Breast Augmentation (Enlargement with Implants)

Sunday, July 28th, 2013

One of the most frequently performed cosmetic surgery procedures worldwide can give women with small or unevenly sized breasts a fuller, better-proportioned look. Newer implants and surgery methods have improved the results and reduced the recovery time.

People choose to undergo breast enlargement for many different medical and aesthetic reasons, including achieving larger breasts and balancing asymmetric breast size. Breast enlargement may need to be combined with another procedure such as a breast lift in order to achieve the best result if gravity has also taken its toll.

To determine what is required to achieve the desired look and what size implant is needed, I believe a considerable amount of time doing an examination and consultation is necessary.  Taking more time than is standard has lowered my redo rates from around 25%, the standard for this procedure, to less than 2%.

Often, an extensive exam and discussion are the most overlooked portions of many consults for breast augmentation. Part of this evaluation process is determining the proper implant to use. A number of studies have shown that, when the implant is matched to patient measurements through a comprehensive exam and further chosen through careful discussion, the satisfaction rate goes up significantly. This is partially because the same sized implant will achieve different results in different people and even different results in the same person depending on placement of the implant. Likewise, the choice of incision should be based mainly on the implant used since the standard incisions all give equal results. As an example, the new cohesive gel Silicone implants, the so-called “Gummy Bear” implants, require a larger incision to allow positioning of the implant without risk of injury to it. (Research has demonstrated that injury from forceful insertion is one of the leading causes of late implant rupture, another cause of revision.) Location of the implant should also be made on individual patient concerns and anatomy. The newer implants now allow a choice. I generally prefer placement under the breast tissue rather than under the muscle. Positioning it above the muscle usually provides a faster recovery with less pain, prevents some displacement, especially down and outward, is ideal for those who are athletic or use their arms a lot as it does not cause the breast to move with arm movement, and may reduce the risk of deflation or rupture. Some people, those with minimal superior tissue and those wishing smooth implants, however, may fare better with submuscular implant placement. These choices then determine patient satisfaction.

My personal goal is to provide natural looking breasts that are proportional to your body, make you look great in clothes, swimwear or nothing, provide an appearance undetectable as surgically enhanced unless that is what you want, return you to normal activities as quickly as possible, usually by the next day, and do this only once. I have been able to achieve these goals using thorough evaluation, newer methods of measurement and modified surgical technique.

My method takes about two hours, a little longer than some methods, but necessary for fast recovery and minimal pain. I also prefer modern light general anesthesia (going to sleep) as an outpatient because it is, in my opinion, the safest, and you awaken faster with fewer side effects. Technique also makes a huge difference in how fast one recovers after surgery. Older techniques, though faster, stretch the tissues to make a place for the implant. This causes significant postoperative discomfort. Modifying the technique eliminates this stretch and eliminated most post procedure pain. Many people require only Tylenol® after the second day. With this type anesthesia and technique many women are back to many activities within just a few hours to a day after surgery and return to most light activities and work within one to two days. On the day after surgery, you can shower and change into a sports bra. You can return to sporting activities by 2-3 weeks. Incisions are closed with deep, dissolvable stitches and skin tapes. Though this takes longer, I believe this helps assure that the scar is as invisible as possible.

The procedure generally increases the bust line by several cup sizes, depending on each person’s desires. If there is preexisting asymmetry, use of different sized implants on each side can provide balance.

Although there are many potential problems with Breast Augmentation, when done by a well-trained surgeon in a certified facility, the risks are minimal making this an exceedingly safe operation. Taking extra time with the consultation and during surgery also results in better outcomes and higher satisfaction.