Common name – Breast Augmentation/Boob Job/Breast Implants. Technical name/also known as – Augmentation Mammaplasty.
Breast augmentation, in its simplest explanation, makes breasts larger. This is done by placing an implant behind the breast gland, and often, also behind the muscle directly beneath the breast as well. This is one of the most commonly requested and performed plastic surgeries. Women may seek breast augmentation for a variety of reasons. Some women have never had the breast size they desire. Others may have lost volume due to pregnancy, breast-feeding, or weight changes. Some may wish to enhance the volume they have just because. The reasons are varied and personal.
It is interesting that we have no true way to describe a woman’s breast size, but instead, rely on bra size. It is no secret that many women wear the wrong sized bra. A C cup on a 120 pound, 5.5 foot tall woman is different from a C cup on a 190 pound, 6 foot tall woman, and everywhere in between. Every woman is unique. I cannot guarantee a cup size, and encourage my patients to be happy with the way they look, not what their bra tag says. For each woman, there is a range of implant sizes that will fit their body, and I have my patients select their size with sizing implants in a bra.
Virtually all breast implants are made of a round or teardrop shaped silicone elastomer (rubber) shell. The shells are filled with either a saline solution (salt water) or silicone gel.
One advantage of saline-filled implants is that they can be implanted through a smaller incision than a silicone-filled implant. This is because saline implants are inserted into the body empty; the shells are filled through a valve once they are in place. Another benefit is that if a saline implant ruptures, the liquid inside is absorbed harmlessly into the body. This usually produces an obvious change in the size and/or shape of the breast, making saline rupture easier to detect than silicone rupture. Imaging is not necessary to diagnose a saline implant rupture. Saline implants are less costly than silicone.
There are two main disadvantages of saline implants. Saline may look and feel less natural than silicone implants. They are heavier in feel compared to a silicone implant of the same volume. This may lead to displacement or bottoming out more quickly than with a silicone implant. Wrinkles and ripples are more easily seen through the skin with saline implants, especially in women with little breast tissue.
The silicone implants of today are not the same silicone implants that received a lot of bad media attention in the 1990s. It has been almost ten years that the FDA has now approved silicone gel-filled implants for both cosmetic and reconstructive breast surgery. The biggest advantage of silicone-filled implants is their soft, natural feel. They are lighter in feel when compared to saline implants. They are also less prone to wrinkling than saline implants. They are made of a silicone shell filled with a cohesive silicone gel. This differs from the early implants which were filled with liquid silicone, which made removal in the cases of rupture difficult. Should a cohesive silicone gel implant rupture, the silicone sticks to itself, making removal of the ruptured implant material easier. This improvement in implant construction makes implant rupture hard to detect, or “silent,” meaning occurring without symptoms. Imaging with MRI may be required to diagnose a ruptured implant. Because silicone implants come pre-filled, a slightly longer incision to insert them is required. They are also more costly than saline.
Now available for use in the United States, the gummy-bear style silicone implant is yet another choice for women considering breast augmentation surgery. These implants are touted for their more natural appearance in the body and lowest rate of rippling and wrinkling among implants. This implant is made of a highly cohesive silicone gel, which holds its form. Unlike standard round silicone implants, which have the same shape all over, gummy-bear implants, come shaped. This means there is a top and bottom to this implant. The bottom, like a natural breast, has more fullness than the top. This accounts for the more natural appearance in the body. A risk of gummy-bear implants is malrotation. This occurs when the implants shift position under the breast. This may result in an odd breast appearance and asymmetry. This implant also feels firmer than a standard silicone implant and is the most costly in comparison to saline and standard silicone.
The implant is placed through an incision hidden at one of several places on the body. This will be where the skin scar resides after surgery. The most commonly used site is the inframammary crease. This involves an incision made at the fold underneath the breast. It allows direct access to the pocket and site that can be well concealed by the breast tissue above. Another location for the incision is periareolar, an incision made around the pigmented skin of the areola. This camouflages the incision against the anatomical border of the areola, but the disadvantage is that the scar is seen at the middle of the breast itself. It may also be associated with a higher risk of nipple numbness or infection. For those interested in a saline implant, a transaxillary incision can be used. This technique hides the scar in the armpit where the hair-bearing skin lies. It involves the use of endoscopic equipment (long instruments and a camera to visualize the surgery on a television screen). This usually requires more time in the operating room and a longer recovery for the patient due to stress on the pectoral muscle where it is attached to the upper arm. However, the scar from this site is completely off of the breast. Transumbilical breast augmentation (TUBA) involves an incision made at the belly button to place the implant. Because this technique involves placing the implants through blunt and blind dissection, Dr. DeLuca-Pytell does not offer this surgery, and she also cautions against it.
