Everything You Should Know About Breast Augmentation
Dr. Matthew Schulman is a New York City Board Certified Plastic Surgeon who has received training at the nation’s top institutions. He received his medical degree from Jefferson Medical College and completed his training in general surgery and plastic surgery at The Mount Sinai School of Medicine of New York University.... more
Breast augmentation remains the top cosmetic surgical procedure performed. About 300,000 breast augmentation procedures are performed each year. Breast augmentation is a consistently requested procedure among female patients who are looking for more enhanced, symmetric, and proportional breasts.
What Is Breast Augmentation?
Breast augmentation (augmentation mammoplasty) can be defined as “surgery to increase breast size.” The procedure involves placing breast implants under the breast tissue or chest muscles in order to enlarge the native breast tissue.
It's not uncommon to confuse breast augmentation with similar procedures like breast lifts. While similar, these two surgeries actually target different results. In nearly all cases, breast augmentation aims to increase the overall size of a woman’s breast with the use of implants. This also helps to improve the overall shape.
On the other hand, breast lifts do not use implants at all. Instead, the existing breast tissue is shaped or altered in such a way as to tighten and lift each breast. The result of a breast lift is perkier, more symmetrical breasts that no longer sag or droop.
This means that a breast augmentation enlarges, but does not lift. A breast lift lifts but does not enlarge. In some cases, both breast augmentation surgery and breast lift surgery are performed together in situations when the goal is to be larger and lifted.
Type of Breast Implants:
Breast Implants generally fall into the category of saline or silicone. This refers to the internal contents of the implant. All implants have a thin silicone rubber shell, but some are filled with saline fluid (salt-water) and some are filled with silicone gel. It is this fill material that classifies it as either saline or silicone.
Saline implants are essentially a water balloon. This means that the can show rippling and wrinkling. Some women report a sensation of “sloshing” and the implants can feel firmer than natural breast tissue. Silicone gel, however, is more like slime, so sloshing will not occur, and rippling and wrinkling are less common. Most patients and plastic surgeons would agree that silicone gel-filled implants tend to look and feel more like a natural breast. However, some women feel more comfortable with a saline implant. Additionally, silicone implants are “pre-filled”, meaning that they come in specific sizes that cannot be adjusted. However, because saline implants come empty, the fill volumes can be adjusted. This offers a good option for women with breast asymmetry since intra-operative size adjustments can be made.
During your consultation with a board-certified plastic surgeon, he or she may recommend one type of implant over another based on your desired appearance, and amount of native breast tissue. You should be sure you are comfortable with whichever type of implant you choose.
Implant Size:
The increase in breast size that you desire will dictate the implant size that you choose. The larger the implant, the larger your breasts will be after the surgery. This is very obvious. However, when selecting an implant size, you need to consider the amount of breast tissue that you are starting with. For example, placing 300cc breast implants in a woman who has A cup breasts, will give a very different result than placing the same 300cc implants in a woman with a C cup breast. This is why when using online photos to help select your implant size can be misleading. You need to make sure that you focus on their “before” photo as well.
The other thing to consider about implant size is what size will fit your body. As implants get larger, they also get wider. This means that a woman with a narrow chest, may not do well with large implants, since they will likely touch in the center (synmastia) or hang off the side of the chest wall (“side-boob”). Your surgeon will take measurement of your breasts and these measurements will be important in deciding which size breast implants fits you.
Additionally, if you have small breasts with tight skin, it will limit the size of the implant that you can get. If an implant stretches your skin, it can give a very unnatural appearance and can cause complications later. This is why your surgeon will do a “pinch test”, to determine how much your skin is able to stretch when the implant is placed.
In cases of breast asymmetry, where one breast is larger than the other, it is common to place implants of different volumes. For example, a larger implant can be placed in the smaller breast, and a smaller implant can be placed in the larger breast.
The main point is that the implant size is determined based on what you want and what your body can hold. It is well accepted among plastic surgeons, that the risk of complications over time increase with implant size.
Incision Placement:
The choice of incision is important because the incision will determine where the scar will be. There are several choices for incisions when having breast augmentation with implants. These include around the areola, within the breast crease, and in the underarm. Each has advantages and disadvantages.
The incision around the areola provides an opportunity for a well-concealed scar since the scar will be along the border of the darker areolar skin. However, if the areola is very small, it may not be possible to use this incision. Also, if someone is a poor healer and they make thick and raised scars, this would leave a bad scar right in the center of the breast. Some also report that the risk for nipple numbness is increased with this approach.
The breast fold incision is a very versatile approach. It provides direct access to the space beneath the breast tissue or beneath the chest muscle. When the incision heals, the scar is well hidden in the breast fold, although this can be seen when the breast is lifted and sometimes when a bikini top rides up. The incision can vary in length depending on the size of implants being placed. This is the preferred incision for most plastic surgeons and has been shown to have the lowest rate of complications.
