BREAST AUGMENTATION Breast Enlargement with Breast Implants

This includes the following procedures;

Augmentation Breast Surgery
Reduction Mammoplasty
Breast Uplift / Suspension Breast
Nipple Areola Complex Cosmetic Surgery

Breast augmentation is one of the most popular cosmetic surgery procedures done world wide. Through the placement of breast implants, women have been able to achieve changes in their figure (breast enlargement / breast enhancement) that otherwise would have been impossible.

In order to determine whether breast augmentation surgery is for you, you must weigh the risks and the benefits of breast augmentation. This page will explain all of the options in breast augmentation surgery.

In spite of their overwhelming popularity, breast implants have limitations. Breast augmentation surgery will not improve nipple asymmetry, move your breasts closer together, lift droopy breasts, or remove stretch marks. If you have droopy breasts, you may need a breast lift (mastopexy). Also, breast implants are not free of problems (see Risks and Complications of Breast Augmentation).

After you have had a chance to learn about the options in breast augmentation (below) and Risks and Complications of Breast Augmentation be sure to visit Tips for Getting the Best Results from your Breast Augmentation to help you minimize your risks, expedite your recovery, and get the best possible results.

Breast Implant Surgery :
Before you decide for Augmentation Breast with Implant, it is important to know the following details:

1. Breast Implant Size [ Volume]
This is the all-important size issue. Breast implants come in all sizes with the most common sizes ranging from 200-600 cc. This is equivalent to 7-20 ounces. By the way, a cc (cubic centimeter) is the same as a ml (milliliter) - just in case you have visited other sites which refer to volumes in mls.
Although the range, 200-300-450cc is probably the most common, the decision is highly personal and highly individualized. The best way to determine your size is by placing breast implant sizers in your bra and then put a sweater, blouse, or t-shirt on (or, perhaps try all of them, as you will appear different in each). Size of implant has to be your choice, you will not be dictated. You must have input in this decision and you must feel comfortable with your size

2. Implant Shape (round or anatomic (teardrop))
Round implants are shaped like jelly donuts. Teardrop implants are shaped more like the breast [ relatively costly]

At first, you might be thinking that (of course) teardrop implants would be better. However, most plastic surgeons disagree: they think that teardrop implants tend to become round with the forces of healing and that the teardrop implants do not necessarily give a better result. Furthermore, they find that teardrop implants may rotate, giving an unnatural appearance, and they impose restrictions in that they must be textured.

Personally, I tend to recommend the techniques that work best in my hands, I recommend round breast implants; but, you can exercise your choice.

3. Breast Implant Projection (standard vs. high profile)
Breast implants are designed so that, as volume increases, so does diameter (the footprint of the implant) and projection (the amount it sticks out, away from your body).

Standard implants are designed so that MOST women who choose a given volume will be able to accommodate the breast implant's diameter beneath her breasts. This is so because women with narrower breast diameters often have smaller bodies and tend to choose smaller breast implants; women with wider breast diameters often have larger body frames and tend to choose larger breast implants. In other words, women tend naturally to choose an implant volume that is in proportion with body size and breast diameter, and the breast implants were designed in anticipation of that.

With a High Profile Implant, the volume is the same, but the diameter (footprint) is narrower and the projection (the amount that it sticks out away from your body) is greater.

4. Breast Implant surface (textured or smooth)
Implant surface is smooth or textured. Once the implants are in place under your breasts, it is impossible to tell whether you have smooth or textured implants. A smooth implant is just that - as smooth as the surface of a balloon. Textured implants are rough and mostly preffered.

5. Position of Implant (under or over the muscle)
By implant position, plastic surgeons are referring to whether the breast implant should be placed above or below the pectoralis muscle. Here is an explanation of the advantages and disadvantages of both options.

The advantages of placing the breast implant above the muscle includes less discomfort post-operatively, less swelling, and less chance that the breast will appear to move when you are exercising your upper body.

