Breast Augmentation Background
Breast augmentation mammoplasty is a procedure performed to increase the size of a woman’s breasts using an implantable prosthesis. Reasons for surgery include: enhancement of small breasts, restoring a women’s breast to a pre-pregnancy, pre-nursing appearance, and correcting mild to moderate degrees of breast asymmetry in women with small breasts. In general, women are very pleased with the results of breast augmentation and would readily undergo the procedure again. Surgery can have a very powerful impact on patient self-esteem and overall has a very high satisfaction rate. There are four primary decisions to be made when considering breast augmentation: the incision used for insertion of the implant; the shape of the implant used; the size of the implant; and the composition of the filler material – that is, either silicone gel or saline.
Breast Augmentation Incision
The number one priority is the shape of the breast. The choices made should never compromise the shape or appearance of the breast. Especially, the location of the incision should not interfere with achieving the best shape possible. Having said that, the scar is certainly important. But in Dr. Brzowski’s hands, most of the scars heal equally well, with a slight advantage to the periareolar location, because the transition in color helps camouflage the scar.
Dr. Brzowski feels that control of the breast shape is best with either the periareolar or inframammary incision, and worst when using the armpit or belly button incision. In Dr. Brzowski’s experience, there is no difference in the length of recovery, postoperative pain, risk of loss of nipple sensation or ability to breast feed. Patients with a small areolar diameter are not good candidates for the periareolar incision due to the limitation in the opening that can be created for insertion of the implants. This is particularly true if a silicone implant is to be used.
Shape of the Breast Implants
Salt Lake City breast surgeon, Dr. Brzowski, has used all shapes of implants during his practice. After experience with thousands of implants of all kinds, Dr. Brzowski appreciates the differences between them all, and has a definite belief in the excellent results obtainable with round implants.
Studies have proven that both the tear drop shaped implants and round implants have a tear drop shape in the upright position. When the patient is on her back, side or in other positions, the round implant moves more like a normal breast, leading to a more natural appearance according to this research. One additional potential downside of the tear drop shaped implants is the potential for them to turn. Although a rare occurrence, this event nearly always results in a misshapen breast and surgical correction is usually indicated: changing to a round implant is advised at that point. Therefore, without any additional improvement in the appearance when upright, a definite potential to an unnatural shape when not upright, and a risk of rotation, Dr. Brzowski feels the use of the tear drop shaped implant to be unadvisable. In cases where an educated patient still feels strongly about using them, Dr. Brzowski is certainly experienced enough in the use of the tear drop shaped implant to insert them with the least amount of potential unfavorable results.
Size of the Breast Implants
This is definitely not a case of one size fits all. The patient’s particular desires, body shape and dimensions, and the limitations which result are taken into account. While the patient has the final say so on the size of the implant which is used, we provide counsel to the patient if the extremes of sizes are selected.
The most accurate way for the patient to determine the best implant size for the desired ultimate breast volume is to have the patient try on the implants while wearing a lightly colored, snug-fitting top. A number of different implant sizes can be tried, providing the patient with enough options to know what looks too big and what looks too small for her desires.
Silicone vs. Saline Breast Implants
Presently, all implants approved for use in the United States for the purposes of breast enlargement have been in use for many years. They all have a solid silicone outer shell (like an IV bag), with some sort of internal filler material: usually either silicone gel or saline (salt water).
Despite a temporary limitation in their use, silicone-filled implants are now again available for use in patients who desire surgery. In November of 2006, the FDA lifted these limitations for patients over the age of 22, and an explosion in the use of silicone implants has occurred. Whereas prior to that date, Dr. Brzowski used saline implants in about 80-90% of his breast implant patients, now 80-90% of them chose silicone implants. Please be aware that patients under the age of 22 may qualify for silicone implants if they meet criteria established by the FDA. Dr. Brzowski can review these criteria with you during your consultation.
In comparing saline and silicone implants, our experience and the research indicate many similarities and differences. While silicone implants are somewhat more expensive, they are typically softer and much less prone to the rippling that has plagued saline-filled implants. Conversely, saline implants are cheaper, firmer, and more prone to the rippling. This rippling can be bad enough to feel, or in the more advanced cases, the rippling is visible. When patients are permitted to compare the implants by holding one of each, the differences are typically obvious, and most will ultimately prefer the silicone implant.