Most often, the implants are placed underneath the muscle. This position is more accurately described as “dual plane” since the implant is partly under the muscle, and partly under the breast gland. The pectoral muscle must be cut in order for the implant to sit properly behind the breast. Placing the implant behind the muscle reduces many known complications of breast implants, most notably, capsular contracture or hardening of the implant. This position can also help reduce wrinkles and ripples seen through the skin. It is also helpful for mammography to have this layer of tissue between the implant and the breast gland. In some patients, it may be appropriate to place the implant over the muscle, but the advantages (quicker, less painful recovery) must be weighed against the disadvantages.
An incision is made, and a pocket is created below the breast pectoralis major muscle. The attachments of the muscle to the lower portion of the breast are surgically divided as well as the attachments of the muscle near the border of the sternum to approximately nipple level. A temporary sizing implant is placed on both sides and brought to the volume chosen by the patient. At this point, the breasts are evaluated for shape and symmetry. If any changes need to be made, they are done with the temporary sizing implant. The permanent implant is selected based on the sizing implant and prepared carefully for placement into the breast pocket. Sutures are used to close the tissue and skin in layers. A bra is placed to hold dressings in place and for gentle support.
For women unhappy with the size of their breasts, an augmentation restores or improves breast volume with (almost) instant gratification. Patients report feeling better in bathing suits and clothing. Increased self confidence is commonly noted.
The final result is not seen right away. For most patients, the implants will “ride high” initially as the muscle pulls the implant up the chest. This is temporary and improves with time, but may take two to three months to drop. Because the muscle in the chest is cut, pain is expected. You will not be able to do all of your usual activities for up to six weeks. No breast implant is a permanent device. You will need at least one, if not more, operations in your lifetime for maintenance of the implants and the appearance of the breast.
This is a cosmetic procedure, paid for by the patient.
Please click this link for suggested bras to be worn after surgery.
– Dr. Danielle DeLuca-Pytell
Call or email us to schedule an appointment and find out if you are a suitable candidate for this procedure.
Give our office a call Monday to Thursday, 9am to 5 pm, Friday 9am to 3 pm.
You can also email us anytime with questions.
See what Dr. DeLuca-Pytell’s patients have to say about their surgical experience.
Follow the link to read some of the many letters received by Dr. Danielle DeLuca-Pytell.
When you come into the office for your appointment, you will be able to see lots more ‘before and after’ photos of this procedure including different options.
Temporary swelling and pain. The implants will not have their final appearance initially. For women with slight breast droop, this can be accentuated early in recovery but is expected to improve with time if a lift was not recommended. Cording, inflammation of the lymphatic channels, can sometimes be seen below the incision appearing like fishing line and may be uncomfortable. The breasts may be very sensitive.
All surgery carries risk. I recommend patients carefully weigh the benefits of having surgery against the potential risks which may arise. Pain, bleeding, infection, damage to nearby structures, need for other procedures, recurrence, dissatisfaction with the result, asymmetry, seroma, sensory changes including permanent loss of sensation, wound healing delays requiring wound care, deep vein thrombosis, and pulmonary embolus. A complete list of risks will be discussed with you before surgery.
If you smoke, it is imperative that you quit six weeks both before and after surgery. Please click this link to better understand why: Smoking and Plastic Surgery
It is unusual to find women with two breasts that are exactly the same. Most women have a difference in nipple position or even shape of the breast. Implants make breasts bigger, so any asymmetry present prior to surgery will be more noticeable after surgery. Some asymmetries may warrant additional surgery involving more scars on the breast.
Some women have breasts that are naturally close together, and others have breasts that are naturally farther apart. Implants will increase the size of breasts, but they cannot make widely spaced breasts come together more. Cleavage can often be enhanced with a bra.
