Breast augmentation is by far the most common plastic surgery procedure. Its quite simple to understand why. Female breast is an important part of a woman’s femininity and self esteem. It is without a doubt a very rewarding operation especially when it is performed under optimal conditions. Long gone are controversies that first were related with breast augmentation.
There is no relation with breast cancer as multiple studies have showed , there are no more problems with breast cancer detection in women that undergo breast augmentation as newer techniques allow radiologists to be very accurate. And of course there isn’t correlation of the procedure with autoimmune diseases as it was thought in the past.
When a patient asks me about breast augmentation there are many factors we need to discuss and take in account. Before we analyze the more important ones let me first say that there is no “approach” that fits all. If you have done your search around the internet you will find a lot of “dogmatic” approaches that are advertised as “better”. In my mind its patient has unique characteristics and the surgeon must present a plan according to them , not based to his own preference or ease. So lets start discussing some of them…
Implants or Fat?
Although for many many years the only option for breast augmentation was only performed with breast implants, the last few years fat is considered also an option for patients. It sounds very “natural and safe” to use your own fat for augmenting the breast but is it a straight forward approach? When we perform fat grafting the main issue that affects our success is “fat take” in other words what percentage of fat that we inject will survive.
We use a lot of fine techniques to extract (fine vanillas) and enhance fat (stem cells) but still there is no way to exactly calculate the final result. Quite often multiple treatments are necessary. In order to reduce multiple treatments and if the patient is very committed we may use a special device called “Brava” to pre-augment the breast before fat grafting.
Today I would advice patients two things. First if you don’t have good breast shape then don’t choose fat grafting because fat can only volumize not shape the breast. Second consider fat grafting as a complimentary procedure to liposuction, meaning to use the fat from a liposuction procedure as an implant instead of throwing it away. You then have nothing to loose as your primary goal would be the liposuction result, with the breast augmentation being a secondary target. In the future we may be more accurate and therefore more effective for fat grafting breast augmentation.
What type of breast implants to choose? Round or Anatomical?
Breast augmentation is full of controversies and certainly implant shape is one of them. I use both depending on my patients anatomy and desire. To put it simple when there is no shape of the breast (flat chest) or the patient was a very inconspicuous result I recommend using anatomical implants.
When we have a nice breast shape or we want to “show” augmented the best choice is a round implant. Having said that our discussion will define our final choice, but as a general information I use both. I only use Silicone Gel implants FDA approved. Once the operation is done you will be handed a certificate with all the details of your implant (manufacturer, LOT number etc).
Over or under the muscle? What incision to choose?
Patient anatomy is the ultimate guide to choose over or under the muscle for implant placement. Under the breast there is a big muscle called pectoralis major. I often choose to place the implant under that muscle (dual plane) as I want the medial part of the implant (close to the sternum) to be as covered as possible. In very few patients with adequate breast tissue I may choose to put the implant on top of the muscle but under its fascia (subfacial technique).
The incision we use depends on the patients anatomy and preference. I don’t use an incision in the armpit, the reason being that we need a 4-6cm incision to insert safely a silicone gel implant so placing it there it can be obvious with summer clothing. I prefer the semi-areolar incision if my patients anatomy allows me to, otherwise I use the inframammary incision.
Breast augmentation is an operation performed under general anesthesia. It lasts about an hour. In some patients it must be combined with a breast lift to produce optimal results.
There a few things that can go wrong after breast augmentation that every patient should be aware of. The most common immediate post surgery complication is hematoma, that means gathering of blood inside the breast cavity that we create during the operation. Although not a life threatening complication it must be treated surgically. The use of drains doesn’t seem to reduce the possibility of hematoma or to obviate the need for surgical treatment.
An infection is rare complication but can lead to temporary implant removal. An important information for all patients is that the body forms a capsule around the implant. In 8% of the patients this capsule at some point starts to shrink and then capsular contracture happens. Although a lot of research has helped us surgeons to reduce the incidence of capsular contraction we still don’t know who will have this or when this will happen. It can present as hardening of the breast, as mild pain or it can even cause a deformation of the shape of the breast. Its a condition that needs surgical treatment and exchange of implants.
Breast augmentation is a very rewarding operation. It makes women feel better for them selves in so many ways. Femininity, sexuality, self confidence may sound old fashion in a political correct society but they are still true.
If you are one step before going into a plastic surgery book an appointment today with dr. FilGood!
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