Importantly, the life span of the implants is equivalent. We believe the breakage rate to be around 3% every 10 years. This gives the implants a life expectancy of 88% at 40 years, 79% at 70 years, and etc. Because of the differences in the filler material, what happens during a break in the shell is different between the two.
The saline-filled implants almost always immediately deflate like a balloon when the shell breaks. A few rare slow leaks over weeks or months have been reported. The body simply absorbs the salt water when this happens, and the breast becomes flat. No health risk occurs. Replacement is straight forward, and an excellent warranty from the manufacturer is in place.
When the shell on a silicone filled implant cracks, it usually goes unnoticed. The silicone gel inside the shell is so sticky, that breakage of the shell is similar to a crack in cellophane placed around jello – the jello doesn’t leak out through the tear in the cellophane, it just sits there. On occasion, around 15 % of the time, the tear is large enough that the silicone is able to irritate the normal scar around the implant, resulting in a contracture. This is detected by a substantial increase in firmness, a change in shape of the breast, and/or pain in the breast. Because of the extensive research done prior to and after November of 2006, we are confident that the breakage of a silicone implant will not result in any increase risk of connective tissue disorders, cancer risk or other health consequences. Please visit www.breastimplantsafety.org for more details about the safety of silicone implants.
Ultimately, the patient is the one who decides whether to use a saline or silicone filled implant. Dr. Brzowski will usually advise the thinner, fitter, smaller-breasted patients to give strong consideration for use of silicone implants because of their superiority over saline implants with respect to appearance and feel. Patients who have more breast tissue have more options when choosing between the two.
Lastly, there are two possible locations for placement of the implant: above the chest muscle and below the chest muscle. The advantages of placing the implant above the muscle are that it is somewhat less painful for the first few days and the final implant appearance and position occurs more rapidly. In addition, if the implant is underneath the muscle, tightening the chest (pectoralis) muscle can created a temporary crease in the midportion of the implant. This resolves immediately when the contraction is relaxed, but this crease is not possible if the implant is on top of the muscle.
Placing the implant underneath the muscle is the most common location because of the advantages it holds over the other location, and is the site Dr. Brzowski usually recommends for his patients. Advantages include a softer transition between the implant and the upper chest tissue (less severe slope), more ease of performing mammograms, less visible rippling because the implant is covered over the top and middle by muscle, and a substantial decrease in the risks of developing a contracture. A contracture is an overreaction on the part of the body to the presence of the implant. Thankfully this is an unusual occurrence in Dr. Brzowski’s practice, but still one that is best avoided. It can result in an increase in firmness, a change in shape of the breast, and/or pain in the breast.
Breast Augmentation Recovery period
You are expected to be up and out of bed after surgery, avoiding prolonged periods of inactivity. Showering is permitted 24 hours after surgery, but the incisions should not be submerged in a tub or pool until after the sutures are removed. Most patients can resume a reasonably normal activity pattern and non-exertional type job situations within 3-5 days after surgery. We prefer you to avoid lifting >5-15 lbs during the first month and avoid bouncing such as running during that time. You are permitted to lift using your legs and back. Following your first visit to the office, you no longer will be required to wear the ACE bandage provided by Dr. Brzowski. We also advise you to avoid bras that lift the breasts upwards until they have fully dropped (normally 6-8 weeks). One bra that we particularly like is a sheer bra made by Barely There™. It is critical during the recovery period that the implants be allowed to settle. Some bras, especially those with underwires, do not allow this process to take place. Once the implants have dropped, any desirable bra may be used.
Risks of Breast Augmentation
Like any surgery, breast augmentation has certain risks involved such as infection, bleeding, poor healing, and scarring. Additional events such as deflation, contractures, and loss of sensation are rare and have been previously discussed. Dissatisfaction with the ultimate breast size is certainly possible but thankfully unusual given the detailed attention you are given and the requirement that the patient select the implant volume to be used. Lastly, implant malposition and the development of an unfavorable shape of the breasts is possible as well, but unlikely.
Learn more about Breast Augmentation
If you feel that Salt Lake City breast augmentation might be right for you, schedule a private consultation with Dr. Brzowski at his Ogden, Utah office.