Capsular contracture is a tightening of the post-surgical scar around the breast implant. This tight scar can squeeze the implant, causing hardness, pain, distortion of the implant, rupture of the implant, and distortion of the breast. If a capsular contracture forms, a procedure can be performed to release or remove the tight capsule. You may also have your implant(s) replaced at the same time. The risk of forming a capsular contracture is higher if you have had one previously.
Sometimes wrinkles or ripples in the implant show through the skin of the breast. It happens more often in women with thinner skin, less breast tissue, and saline implants, especially if the implants are under filled. Careful surgical planning and technique can minimize but not entirely prevent this result.
Calcium deposits sometimes form within the capsule around the implant. These can be detected on mammograms. A radiologist experienced in reading images of implanted breasts will be able to distinguish these deposits from calcium located within the breast tissue itself, which may be concerning. A biopsy should be performed on any suspicious calcifications.
The rupture rate for both saline and silicone implants are low for the first ten years after implantation. Older implants are more susceptible to rupture, as are those that have undergone trauma such as chest injury from an automobile accident. Saline implant ruptures tend to be easy to detect, while silicone implant ruptures can go unnoticed if the silicone remains within the scar capsule around the implant. An MRI may be required for a diagnosis of silicone implant rupture. Silicone implant rupture often occurs without symptoms, but some patients with older implants might experience lumps, pain, tingling, swelling, or change in implant size or shape. It is expected that most implants will rupture by twenty years following initial operation.
Infection is a risk of any surgery. Most infections resulting from surgery appear within a few days to a few weeks after the operation. However, infection is possible at any time.
Infections are harder to treat when an implant is present than in normal body tissues. If an infection doesn’t respond to antibiotics, the implant will need to be removed. Once the infection has resolved and the tissues have healed, usually six months, an implant can be replaced if the patient chooses.
In rare instances, women who have had breast implant surgery contract a life-threatening infection called Toxic Shock Syndrome. Symptoms of Toxic Shock Syndrome include sudden fever, vomiting, diarrhea, fainting, dizziness, and/or a sunburn-like rash.
Women may experience pain of varying duration and intensity following breast implant surgery. Pain sometimes depends on the size of the implant or whether the implants are placed under the muscle. Capsular contracture may also cause pain.
Breast and nipple sensitivity may increase or decrease after implant surgery, ranging from heightened sensitivity to complete loss of sensation. These changes are often temporary, but in some cases they are permanent. This may affect erotic response or the ability to nurse.
As their bodies change with age, some women may notice an increase in the size of their breasts, especially around the time of menopause. These women may be helped with explantation (removal of the breast implant), sometimes combined with a breast lift.
For women who have pregnancy after the placement of implants, it is very possible that the appearance of the breast may change. The breast may become larger or droopy. It is not possible to predict this change, as all women are different. Having a breast implant does not make breast-feeding unsafe, but it may interfere with success in the ability to breast-feed.
For a menstruating woman, breast exams are best performed at the end of the menstrual cycle so that hormonal influences on the breast tissue are at a minimum. For post-menopausal women, choose a time each month that is easy to remember, such as the first of the month.
Rest at home (princess treatment) for 2 weeks (no housework or exercise). Outsource housework and child care while you rest. Walk around the house, but do not work out.
Return to gentle exercise and household chores at two weeks, but no heavy lifting or bouncing for six weeks.
Return to full activity 6 weeks after surgery.
This depends on the type of work that you do. Many women can return to sedentary work a week to 10 days following straightforward breast augmentation, though not everyone is ready to return to work by then. Surgery affects different people differently. If your work is more strenuous, six weeks off work may be needed.
Breasts can increase or decrease in size with weight changes, pregnancy, or other hormonal changes. Age can change the appearance of the breast as well. It is expected that implants will need to be replaced.
It will take time for the breast size and shape to settle. I usually recommend waiting until at least 3 months after surgery to be sized and shop for new bras. A list of bras that can be worn after surgery are available in the office.
When you visit the office for your appointment, we will talk about the side effects and risks of this procedure. You will have the chance to ask any questions you might have.
Don’t forget: it is your body! There is no such thing as a bad or silly question!
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