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Breast Augmentation

“Now I have breasts!” were the first words I heard from one of my first breast augmentation patients. It was a statement that made a lasting impression. Soon after breast augmentation many patients psychologically and physically incorporate their breast implants as “their breasts.” Many patients tell me that their breast augmentation made them feel “complete” and it has enhanced their self-confidence. These women have had breast augmentations that are natural in appearance and complement their body shape. They feel empowered in professional and social situations with both women and men. For many wo]men who make the decision to have a breast augmentation, it was something they had wanted for a very long time. Performing breast augmentations is one of the most gratifying procedures that I do. While breast augmentation may seem like a “simple” procedure, achieving beautiful results takes skill, artistry, and a keen aesthetic eye. Establishing a dialogue and good communication with my patients is key to understanding what they want and achieving an optimal result.

What does breast augmentation do?

  • Significant improvements in psychosocial well-being
  • Improved confidence in social settings
  • Improved feeling of attractiveness and self-assurance
  • Enhanced confidence with sexual activity and sexual attractiveness
  • Increased satisfaction with breast appearance, size, softness
  • Greater satisfaction with amount of cleavage
  • Improves breast shape
  • Improves breast symmetry
  • Patients look better in clothes
  • Feel better when wearing swimwear

What is the right size implant for me?

Almost every patient says “I don’t want to be too big.” During your initial consultation the plastic surgeon will talk with you about the look and size you desire. Some women want only enough of an augmentation so that they won’t have to use padding in their bras while other women would like to be a “full C”. Occasionally women express a desire to be very large. Bringing photos form magazines or downloading photos from the Internet will not determine a specific size but it will give your plastic surgeon insight into the aesthetic appearance you desire.

There are different methods that surgeons use to help determine what size implant will work best for a given patient. Some plastic surgeons use measurements such as the width of the patient’s breast and other breast-based measurements to determine implants size. Other surgeons use “try-on-bras” with pockets in which to place sample implants. More technologically advanced approaches include devices that can let you visualized before th procedure how you ay look after the procedure. Vectra (Canfield Scientific Inc. USA imaging) and e-stetix by Crisalix of Switzerland and Axis Three (Boston, MA) are technologies that will simulate 3-d images of what a patient would look like with different implant sizes or shapes bother with and with clothing as well as in a bathing suit top or evening gown.

There are many factors that determine what implant size and shape will work best for a given patient. These include: height and weight, existing breast size, quality of skin, thickness and elasticity of tissues, breast shape, including your existing breast size, how much natural breast tissue you have, your skin elasticity, the underlying muscle, the prominence and configuration of your ribcage and the distance between your breasts.

Dr. Bruck also uses Crisilex, a simulation tool that enables you to visualize a facsimile of how you would appear after breast augmentation using variety of size implants both in and out of clothing. With this information, he will choose a range of sizes that he feels would work well for you. At the time of your procedure, prior to inserting the actual implant, Dr. Bruck uses a sizers, a temporary implant with dimensions and shape like the actual implant used for augmentation. Once inserted, the operating table is adjusted to a sitting position and Dr. Bruck can ascertain whether the size is right or to go a bit bigger or smaller. While this adds time to the procedure, it is time well spent as it further refines the process of implant size selection.

What about shape of the implant, am I better with a teardrop or round implant?

Implants come in a variety of shapes, volumes, dimensions, and textured and non-textured surfaces. Breast implants can be round or teardrop shape (anatomic). While it may seem that the teardrop shape gives a more nature result this is not necessarily the case. Once inserted, an envelope of scar tissue forms around the implant (the capsule) and the teardrop shape may become somewhat round; the round shape implant may become somewhat tear-drop. All tear-drop implants have a textured surface that prevents rotation of the implant and maintains its orientation. There is now a new class of implants—form-stable or highly cohesive gel implants. These implants are firmer and less malleable, they require a longer incision and can help shape the breast. More recently highly Cohesive Gel anatomic implants have been FDA approved for use in women at least 22 years of age. These implants are available in a variety of size and dimensions.

Which is better silicone or saline?

Breast augmentation with either silicone or saline can produce aesthetically pleasing breasts and satisfied patients. Each type of implant and its advantages and disadvantages. Thin patients with little actual breast tissue have a greater risk of visible and palpable ripple or wrinkling with saline implants. Saline implants require shorter incisions, and no follow up is necessary regarding rupture of the implant. Silicone implants require longer incisions and follow-up with MRI to determine whether there is a silent rupture. The choice ultimately is the patient’s.

Are Silicone implants safe?

The answer is YES. In the 1992 silicone implants were taken off the market. After 14 years of investigation by the FDA, the FDA concluded that there was no cause and effect relationship between the presence of a breast implants and health problems. In 1999 moratorium on silicone breast implants was lifted but with strict guidelines for their use. After further investigation, in 2006 the FDA cleared the use of Silicone implants for all patients age 22 and older. Follow-up guidelines included periodic breast MRI and the usual and customary requirements for mammography. Additional information on breast implant safety can be found on these websites: http://www.breastimplantsafety.org and http://www.fda.gov .

Which is the best place to have an incision?

Incisions can be made in one of four locations: Slightly above the fold under the breast (inframammary); in the lower part of the areola where the areola skin meets the normal breast skin (periareolar); in the fold in the armpit (axillary); within the bellybutton (transumbilical). Dr. Bruck does not use the transumbilical incision or the axillary incision as it is his opinion that implant placement is less precise, it is more difficult to make minor adjustments once the implant is inserted. Whether a periareolar incision or a inframammary incision is used is discussed with the patient.

Is It Better to have my implants above or under my muscle?

Placing implants under the chest muscle is recommended for several reasons. The muscle provides an added layer of tissue covering the implant and minimizes the appearance and feel of rippling. Breasts tend to feel softer when implants area placed under the muscle and the incidence of capsular contracture is minimized. It is better for mammography for implants to be placed under the muscle. While implants that are placed over the muscle can give some “lift” to the breast, the benefits of submuscular placement outweigh the benefit of a modest lift. If a true lift is indicated then a breast lift may be necessary in addition to a breast augmentation.

Will I have to have my breast implants replaced at some time?

Breast implants are a manufactured devices and like any manufactured devices they will at some time have to be replaced. A leak or rupture of a saline implant will result in deflation of the breast. If there is a rupture of a silicone implant there may not be a noticeable difference in the appearance or feel of the breast. FDA guidelines recommend an MRI three years after silicone breast implant surgery and periodically thereafter. A warrantee covers the replacement of the implants, and as well as some of the cost associated with replacement—operating room and anesthesia.

Where is the surgery performed and what type of anesthesia is used?

Breast augmentation surgery is generally performed as an outpatient either in a certified office based facility, the hospital outpatient facility or an ambulatory surgicenter.

What about Mammograms?

Screening mammograms should be done at age 40 and every 1 to 2 years thereafter in accordance with the National Cancer Institute. However women who are at higher than average risk of developing breast cancer due to a family history or who are known to carry a gene that increases the possibility of developing breast cancer (BRCA gene) may have mammography at an earlier age. In patients who have had a breast augmentation special views are performed. In addition to screening mammography women should perform self-breast examination monthly and have physician breast exam as well.