Breast Augmentation is a surgical procedure which should be considered by a woman who wishes to increase her breast volume and improve the aesthetic appearance of her breasts. This procedure, like many other aesthetic surgery procedures, is generally offered to patients who are felt to be good candidates. It is important for a woman to display appropriate self-motivation and to have reasonable expectations regarding her outcome.
Implants are chosen after obtaining measurements that indicate the required implant diameter and anterior projection. The implant used should increase lateral breast width and projection thus providing a natural appearance. This approach toward implant selection is known as dimensional planning and Implant Selection, it is embraced by most board-certified plastic surgeons and implant manufacturers. No surgeon can guarantee that a given implant in a specific patient will allow the patient to wear a specific cup size in a brassiere. There is simply not a mathematical relationship between implant volume and cup size. Additionally, cup sizes are variable from manufacturer to manufacturer.
Placement of the implant beneath the muscle layer is most important for women with very little breast tissue or thin soft tissue coverage. The small incision used to initiate the creation of the pocket is either made just above the fold beneath the breast (inframammary fold, IMF) or around the areola (periareolar). These two options provide access for symmetric pocket creation and careful control of bleeding. The scars fade over time and are typically inconspicuous. A successful outcome requires precise and symmetric creation of the pocket and meticulous technique.
Breast Augmentation is done with either saline implants or cohesive, silicone gel implants. Saline implants are filled with sterile IV saline solution using a closed filling mechanism. This is the safest way to fill an implant as it prevents any contamination of the fluid. Saline implants should be filled to the volume recommended by the manufacturer. Literature indicates that near-maximum fill volumes minimize the possibility of creases and folds in the implant and enhance implant lifespan. No bio-mechanical device should be expected to last forever. Nevertheless, the saline-filled implants that are used today have an excellent track record regarding longevity and rarely leak or rupture in the absence of trauma.
Silicone gel implants are currently used approximately 80% of the time for breast augmentation patients. The newer gel implants are truly “cohesive” and do not leak or ooze if ruptured. The data required by the Food and Drug Administration shows an excellent track record for these devices and they have certain advantages over saline implants in many patients.The gel implants from the three manufacturers are different and proprietary. Sientra Gel Implants are the most cohesive and form-stable implants and are primarily used for our augmentation and reconstruction patients. Many patients are good candidates for either gel or saline implants; the choice is based on a carefully comparison of the two; weighing the advantages and disadvantages of each during the consultation.
Drooping of the breasts (ptosis) is usually not improved by augmentation mammoplasty alone, unless it is early or minor in degree. It is important to understand the relationships between the skin envelope and breast gland, (with or without an implant), and how alterations in balance affect the final aesthetic appearance of the breast. Some women with significant ptosis will benefit from breast lift surgery (mastopexy), with or without implant placement.
- Medical and Surgical History
- Personal History of Breast Surgery, Breast Disease and Mammography
- Family History of Breast Cancer
- Occupation and Job Requirements
- Participation in Sports and Hobbies
- Patient Motivation and Expectations
- Examination of the Breasts Including Standard Measurements for Dimensional Planning and Implant Selection
- Recommendations regarding the incisional approach
- Discussion of alternatives (if applicable), and/or adjunctive procedures
- Discussion regarding anticipated recovery and limitation of post-operative activities
- Recommendations regarding anesthesia care
- Follow-up Care in the Office
- Financial Requirements/Considerations
- Scheduling Surgery and Pre-Operative visits
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