Breast augmentation refers to the enlargement of the female breast utilizing either silicone or saline breast implants. It is one of the most commonly performed cosmetic surgical procedures and is done to improve the patient’s body proportions and her self-image.
Though generally a very safe procedure with a high level of patient satisfaction, a woman considering breast augmentation should carefully consider the various options and potential risks of the procedure that may have lifelong implications.
Though the concept of placement of an implant to enlarge the breast may seem simple, there are many differences in opinion as to which of the following variables will produce the best result: most attractive, least potential for complication, etc.
- Incision location
- Implant type (saline vs. silicone)
- Size selection
- Location and size of surgical pocket (space) created
- Post-operative care–activity, drains, compression etc.
One should understand that there is no standard breast augmentation operation. Each breast augmentation surgeon has their own opinions and methods. One should select the plastic surgeon they trust and with whom they feel most comfortable. Based on professional judgment and experience, the surgeon will explain the procedure, present options, and make a recommendation based on evaluation of the patient’s examination, discussion and goals.
There are three standard breast augmentation incisions; peri-areolar, inframammary, and trans-axillary. Selection of an incision site is based on which incision is most hidden and the patient’s preferences.
Peri-areolar incision is located at the transition between the pigmented areolar skin and the breast skin. It takes advantage of the color transition to hide the scar. This area scars very well and is often difficult to see once the scar has matured. Though often a concern to patients, there is no greater post-operative pain with this incision nor is there a greater risk of loss of nipple sensation.
Inframammary incision is probably the most common incision and is located in the fold under the breast. It is a well-hidden incision in patients with a little droop to their breasts and goes through a minimum amount of breast tissue.
Trans-axillary incisions are placed under the arm and are touted for not requiring any incisions on the breast. However, they have many limitations in what can be done through these incisions, difficult placement of silicone implants and placement of an incision in a place that is commonly exposed, and not suitable in the unlikely need for a secondary procedure. Therefore, we rarely use this incision in our practice.
Our goal is cosmetically pleasing, long-term results – a soft, natural appearance with an appropriate breast size for the individual patient.
- Anesthesia for breast augmentation: the type of anesthesia for this surgery is a decision made by the surgeon and patient and is based on several factors including patient’s general health and preference. Local anesthesia only for breast augmentation has been suggested, but in our experience it is a bad idea since this approach can be uncomfortable. However, our preference of anesthesia for breast augmentation is twilight sleep which provides safe, effective anesthesia and shorter recovery with less postoperative nausea and vomiting. General anesthesia is used when appropriate or when it is the patient’s preference.
- Location of surgery is also a choice of the patient. We provide surgical care in a variety of facilities including major hospitals, outpatient surgery centers and in our office-operating suite. Our office surgical suite is accredited by the American Association for the Accreditation of Ambulatory Surgical Facilities (AAAASF).
- Specific surgical technique varies with individual patient, and is determined and explained at the initial consultation. Consultation is with the surgeon who spends adequate time with the patient to explain specifics of physical findings, recommendations and surgical plan.
- Implants used depend on the particular needs and requests of the individual patient. Saline filled implants can be put in though a small incision, which is a factor when the peri-areolar incision is used. These are very safe and effective implants and are an option for patients to consider. In January 2007, silicone implants were released for general use and provide another choice for patients to consider. These implants are safe and effective and result in a softer feeling breast. A slightly larger incision is required (usually under the breast) and these implants are slightly more expensive than the saline implants. Both saline and silicone implants usually result in very satisfactory results.
- Suction drains are sometimes used. When determined appropriate, small drains are used to minimize fluid accumulation, thereby preventing swelling and pain in the early postoperative period. These drains effectively minimize early distortion of the appearance of the breasts.
After surgery, patients are usually able to return to normal activities fairly quickly. We instruct our patients to resume normal activities as soon as they are able to do so comfortably. Though most patients are comfortable and get back to routine activities very soon after surgery, some patients are slower in their recovery.
We have resisted the marketing pressure to feature a gallery of before and after pictures on our website. We are very proud of our results, but have had strong ethical reservations featuring such a gallery. In our consultations, our surgeons (not an assistant) show and discuss before and after pictures with potential patients.
We are happy to show the quality of our results to prospective patients. The intent of showing photos is educational: to illustrate key points about the procedure and its results. We do, in fact, show prospective patients less than ideal results to illustrate particular issues.
Favorable, often dramatic results shown in print ads and Internet sites are very enticing to the consumer. The potential patient is asked to assume that the outstanding results displayed are representations of the surgeon’s typical result and a guarantee of a similar result for him/herself is implied.
Breast augmentation accomplishes an enlargement and enhancement of the female breasts to improve body proportions and a patient’s self-image. However, patients should consider the following:
- Selecting a Surgeon: Any physician can represent himself/herself as a plastic or cosmetic surgeon and can do the procedure in an office facility. Always check the surgeon’s credentials.
- Variation in Techniques and Results: Though simple in concept, there are many specifics in technique that vary from surgeon to surgeon. A patient should approach the decision about this surgery in a cautious and thoughtful manner.
- Goals: A patient should have a clear concept of exactly what she would like to accomplish with surgery, and be able to express these goals to the surgeon. She should spend time with the surgeon, understanding his/her technique, goals and opinions. It is important that the surgeon determine whether the patient’s goals are realistic. This discussion should be the responsibility of the surgeon, not an assistant.
- Breast Sagging: Breast implants alone cannot be expected to correct significant breast sagging. It is a mistake to place large implants to fill a sagging breast. This can cause an unnatural and aesthetically displeasing appearance that can be difficult to correct.
- Risks: Although serious complications are rare, this is a real surgical procedure with all the potential risk of any surgery. Secondary procedures may be indicated in approximately 5-20% of patients undergoing breast augmentation. In order to be able to anticipate future expenses, the patient should be advised of her financial responsibility for any secondary surgery required.
- The Consultation: It is important to approach a consultation with an open mind. The research a potential patient does is helpful. Although there is a lot of information available in books, on the Internet, and in the media, it can be very difficult for the average individual to separate marketing hype and opinions from fact. The only way to obtain information relevant to your situation is in a personal consultation.
- Surgical Judgment: The responsibility of the surgeon goes way beyond the role of a surgical technician. The surgeon is expected to exercise judgment in recommending, planning and carrying out a surgical procedure. This judgment is the result of training and experience, and this is the ultimate rationale for choosing a surgeon certified by the American Board of Plastic Surgery.