Breast Augmentation (Augmentation Mammoplasty)
Breast augmentation is the most popular plastic surgery performed.
Women with small breasts, or with breast that have become droopy over time (e.g. after birth, breast feeding) can most certainly benefit from breast augmentation. Women who have gone through this surgery attest to significantly increased self-confidence.
The aim of surgery is to provide the breasts with volume and shape, thus enhancing their harmony with the female figure. In this surgery, each breast is enlarged via insertion of silicone implants into a “pocket” that is created either directly under the breast tissue or underneath the deeper chest muscle layer. The surgery is performed under general anesthesia and the duration of surgery is approximately one hour.
Note that in situations where breast mass is depleted and “droopy” it may be necessary for the patient to undergo a breast-lift, with or without actual enlargement. Breast augmentation is accomplished via surgery most commonly necessitating an incision of approximately 3-5 cm along the infra-mammary fold. However, in certain situations the surgery is performed via in incision in the shape of a partial crescent along the lower areola/skin interface.
Breasts are fully developed only after completion of sexual puberty, and therefore it is recommended that surgery be performed no earlier than age 17.
Results of this surgery are subject to variability due to changes in the patient’s life after surgery, such as pregnancy and breast-feeding. Any increase exceeding 5 kg in the patient’s weight can lead to changes in breast shape and surgical outcome.
During the pre-surgical consultation, the patient will be asked about any family history of breast or ovarian cancer. A breast examination will also be performed. An up to date mammography examination will be required for women above the age of 40, or for those who present with a family history of these cancers at a younger age. If the patient’s history is significant, or if the patient’s breast examination is suspicious for any abnormality, the patient will be referred to a breast surgeon.
Breast augmentation is performed with a great deal of planning before-hand, and factors such as breast size, chest measurements, body shape, and the patient’s wishes are all taken into consideration. Breast augmentation can provide the patient with a naturally appearing look or, if desired, a highly provocative appearance.
The most popular and desired location of incision is located along the infra-mammary fold. In this location, the scar is successfully inconspicuous. It is possible, however, to have the incision made along the areola or within the axilla region. Note that the appearance of the remaining scar, despite its genetically determined nature, is always less than ideal when located on the areola or near the armpit.
Breast enlargement with silicone implants can be performed by creating a “pocket” above or below the chest muscle. Not every woman is suitable for placement of implant beneath the muscle, just like not every woman is suitable for placement of implant above the muscle. Women who have an adequate amount of breast tissue that can help camouflage the underlying implant can indeed have the implant place above the muscle layer. In this scenario, the implant is sure to be placed at the right breast height. On the other hand, women with thin breast tissue, small breasts, or a narrow chest wall, are better off having the implant placed below the chest muscle (at least the upper part of the implant concealed below the chest muscle). In this way, the implant will be inconspicuous at its upper pole. When the implant is placed below the muscle, it is usually inferred that the implant is placed in a “dual-plane”: the upper part of the implant is placed below the muscle, while the lower part of the implant is situated above the muscle.
To date, most breast augmentation surgeries are performed using silicone implants. In the past, implants containing saline solution were also used, however today they are mainly utilized for breast reconstruction surgeries.
Today’s new generation of silicone implants are composed of an outside shell that is multi-layered and textured, with a moderate/high-viscosity silicone center. This elevated viscosity prevents silicone leakage, even if the implant is ruptured.
There are two main types of implants. The first is the Round type, with various levels of projection. In most breast augmentation surgeries, this type of implant is used.
The second type of implant is the Anatomic type (tear-drop shape), and they come in various sizes and lengths as well.
The type of implant and size are chosen based on considerations determined at the pre-surgical consultation. During the surgery, these final parameters are established and the exact implant is then chosen. The size of implant is limited based on breast and muscle tissue elasticity, chest wall size, and the size of “pocket” formed.
After insertion of the appropriate silicone implants, the incision is closed with absorbable sutures.
At times, slight asymmetry may exist between the breasts. In such cases, differently sized implants will be placed in under each breast in order to achieve overall symmetry.
For each implant purchased, the patient will receive a product warranty from the manufacturer. The company will be responsible for a new implant in any case of deformity, defect, or spontaneous rupture. The shelf life of the implant is approximately 20 years. It is important to schedule periodic check-ups in order to evaluate the intactness of the implant. Upon completion of surgery, the patient is to wear a “sports-bra”. This bra is to remain in place for approximately one month.
Duration of initial recovery is about 2 weeks. During this period, the patient may suffer from local tenderness, bruising, edema and swelling, nipple protrusion, and slight changes in breast and nipple sensitivity. These signs pass several weeks after surgery.
During the first period after surgery, the chest will appear and feel artificial in nature. Only after several weeks to several months will the breast reach its final natural appearance.
Physical activity is highly discouraged in the first 2-3 weeks after surgery, and it is recommended that one avoid sleeping on the stomach side for at least one month.
Breast enlargement surgery does not pose any potential difficulty in future breast-feeding.
Throughout life, every woman undergoes routine breast examinations and mammography imaging every several years. During these examinations, it is very important that the patient notify her examining physician if she underwent any breast augmentation surgery. Note that breast enlargement surgery renders these routine examinations less efficient in detecting any breast abnormality, thus making it vital for the patient to undergo additional imaging tests.
Complications of this surgery are rare, and may include:
1) Excessive bleeding that may require drainage in the operating room
2) Infection that may, in most cases, be treated conservatively
3) Implant folding towards the upper pole
4) Capsular contraction – hardening of the outer implant shell- this envelope appears due to the body’s natural response to a foreign body. This texture of this envelope is initially soft and delicate, but any surrounding changes – such as rupture, time, or other causes – can lead to hardening of this envelope, breast distortion, and local tenderness. It is highly recommended that the patient consult her surgeon when such a scenario arises.
5) Hypertrophic or keloid scarring
6) Rotation of the implant
7) Opening of sutures
8) Rupture of the implant- a very rare complication. The chances of this outcome increase with years elapsed after breast augmentation. In such a scenario, it is recommended that the implant be replaced
Additional information about this surgery will be made available during the pre-surgical consultation.
Please take the time to look at "Before and After" pictures.