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Breast Augmentation

What is Breast Augmentation?

A breast augmentation is performed for patients who desire a larger breast size, or a fuller appearance to their breast. During a breast augmentation, a silicone or saline implant is placed either under the pectoralis muscle (subpectoral) or on top it (subglandular). The goal of breast augmentation is to create a fuller breast mound with an aesthetically pleasing shape and position.

Who is a Candidate for Breast Augmentation?

You may want to consider a breast augmentation if you have:

  • Concerns about the size of your breasts and would like them to be fuller
  • Concerns about your body proportions and feel like there is a breast/hip disproportion
  • Concerns about breast asymmetry
  • Loss of breast volume secondary to age, pregnancy or breast feeding
  • Development of ptosis (lowered nipple position) in addition to volume loss secondary to age, pregnancy, or breast feeding

How is Breast Augmentation Performed?

There are many different ways to perform a breast augmentation, depending on an individual’s unique breast shape, size, position, and aesthetic goals. When determining how to customize a breast augmentation for an individual patient, several factors are considered.

    • Implant material: Implants can be made of either saline or silicone. Saline implants feel firmer and when they leak, there is an immediate collapse of the implant and breast size. By contrast, when a silicone implant leaks, it stays within its capsule, or immediately adjacent to it, and there is not a dramatic loss of volume. Many surgeons and patients prefer silicone implants, as they feel softer and more natural than saline implants. “Gummy bear” implants (form stable implants, cohesive implants) are silicone implants that are composed of a firmer silicone gel. This firmer, or more cohesive gel, does not freely leak into surrounding tissues when the implant ruptures. Cohesive implants tend to feel firmer than regular silicone implants, although they do have specific indications for use. During your consultation with Dr. Rovelo, discuss whether you would benefit from having a more form stable implant.
    • Implant size: Implant size is determined by the current size of the breast, as well as the patient’s desired size. When determining an implant size, it is important to take into consideration a patient’s size, height, weight, and chest wall width. Implants come in low, medium, or high profiles, and which profile is optimal for you is a discussion to have with Dr. Rovelo at the time of your consult.
    • Implant location: Implants can be placed either under the pectoralis muscle (subpectoral) or on top of it (subglandular). Placing the implant under the muscle results in decreased visibility of the implant and decreased rates of capsular contracture. However, submuscular positioning is associated with motion abnormalities when the patient contracts their pectoral muscles. For patients that have adequate amounts of breast tissue, placing the implant on top of the muscle is an appropriate option. Implants placed on top of the muscle may be more visible and there is an increased risk of capsular contracture. However, the benefit of subglandular implant placement is decreased motion abnormality. During your consultation with Dr. Rovelo, you will discuss which option is best for you and your body.
  • Incision placement: Implants can be placed through several different incisions. One of the more common incisions is under the breast at the level of the inframammary fold (IMF). This incision provides easy access to the breast and is well hidden under the breast, although it is still visible on the skin. Another incision location is around the nipple (periareolar). This incision is usually well hidden, however it is associated with a higher capsular contracture rate. An additional incision location is under the arm, however this is associated with increased risks and is best performed by surgeons who use this incision routinely.

Some patients will benefit from having a breast lift (mastopexy) at the same time as the breast augmentation. This combination is advisable for women who have developed significant ptosis (nipple descent). A mastopexy does involve placing additional incisions on the breast, however for patients that require it, a mastopexy results in a more youthful and aesthetically pleasing appearance of the breast.

It is also important to know that breast implants are not designed to last a lifetime, and patients may need to replace one or both implants over time.

Breast augmentation is a procedure that requires attention to detail, as each patient’s breast is unique and requires a unique approach. Dr. Rovelo enjoys taking the time to listen to your requests and desires. After careful listening, she will examine your breasts to determine your exact size and dimensions. She will then work with you in planning a breast augmentation that will provide you with your most beautiful, enhanced breasts.

Risks

All surgery is associated with risks. Risks of breast augmentation include bleeding, infection, scarring, implant visibility and rippling, implant rupture, and need for revisional surgery. One of the more frustrating complications of breast augmentation is capsular contracture. A capsular contracture occurs when excess scar tissue forms around the implant capsule, resulting in a firm, and sometime painful breast implant. Treatment of capsular contracture typically requires additional surgery to exchange the implant, or to remove it entirely. It is important to talk with Dr. Rovelo about the risks of your surgery and how the risks can be minimized to provide the best possible outcome.

Recovery

Breast augmentation is performed in the outpatient surgery setting, under general anesthesia. Surgery will take approximately 2 hours, and potentially longer, if a mastopexy is required. Patients will be placed in a surgical bra and sent home the same day. Patients will be seen back in clinic in 1-2 days, and then again in one week. Pain and discomfort is present for 1-3 days postoperatively, and then will gradually improve. Most patients can return to work and daily activities within 1 week. Patients are advised to avoid vigorous exercise or heavy lifting for 6 weeks. Patients will need to wear a non-underwire bra for 6 weeks. In addition, swelling will be present for at least 6 weeks, but may take up to several months to fully resolve.

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