Breast Augmentation

Breast augmentation is one of the most common procedures performed by plastic surgeons. Women choose to undergo a breast augmentation for many reasons. A common goal in breast augmentation is the enhancement of one’s self image. Some women are dissatisfied because their breasts never develop to a size that meets their expectations. Others wish to achieve proportion, symmetry or restoration of their natural breast volume, which may have decreased as a result of pregnancy, weight loss, or aging. Before pursuing the procedure, be absolutely certain that you are comfortable with the plastic surgeon and his/her staff. If you are not certain that your desires are clear, revisit with your plastic surgeon as often as necessary to ensure you both share the same post-op goals.

TYPES OF BREAST IMPLANTS

Breast implants are designed with various shapes and surface textures and fill material. Implant shape is either round or anatomic (‘teardrop’). The round implant is, by far, the most commonly used in patients undergoing breast augmentation. The ‘teardrop’ implant shape was designed to more closely mimic the breast shape (flat up top and more full at the bottom), and is well-suited for use in breast reconstruction following mastectomy where the breast tissue has been removed. Once placed, it is virtually impossible for any observer (including plastic surgeons) to tell the difference between round and tear drop shaped implants.

Implants can be filled with either SALINE (salt water) or SILICONE GEL. In November 2006, the FDA (after exhaustive studies over 14 years) approved SILICONE GEL implants for use in all patients having determined that the were safe and never demonstrated any relationship to women who developed various medical issues. Of note, the SILICONE breast implant is the most extensively studied device ever conducted by the FDA. Safety has been well-established.

The differences between SALINE and SILICONE gel implants are extremely important. These different properties guide the choice of implant fill material. In 2017, the vast majority of implants placed are filled with the most advanced SILICONE GEL material. The reasons for choosing SILICONE GEL implants are primarily much more natural feel and minimal chance of implant rippling. The SILICONE GEL mimics the feel of a natural breast. SALINE implants, on the other hand, are much like ‘water balloons.’ The feel much less natural and, particularly in thin women and large implant choices, have a much higher risk of rippling that can be both seen and felt.

The SILICONE GEL material that is used in today’s implant is similar in consistency to Jell-o® (the term ‘gummy bear’ is often used. I, personally, find ‘gummy bears’ too firm in consistency to properly describe the softness of the current SILICONE GEL technology). With this composition, the SILICONE GEL remains in place should there ever be a leak in the implant shell. Unlike the older SILICONE GEL implants which were much more liquid in consistency and would ‘ooze’ out of a tear in the implant shell, the current SILICONE GEL material stays put.

The surface of the implant can be either smooth or textured. The smooth implant is similar to the surface of a balloon. The textured implant has a surface that is ‘rough’ or ‘gritty’ similar to a high grade sandpaper. The smooth implants are used far more commonly in patients undergoing breast augmentation. I find textured implants helpful in a very small subset of patients. This can include a patient with a history of multiple capsular contractures (firmness of the breast) or a significant issue with the pocket in which the implant has been placed.

IMPLANT PLACEMENT

The implant can be positioned either above or below the chest muscles. I strongly favor subpectoral (under the muscle) placement because there is strong evidence that there is a lower rate of capsular contracture (hardening of the tissue around the implant). Additionally, when placed under the muscle, the implant outline is virtually invisible, less likely to be felt and, provides more ample cleavage. Placing the implants above the muscle (or just below the breast tissue) can be an appropriate option in some patients based on an individual’s breast shape, aesthetic goals or implant choice. The appropriate placement can be determined by your plastic surgeon after reviewing your aesthetic goals and completing a thorough breast examination.

INCISIONS

A number of incisions can be used in breast augmentation. The most common incisions are the inframammary (within the crease under the breast) or the perieareolar (around the lower portion of the nipple/areola region). Other approaches include the transaxillary (armpit) and the transumbilical (around the belly button). These approaches are used much less frequently. The choice of incision can often be selected by the patient. At times, however, a particular incision that is most appropriate for your breast anatomy may be recommended.

RECOVERY TIME

Recovery time varies by procedure. Most of Dr. DeLuca’s patients are performing their routine activities within 3-5 days. Patients should plan on 6-7 days for recovery. Most of Dr. DeLuca’s patients are back at work within a week.