A third incision option for breast implant placement is the underarm. This is intended to provide the most hidden scar when healed. This approach is more technically difficult and there is a higher incidence of implants being in the incorrect position (malposition). Proper placement usually requires the use of a small camera to allow the surgeon to see what he/she is doing. This approach may be impossible for very large implants. Also, some women do find that if the scar becomes slightly raised, it is irritating when they shave their underarms.
Implant Placement:
Implant placement refers to the relationship between the breast implant and the chest muscle. Breast implants can be placed under or over the chest muscle (pectoralis major). This is independent of implant type, size, and incision.
When an implant is placed under the chest muscle, the muscle offers an additional layer of covering to the implant. This means that on top of the implant is skin, breast tissue, and muscle. The more hidden the implant is, the more natural it looks. Placing an implant under the muscle, however, does increase the post-operative pain of the procedure and does extend the recovery time and activity restrictions after surgery. For women with very little breast tissue, placing an implant under the muscle is preferred. Also, there are some studies that show that placing an implant below the chest muscle reduces the rate of capsular contracture and infection, although this has become less true with newer implants and newer surgical techniques.
When an implant is placed over the muscle, it is in the space between the breast tissue and the chest wall. This means that the chest muscle is not disrupted during the surgery, so recovery is less painful and there are fewer restrictions. This may be a desirable approach for women who are very active or desire the most rapid recovery. Because there is less tissue covering the implant, the implant will be more visible. This means that you will see more roundness to the breast which can be perceived as more “unnatural”, but some women do prefer this “augmented” look. In women with a lot of breast tissue, placing an implant over the muscle may still look very natural.
The Surgical Process:
Breast augmentation is best performed under deep IV sedation or general anesthesia. This is done in a fully accredited surgical facility or hospital, and you will be monitored by a board-certified anesthesiologist. There are a variety of anesthesia techniques and your surgeon’s preferred method may vary. However, doing this procedure under local anesthesia is not recommended. Improper anesthesia can be uncomfortable and dangerous. Movement during this procedure can place you at risk of injury to your lungs which can be very serious.
When done by a skilled board-certified plastic surgeon, the procedure should take anywhere from 60-90 minutes and you will be able to go home the same day. If the surgery is combined with other procedures, or if your breast augmentation is a complex revision, more time will be required and sometimes an overnight stay at a hospital is advised.
Who Is a Good Candidate for Breast Augmentation?
The best candidates for breast augmentation surgery are physically and mentally healthy. You should not be pregnant or breast-feeding, and you should be a non-smoker. Although your breast augmentation surgery will aim to increase your confidence and ultimately remedy concerns you have about the size, shape, or evenness of your current breasts, you should have realistic expectations when it comes to your results. Breast augmentation can certainly increase your confidence and help you feel better about yourself and the way you look. At the same time, you should not expect breast augmentation or any other type of plastic surgery to completely change your life and fix all of your problems.
Before your surgery, you will meet with your chosen surgeon to discuss your options. At this appointment, you should have a concrete idea of what you're looking for in your future physique. Speak with your surgeon about the size of breasts you hope to achieve and what you want them to look like. If you have photos of celebrities or other women who have breasts that you like the look of, you can bring these photos with you.
You should also bring a list of any questions or concerns you may have about the surgery, surgery preparation, and recovery. It's important to be as prepared as possible at your initial consultation appointment so that you can ultimately achieve the exact results you desire. You will also likely have an additional “pre-op” meeting a few weeks before your surgery so that you can ask any remaining questions and be sure about your chosen implant size.
Choosing a Surgeon for Your Breast Augmentation
Once you’ve confirmed your decision to undergo breast augmentation surgery, it's important to find a capable surgeon to perform the procedure. Here, you'll want to take several factors into consideration, including each candidates:
- Education and training
- American Board of Plastic Surgery certification status (they should be board-certified)
- Years of experience with breast augmentation
- Patient satisfaction
When selecting your surgeon for your breast augmentation with implants, you want to make sure you select a board-certified plastic surgeon who is experienced with breast augmentation. You should take a look at the results your surgeon has achieved and made sure you are in agreement with his or her aesthetic. You also want to be sure that your surgeon has experience with the various implant types, sizes, incisions, and implant placements. This will help ensure that he or she can appropriately guide you and allow you to choose the best options for your body and desires. You also want to be sure that your surgeon will allow you adequate time to select your implant size. I personally think you should avoid any surgeon who tells you that he or she will pick a size for you while you are in the operating room. You also want to find out where your surgeon performs their surgeries – in an office operating room, ambulatory surgery center, or a hospital.
References
https://www.verywellhealth.com/choose-the-right-breast-implant-size-with-the-rice-test-2709981
https://www.drschulmanplasticsurgery.com/breast/breast-augmentation/
https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/implants
https://www.mayoclinic.org/placement-of-breast-implants/img-20007384
