skin.
Axillary: Within the axila (armpit).
All 3 incisions can provide excellent results. The incision along the margin of the areola allows for very accurate implant placement. The scar becomes almost imperceptible within 2 months for most women. The incision within the inframammary fold at the bottom of the breast can provide excellent results but in some women scar widening can occur with this incision. Also these incisions tend to remain redder for a longer period of time than the Peri-areolar incision. The axillary incision also can provide a great result but implant placement is more difficult because the implant is being placed from a remote location.
Benefits of Breast Augmentation
There are many benefits to breast enlargement. These range from an improvement in how clothes fit you to how you feel about yourself. In general, there are two types of women who benefit most from breast augmentation. Both of these are dramatically helped by the procedure.
The first is a woman with naturally small breasts who has always wanted to have larger breasts. Typically, she is very self-confident but believes she would feel even more self-confident with larger breasts.
The second type is the woman who has developed saggy breasts. This often occurs as a result of childbirth, aging, or weight loss. This woman wants her breasts to be “perky like they used to be” and she may even want her breasts to be a little bigger than they used to be.
Breast augmentation can correct only minor amounts of breast sag. If the sag is minimal, a breast augmentation can provide the necessary breast lift. If there is a significant amount of sag, a breast lift is required. This can be done with or without an implant, depending on how much breast tissue remains and what the patient wants. By increasing the breast volume with an implant, the nipple/areola complex elevates slightly.
Below are some of the reasons you might desire breast augmentation.
- If you are self-conscious about your small breasts size.
- If you feel that larger breasts would make you feel more attractive and improve your self-confidence.
- If you have a hard time finding clothes that fit because of the discrepancy between your breasts and your buttocks.
- If you have saggy breasts due to age or childbirth.
- If you desire more cleavage.
- If a recent weight loss left you with smaller, sagging breasts.
- If there is a significant difference between one breast and the other.
- If you feel unable to wear sexy clothes because of your small breast size.
- If you feel your body is disproportionate because your hips are much larger than your breasts.
The benefits of breast enlargement are significant; however, they must be weighed against the downsides. These include cost, time away from work, need to buy new clothes, and a possible need for revision surgery.
When is a breast lift necessary?
The answer to this commonly asked question is not simple. Below are some of the many variables that must be considered.
The infra-mammary fold (IMF) is the fold below the breast tissue. In general, if the nipple is above the IMF, then a breast lift is usually not necessary. If the nipple is more than 1 centimeter (about one-half inch) below the the IMF, then a breast lift is most likely required.
What if the nipple is at the level of the IMF?
In this situation, the need for a breast lift depends on two factors. The first is how big the implant will be. A large implant will create more lift. The second is what bothers you more: low nipples or scars around the areola? Although the scars are not very noticeable, they are still scars.
Are you a good candidate for Breast Implants?
To determine whether you are a good candidate just look above and see if any of the scenarios apply to you. Most women who consult with your Dr for breast augmentation have known for quite a while that they want their breasts enhanced. Often, they know of friends or family that have had it done. The most important consideration is to do it for the right reasons! Do it for yourself! Don’t do it for a boyfriend or a husband or anyone else. Do it because you believe that you would be more self-confident, your body would be more proportional, and you would feel better about yourself.
Possible Complications Associated with Breast Augmentation
The most common complications of breast augmentation are:
- Wrong choice of implant size. Sometimes patients believe that their implants are too big; more commonly they believe that they are are too small. The likelihood of patient dissatisfaction can be markedly reduced by a proper preoperative evaluation as well as by the surgeon’s experience. Implant size is always discussed with your Dr during preoperative evaluation and consultation. At that time, you will try on specially-designed bras filled with different volumes to imitate what the implants will look and feel like. Patients report that this helps tremendously to determine what size is best for them.
- Asymmetry and/or implant mal position.
- Capsular contracture. This is when thick scar tissue forms over the implant making the breast feel hard.
- Nipple sensory changes. This is common right after surgery but usually goes away. Often, the nipple is hypersensitive for the first 6 weeks after the procedure and may be quite erect. This will go away with time.
- Infection. Because an implant is a foreign body, infection is always a consideration. To avoid this, antibiotics during and after the operation as well as a meticulously sterile technique. If infection does occur, it is possible that the implant may need to be
- Implant rupture. If this happens, the saline leaks harmlessly into the body tissues. Most of the time the implant manufacturer will pay for a new implant.
- Implant rippling. This is markedly reduced when the implant is placed under the muscle. It occurs more commonly along the lateral margin where complete submuscular coverage is not always possible.
What are the Advantages of Silicone over Saline?
Silicone has two significant advantages:
1. It feels more like breast tissue. The gel-like feel is more natural than the fluid-like feel of saline.
2. Silicone gel is less likely to ripple than saline.
What are the Advantages of Saline over Silicone?
Saline has several advantages over silicone:
1. Sixty per cent of the human body is made of saline. Therefore, if there is a rupture the saline just gets flushed out of the body. With silicone, the gel remains and is much harder to remove it completely.
2. The incision to put silicone implants in is a little longer than that of saline. This is because saline implants go into the breast empty and then are inflated, silicone implants, on the other hand, go into the body already filled.
3. Cost. Silicone implants cost more.
What to expect as you recover
1. Immediately after surgery, some patients feel groggy or nauseous. These feelings normally subside by the next day.
2. Many patients experience some pain for the first 3 to 4 days and soreness for the first 2 weeks
3. Do not be concerned if the breasts are swollen and tight for the first six weeks after surgery; they will relax and drop with time. At your follow up appointment, your Dr will show you how to massage your breasts to make sure positioning is appropriate. Since the body heals asymmetrically, one breast might be more swollen, hurt more, and appear higher or lower than the other. This is normal; do not be concerned.
4. Swelling and bruising usually clear up within 2 weeks.
5. Pink scars will eventually fade to an unnoticeable skin tone. It may take up to a year for the scar to fade to its minimal color. Some firmness may develop. Once the tenderness subsides, you may begin to massage the breasts to help soften them. At 3 months after surgery, you should massage your breasts daily during your shower for 30 seconds. Continue to do this for the rest of your life.
6. During the first 3 months after surgery, your nipples might become hypersensitive or lose sensation. This usually disappear with time.
Recovery time after Breast Enlargement
Some people with sedentary jobs go back to work as early as 3 or 4 days. If your job, however, requires aggressive arm movements it may take as long as 4 weeks to return to work. Most people return to work after one week.