Breast augmentation is a popular cosmetic procedure performed to increase a woman’s breast size using saline implants, silicone gel implants or in certain cases, fat transfer. It allows a woman to achieve a better-proportioned figure and gain a better fit into her clothes, often resulting in improved confidence.
Who is a candidate for breast augmentation?
Good candidates for this procedure are healthy patients who are self-conscious about their breasts being too small for their body or whose breasts have become smaller after weight loss or childbirth. Patients should have realistic expectations regarding their breast size.
How is breast augmentation performed?
Breast augmentation is typically performed using implants, either saline or silicone gel implants. Saline implants are filled with sterile salt water and are usually filled at the time of surgery. Silicone implants are filled with a silicone gel material and come in a variety of shapes. These implants are pre-filled when manufactured and may require a longer incision to fit them through. Anatomic (gummy bear or form stable) implants are designed to hold their shape better and often appear “tear dropped.” Less frequently, fat transfer is utilized for modest breast augmentation by using fat obtained from your abdomen, hips or thighs.
The choice of implant depends on many factors and preference as well. Silicone gel implants feel more natural and softer compared to typical saline implants but may require slightly longer incisions. The size of the implant is determined based on a couple of factors. First, measurements of your breasts are taken to ensure that the diameter of the implant fits your chest. This serves as an initial guide. Next, patients try on different implant sizers within a regular bra and a tight t-shirt to get a better idea of the look and feel that they want. It’s important that enough time is dedicated to this process, as implant selection is one of the most crucial steps in breast augmentation. Based on the volume and diameter of the breast implant, the projection (how much the implant sticks out from the chest) can be determined. Implants can have several different projection profiles, including extra-full, full, moderate and low profiles.
Once the appropriate implant size and profile is chosen, the implant is placed in a pocket usually underneath your pectoralis major (subpectoral) muscle in a dual plane. This allows for a more natural result as the muscle over the implant provides additional tissue for coverage and results in a smoother slope at the upper chest. Placement under the muscle also reduces the risk of capsular contracture, an infrequent complication that occurs when the scar tissue around the implant becomes thick and tight, leading to discomfort or disfigurement. At times, the breast implant may be placed above the muscle for certain individuals like body builders in order to avoid animation deformity, a situation where the implant moves when the pectoralis muscle is activated. Commonly, the incision is made under the breast at the breast crease or at the areola border. Less frequently, the incision is made in the armpit or the belly button (saline only).
Decisions to make in Breast Augmentation:
- Implant Filler: Silicone or Saline
- Implant Shape: Round or Anatomic (form stable/gummy bear/tear-dropped)
- Implant Size/Volume: based on breast measurements and trying on sizers
- Implant Profile: extra-full, full, moderate, low/flat (how much it sticks out)
- Implant Surface: Smooth (common & safe) or Textured
- Incision Location: breast crease, areola border, arm pit
- Implant Placement: Submuscular dual plane or Subglandular (above the muscle)
What to expect after surgery?
Dr. Farris and his staff at Farris Plastic Surgery will provide specific instructions regarding your surgery. Postoperative pain is minimal and recovery is within 1 week, usually a few days. Strenuous activity should be avoided for 3 weeks. Breast implant massage should begin after surgery and will be described to you in the office. This massage will reduce the risk of capsular contracture (tightening due to scar tissue around the implant). The results of breast augmentation are long lasting under normal circumstances. Keep in mind however, implants need to be replaced if they leak or rupture. As you age, experience childbirth or undergo weight change, you may need revision surgery to change your implants or have a breast lift.
- Where are the incisions made during a beast augmentation and will they leave scars?
The two most common incisions used for breast augmentation are either the small incision placed at the lower breast fold/crease or at the lower half areola (pigmented skin around the nipple) border. All incisions result in permanent scars but these scars tend to fade and heal very well and are well concealed.
- How do you determine what type of implant to use?
To begin, you can choose between silicone or saline implants. Saline implants are filled with “salt water” and have sometimes been called “water balloons.” Silicone implants are filled with thick cohesive silicone material that allows these implants to typically feel softer and more natural. Both types are safe and FDA approved. Implants can be round or shaped (gummy bear/anatomical/form stable). The shaped implants appear tear-dropped and bottom heavy. The round implants are pretty standard and provide more upper pole fullness. The size of the implant is determined based on a couple of factors. First, measurements of your breasts are taken to ensure that the diameter of the implant fits your chest. This serves as an initial guide. Next, patients try on different implant sizes within a regular bra and a tight t-shirt to get a better idea of the look and feel that they want. It’s important that enough time is dedicated to this process, as implant selection is one of the most crucial steps in breast augmentation. Based on the volume and diameter of the breast implant, the projection (how much the implant sticks out from the chest) can be determined. Implants can have several different projection profiles, including extra-full, full, moderate and low profiles.
- How long do breast implants last and/or will they need to be exchanged?
There is a common misconception that implants need to be exchanged every 10 years. This is not true! There is no expiration date! A rough estimate of overall implant failure would be 1% per year. If there is nothing wrong with your implant, there is no need to change your implant. However, reasons to have your implant exchanged include implant rupture (silicone) or deflation (saline), capsular contracture or desire to change the size.
- Is there a possibility my body will reject the breast implants?
The term “rejection” refers to an immune mediated response where the body mounts a cellular attack to something recognized as “foreign” in order to remove it. Breast implants have been studied extensively over the years and show no evidence of eliciting a rejection. The outer shell of a breast implant is inert and does not cause a “rejection.”
- How come some implants cause the breast tissue to feel hard?
If your breast feels hard after having breast implants, you likely have a capsular contracture. This is one of the potential complications of breast augmentation with implants. Any foreign object that is placed within your body is typically walled off by a thin layer of scar tissue called a capsule. Over time, there is a risk that this capsule can thicken and tighten, causing disfigurement of your breast, hardness and discomfort. The treatment for capsular contracture is surgical removal or breaking up of the capsule. Often, preventative measures like breast exercises performed immediately after breast augmentation help reduce the risk of capsular contracture by loosening up the capsule.
- Will breast implants affect being able to breast-feed?
Breast implants should generally not affect your ability to breast-feed.
- Should I get breast implants if I plan on getting pregnant later?
After pregnancy and breast-feeding, the breasts often change size and shape and may appear deflated and saggy. This would ruin your cosmetic result if you had breast implants placed before your pregnancy. If you had the choice, get the breast implants after your pregnancy. This way, you can get the implants and also have the option of a mastopexy or breast lift to address the saggy, loose skin.
- What is the benefit of placing the implant under the muscle as opposed to above the muscle?
Placing the breast implant under the pectoralis major muscle (submuscular) allows for more tissue coverage of the implant (good for thin patients), decreases rippling, reduces capsular contracture risk, conceals the borders of the implant better, provides a more gradual slope and allows for easier breast cancer screening. Keep in mind that a submuscular implant is typically under the muscle superiorly and medially only. Placing the breast implant above the muscle (subglandular) allows for a faster recovery, avoids the risk of visible muscle contracture around the implant and is good for women with ample breast tissue or those with slightly sagging breasts who don’t want a lift. Generally, most breast implants are placed in a submuscular plane.
- What can a patient do after the breast augmentation surgery if she feels that her breast size is too small or too large?
Although you may feel disappointed over your breast size, revision surgery is an option for you. Revision surgery to exchange breast implants for a different size is not difficult and associated with a shortened recovery time. It’s advisable to wait a couple of months for proper healing before doing this. Having said that, it is paramount that you have good communication with your surgeon about expectations regarding implant size in the first place.