Movement during exercise has been a great concern for many women. Athletic women should consider placement of the implant above the muscle (as long as they have adequate breast tissue and body fat) to avoid breast distortion during flexing. Simply put, if your breast implants are under the muscle, then when you flex your pectoralis muscles (as you often do during workouts), your breasts may appear to move. Sometimes (though not commonly) the breast motion will appear quite distorted.

One drawback is that rippling can be a significant cosmetic problem that can occur when the implant is placed over the muscle. (See Breast Implant Risks and Complications for an explanation of these things.)

The advantages for placing the implants under the muscle include less interference with a mammography and less rippling in the upper half of the breast. Also, there is more cushion between the implant and skin. In general, thin and small-breasted women are probably better off with implants under the muscle

Placement of the implants under the muscle has few drawbacks, many of which are temporary. The discomfort after surgery can be heightened along with more swelling. You may also find that your breast appears to move when you are exercising your upper body.

Of course, the placement of your implants is your call. Be sure to discuss it carefully.

Personally, in my experience, more patients choose to have implants over the muscles.

6. Saline Filled Vs. Pre-filled Silicone Gel Implants
Silicone breast implants provide a more natural look and feel, which is particularly important to women who have a modest amount of breast tissue. Although all women want a natural look and feel, women with larger breasts can often achieve this with saline implants. Women with smaller breasts typically cannot. The main disadvantage of silicone gel breast implants is that they might have a higher rate of capsular contracture, the incision is usually longer, and the cost is higher than saline breast implants. 
Each saline implant can be and SHOULD BE overfilled by an additional 25-30 cc. This is because the implants were meant to be overfilled, and the implant manufacturers not only stand by their products when they are overfilled, but they encourage surgeons to overfill them. Here's why: overfilling reduces deflation, rippling, and sloshing. (See Risks and Complications for an explanation of these things).

Underfilling has no advantages and significant disadvantages (rippling, sloshing, and deflation). So, after you select your desired final volume, your surgeon should select an implant that is one size smaller, and then overfill it to your desired volume.

7. Site of Incision 
The options for site of incision are under your breast, around your nipple, in your armpit. An incision under the breast is placed within or near the natural crease beneath your breast. This incision has the advantage of having the scar hidden in the shadow of the crease under the breast. It also heals well. It also is the incision you would likely get anyway if you require revision surgery later in life. Most plastic surgeons use this incision. I personally prefers this incision.

Around the nipple can give a good result in some women, but is riskier because it is at the focal point of the breast, so any irregularities in the scar will make it far more obvious. It also imposes a higher risk of nipple numbness and inability to breastfeed.

Under the arm is an option and has the advantage of being hidden in the armpit. Although many of these scars heal favorably, some armpit (axillary) incisions can be unsightly. Also, revision surgery, if needed, might not be possible through the existing armpit scar, so an additional scar would be necessary.

Risks and Complications
Breast augmentation can give you fabulous results. However, it also poses some risks that can lead to complications and unfavorable results. This page will explain the risks and complications associated with breast augmentation surgery when you are exercising your upper body.   

1. Capsular contracture :
Capsular contracture is a scar that forms around the implant, causing it to feel firm, look unnatural, and potentially hurt. When you see pictures of a woman with obvious implants who looks like she has "coconut breasts", she more than likely has a severe capsular contracture. These are though to be less common and less severe with saline implants than with silicone implants, although studies are underway to determine whether this is true. If you develop a mild capsular contracture, you may not be bothered by it and may not even notice you have one. If you develop one that is moderate or severe, you will probably require surgery to correct the problem. Surgery involves removing the scar and placing a new implant. In spite of this, the capsular contracture may return. 

Placing the implant under the muscle has a lower risk of capsular contracture than placing the implant over the muscle. 

2. Interference with mammography 
Breast implants do interfere with the ability of a mammogram to "see" all of your breast tissue. Placing the implant under the muscle allows for the least amount of interference.

With the breast implant under your muscle, mammograms can "see" about 90% of your breast tissue. With the breast implant over the muscle (AKA under the breast), mammograms can "see" 75% of your breast tissue.

