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Breast Augmentation

If you are considering breast augmentation surgery, there may be many different reasons why you seek to have this done.  It is a personal decision and really only something you should be doing for yourself.  While some may just want to restore the shape and size of their breasts pre-pregnancy and breast-feeding;  some may want to obtain a more feminine shape and feel and look better in certain clothing or bathing suit.  Breast augmentation can help you to feel better about yourself and more confident in your self image.

Breast Augmentation, or Augmentation Mammaplasty (breast enlargement), is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty is not a substitute for mastopexy, which is a procedure to "lift" breasts that sag significantly.

Breast Augmentation with Implants

Silicone and saline are the two implant types most commonly used in augmentation mammaplasty. Silicone implants feel more like natural breasts than saline ones. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant has an extracapsular rupture (a rupture to the outer capsule), silicone filler leaks into the body, possibly resulting in inflammatory nodules or enlarged lymph glands.

Implants are placed behind each breast, underneath either breast tissue or the chest-wall muscle. The procedure lasts 1 to 2 hours, and is typically performed with general anesthesia. Incisions are made in inconspicuous places (in the crease on the underside of the breast, or around the areola, or in the armpit) to minimize scar visibility. The breast is then lifted, creating a pocket into which the implant is inserted.

Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around implant), and less interference during mammograms. Disadvantages include the possibility of a longer recovery period. Advantages of implant placement beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles, and that slight breast sagging is corrected.

Other types of implants include "gummy bear," round, smooth and textured.

Saline versus Silicone Breast Implants

The silicone gel breast implant has a silicone based shell, and is pre-filled with a silicone gel from the manufacturer.  The saline-filled breast implant has a silicone based shell, and is then filled with saline by the surgeon at time of the operation.  Currently, in my practice, about 85-90% of women will choose the silicone gel implants.  But keep in mind that majority of women can get a great result with either silicone gel or saline implants.

It is important to note that the FDA has approved the use of the silicone gel breast implants for cosmetic breast augmentation for women of 22 years of age and up. There is no age restriction for the saline implants.

"No-Touch" Technique

Dr. Rhee utilizes the "no-touch" technique when performing her implant-based breast augmentations.  The implants will not touch anything outside of its sterile encasing and will be soaked in an antibiotic solution and then directly transferred into an implant funnel which will then be inserted through the incision into the pocket, which will be also washed with antibiotic solution, so that the implant does not have contact with the patient's skin.  The theory behind this method is it may help decrease the risk of infections.  And although capsular contracture is still not fully well understood, it is thought to be impacted by a subclinical infection (infection without symptoms) that creates a bio-film around the implant.

Breast Augmentation with Fat Grafting

Breast augmentation with fat grafting (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. This method is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible and also have enough fat to be harvested.

First, fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified. Then, the fat is injected into the breast through small incisions. The procedure takes approximately 3 to 4 hours.

Recovery from Breast Augmentation

After breast augmentation with implants, your incisions are stitched, taped and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days postsurgery, most patients feel tired and sore, but many return to work within a week. Stitches are removed in 1 week to 10 days; postoperative pain, swelling and sensitivity diminish during the first few weeks. Scars begin to fade in a few months.

After augmentation mammaplasty with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction.

Risks of Breast Augmentation

In addition to the risks associated with surgery and anesthesia, those related to augmentation mammaplasty using implants include the following:

  • Capsular contracture
  • Implant leaks and ruptures
  • Implant deflation or shifting
  • Temporary or permanent change in nipple/breast sensation
  • Irregularities in breast contour/shape
  • Asymmetry
  • Partial or total loss of nipple/areola

The risks related to augmentation mammaplasty using fat transplantation include those related to liposuction, as well as the following:

  • Calcification
  • Fat embolism
  • Fat necrosis
  • Oil cysts
  • Loss of volume

Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary. Injections can be performed using local anesthesia.

FAQs

A woman who wants to increase the size of her breasts, to fix asymmetrical breasts, or to restore lost volume to her breasts is a candidate for augmentation mammaplasty. She must have fully developed breasts, be physically healthy, and have realistic expectations about the outcome of the surgery.

There are two ways of augmenting breasts: implants and fat implantation (fat transfer; fat grafting). Silicone, saline, "gummy bear," round, smooth and textured are types of implants that are inserted underneath either breast tissue or the chest-wall muscle. Fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the patient's body; the fat is then injected into the breasts.

During augmentation mammaplasty using implants, incisions are made in inconspicuous places (Dr. Rhee prefers in the crease on the underside of the breast, or around the areola in certain breast types), which minimizes scar visibility. During augmentation mammaplasty using fat transplantation, there are no incisions because fat is injected, so scarring is rarely an issue.

In addition to the risks associated with surgery and anesthesia, those related to augmentation mammaplasty using implants include capsular contracture; implant leaks and ruptures; and implant deflation or shifting. The risks related to augmentation mammaplasty using fat transplantation include calcification; fat embolism or necrosis; and oil cysts. In addition, because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary.

Which procedure is more appropriate depends on the particular patient and the goals of the surgery. Augmentation mammaplasty using implants is appropriate for women who want to significantly increase breast size. Augmentation mammaplasty using fat implantation is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible. In some cases, implants and fat transplantation are used together.

After augmentation mammaplasty with implants, most patients feel tired and sore, but many return to work within a week. After augmentation mammaplasty with fat transplantation, recovery time is quite short, with normal activities being resumed as soon as the patient feels comfortable.

A full C cup to small D cup.  It is important to note, however, that I use bra cup sizes as a loose reference as they are notoriously varied from brand to brand and style.  Bra-cup sizes are not standardized.  Meaning that a C-cup bra from one store could be a B-cup at another.  

In my experience, patients typically prefer to have the final opinion of their size choice.  During your consultation, I will personally spend a great deal of time with you getting to know and understand what your end-goals are.  We will take multiple measurements and assess several different factors that can impact your result.  With all that in mind, I prefer to use an actual implant to do your sizings with you, as this will give us both the most accurate idea of how the shape and size of the implant will look on you.

Yes, as soon as your initial swelling resolves.  Also, the sizers will appear larger when you try them on with a sports bra as they are just sitting on top of your skin, when in reality, the implant will be pressed up against your chest wall, typically under your pec muscle. Because of this, you may want to keep this in mind when you are sizing for your implants. 

Yes, it may.  When your weight fluctuates, to an extent, so will your breast size and shape.  So if you are planning to lose more than 10 pounds, you may want to be re-sized once you have reached your target goal weight. 

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