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Breast augmentation is the use of implants or ones own tissue to increase the size and projection of the breast in women dissatisfied with their appearance. Surgical enhancement of breast size is one of the most common cosmetic procedures performed today with a wide variety of techniques and implants used to help patients reach their desired goals. Our surgeons seek to tailor treatment plans to each individual patient using the entire gamut of procedure and implant options available.
The different methods for performing breast augmentation can be separated based on the type of incision and the location of implant placement (above or below the pectoralis major muscle). The common incisions used are the peri-areolar (around the bottom of the nipple) and the inframammary fold (in the fold underneath your breast). The main benefit of the peri-areolar incision is that it is generally very well hidden and can oftentimes be nearly impossible to see. This must be measured against the downside of increased rates of capsular contracture and decreased visualization possible during the procedure and thus impaired ability of the surgeon to optimize shape. Although the inframammary fold incision is not as well hidden as the periareolar, its scar is typically quite minimal and can be difficult to see. In addition this technique has a lower rate of complications and enhanced ability of the surgeon to see the entire surgical field leading to improved ability to shape and optimize outcomes. These options can be discussed and the best option for each patient chosen.
The second important decision in breast augmentation is the type of implant to use. There are 2 general categories of implant type available today. These are saline filled versus silicone filled.
The category of saline filled is fairly straightforward and standard as these are simply silicone shells filled with saline to a preoperatively determined size. The main benefit of saline implants is that if a rupture of the implant were to occur the event would be easily recognizable and therefore quickly addressed. A major disadvantages of saline are that the implant tends to confer a less natural feel as saline is an unyielding fluid as compared to silicone.
Silicone breast implants are once more available for breast augmentation following their removal from the market in the late 90s. Due to a series of high profile litigation suits the implants were pulled from the market until they could be fully investigated for any potential negative health implants of their implantation. Since that time a plethora of research has come out disproving the accusations made against the devices allowing them to once more be approved by the FDA. Silicone breast implants come in a variety of shapes, sizes, and feels allowing increased customization for the surgeon and patient. Through careful preoperative planning patients can have implants chosen that will uniquely meet their desired goals. The main advantages of soft, natural feeling and customizable effect from the implant make silicone the preferred choice for the vast majority of surgeons and patients in the United States and the World. The main disadvantage of silicone implants is that if a leak were to occur it could go undetected if medical imaging is not performed. It is important that each person identify what is important to them and discuss their options candidly with their patient.
The final decision to make in breast augmentation surgery is where to put the implant. The options for implant placement are essentially above (subglandular) or below (subpectoral) the pectoralis major muscle. Both possible locations carry with them advantages and disadvantages which should be recognized and discussed with your surgeon.
The subglandular location refers to placement of the implant above the pectoralis major muscle and below the glandular tissue of the breast. The final look from using this location is typically one of increased upper pole fullness and frequently results in a more augmented appearance. Since the muscle is left alone during this procedure some patients experience less pain than they otherwise would have. The main problem with this procedure is that it carries with it a higher risk of developing capsular contracture, a complication of implant placement wherein a tight capsule forms around the implant possibly resulting in deformity and even pain. Another potential problem with this approach is in patients with thinner skin the implant may be somewhat visible with notable rippling of the skin and implant edges. For this reason not all patients are a good candidate for the subglandular procedure.
The submuscular location refers to placement of the implant below the pectoralis major muscle with or without release of the muscle from its inferior attachments to the chest wall. This approach tends to result in a more natural appearance of the breast and is ideal for patients who desire larger breasts but do not want people to know they were augmented. The main disadvantage of this technique is that more is done during the procedure and thus has a higher potential for discomfort in the immediate postoperative period. The benefits of submuscular placement are a more natural final result, lower risk of capsular contracture and decreased risk of rippling and visible implant edges are typically felt to outweigh this risk of discomfort. Placing the implant below the pectoralis major muscle does not result in weakness of the chest muscle and is the preferred technique used by most surgeons today. Since some patients are not ideal candidates for this technique it is important to discuss all options with your surgeon.
Finally, exciting new techniques are being researched that seek to transplant undesired fat into the breast for the purpose of augmentation. Although not currently offered by our surgeons, the evolution of these techniques are being closely monitored and their applicability assessed in hopes to one day offer them.
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