Whether under of over the muscle, implants do not interfere with your ability to detect lumps in a self breast examination. Self exams are found to be the most successful way in discovering the majority of breast cancers. Implants also do not interfere with ultrasound or MRI scans, which are helpful in the evaluation of breast masses. 

3. Implant displacement 
Implants can move out of position at anytime after breast augmentation surgery. They can move upward, downward, left or right. If they move only a little, you may not even notice. If they move a lot, you may need further surgery to move them back into position. Fortunately, this problem is not common. The larger the implant, the greater the chance that it will displace downward.

4. Saline Implant deflation 
Saline implants can develop a leak and deflate. If this happens, your breast will shrink to its preoperative size over a matter of a day or so. You will need another breast augmentation surgery to replace the deflated implant. 
Deflation is most likely to occur in implants that have not been overfilled. Yes, you read that right. Overfilling reduces deflation. This is because deflation is a result of folding of the implant shell, which occurs repetitively in implants that are not overfilled. After the implant shell has folded hundreds or thousands of times with your natural body movement, the implant shell tears - just like a piece of paper that has been folded time after time.

Risk of deflation is about 4% during the first year following breast augmentation surgery , the chance is then about 1% per implant per year for each year thereafter. 

5. Silicone Implant rupture
Whereas saline implants are said to deflate when the silicone shell becomes disrupted, silicone implants are said to rupture [not frequently happens]. It really is the same thing, except that when silicone gel implant shells rupture, the silicone does not become quickly reabsorbed by your body. Hence, you might not know whether you have a rupture. If silicone gel extrudes out of teh implant shell, then it might provoke an inflammatory response, leading to...that's right....a capsular contracture. This is often the first sign of a silicone gel implant rupture. Whereas ruptures occurred with great frequency in implants made in the 1980's, the newer silicone gel implants have thicker shells and are presumed to have a lower rupture rate (studies are underway). If you develop a moderate or severe capsular contracture with a silicone implant, then the usual treatment is surgical removal of the implant along with the capsule, which is really made up of surrounding scar tissue. A new implant can be placed at the same time. 

6. Rippling 
This is the visible appearance of waviness of the skin over your implants, like the ripples of a wave on a lake. Some doctors refer to this as "wrinkling."

The rippling occurs due to saline shifting around inside your implants. It is most troublesome if it occurs in the upper half of the breast, because it would be evident in low-cut clothing and swim wear.

Rippling is uncommon when the implants are over filled and is less common with smooth implants than with textured ones. Also, when the implants are placed under the muscle, there is less chance of rippling in the upper half of the breast. Rippling is much less common with silicone than saline. 

7. Infection 
Infection, if it occurs, usually does so within two months of surgery. Infection occurs in about 1% of all implant surgeries. If an infection occurs it often requires antibiotics and the removal of the involved implant. A new implant can be placed six months later, which means you would have to go for six months with very uneven breasts. 

8. Nipple numbness 
If the possibility of having numb nipples is unacceptable to you, you should not have breast augmentation because no surgeon can guarantee preservation of nipple sensation. The national risk of having permanently numb nipples is about 15%.

9. Breast feeding and pregnancy
Breast feeding ability is not altered by implants. Many women ask about the effect of future pregnancy on augmented breasts. In most cases, implants will not affect the fate of your postpartum breasts. Here is why: following pregnancy (and breast feeding), your breasts will shrink to their pre-pregnancy size (or there about). During this process of shrinking, your breast skin may either tighten or not tighten. If it tightens, you will most likely not have breast droop. If it does not tighten, then your breasts will unfortunately droop. Whether or not the skin tightens has little or nothing to do with the presence or absence of implants. 

10. Need for Further Surgery 
Women unwilling to accept the potential need for further surgery should not have breast augmentation. Understand that if you receive any implant in your body - whether it be a pace maker, artificial joint, artificial heart valve, or anything - that one of the inherent risks is that you may need further surgery on it at some point in your life. With breast implants, you may need further surgery for capsular contracture, deflation, rippling, displacement, infection, desire for a different size, or another reason. 

You may also go a lifetime without having any problems. But, it is most prudent to assume that at some point, you will probably want or need another surgery to address one of these problems.

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