Breast Augmentation Surgery

Breast Augmentation is the most common cosmetic procedure performed in the United States. The goal of this surgery is to enlarge the size of the breasts. The results can lead to an improved proportion with the rest of the body, resolve any size differences, re-create volume loss from pregnancy or weight change, or even to just enhance the breasts. It has been well established that patients gain increased self confidence and quality of life if performed under the correct circumstances. Outside of cosmetic surgery, breast augmentation is frequently performed to treat congenital breast anomalies as well as breast reconstruction in patients with breast cancer.
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There are several factors that influence the way breast augmentation is performed and is unique for every patient. During your consultation, Dr. Tsai will present you with all the possible options in detail and work with you to individualize treatment according to your specific goals and expectations to provide you with the best possible result.

  • Implant type: Saline or Silicone filled implants
  • Implant shape: Round or anatomic (tear drop)
  • Incision site: Under the breast, around the areola, or under the armpit
  • Placement: Under the breast gland, under the muscle, or dual plane

Recovery is short and patients usually return to work and normal daily activities within a few days. Patients return home the same day and pain is minimal, well tolerated with prescribed oral medication. Your first checkup will be the following day in clinic. Bandages are removed a few days after surgery and a specialty bra is worn for a few weeks. The breasts will feel tight initially and results may take several weeks for the tissue to stretch and implants to rest into its final position. Scars are thin and hide well. Exercise maybe resumed in approximately 4-6 weeks.

Procedure:

Breast Augmentation surgery is performed under general anesthesia (patient fully asleep) in the adjacent surgicenter and usually takes about an hour to complete. Options to consider that Dr. Tsai offers include:

Implant type: Currently there are only two available choices for implant fill, saline or silicone. It is important to note that the shell, or covering of the implant, are both made from silicone.

  • Saline is an isotonic fluid, the exact type given to dehydrated or hospitalized patients through an IV. It is safe and harmless and if a leak were to occur, the body would absorb it without any consequences. These implants are filled during surgery; therefore, a smaller incision can be created to place the implant.
    • Advantages: safe isotonic fluid, easily detectable if implant leaks/tears, smaller incision
    • Disadvantages: heavier, more firm/less compressible, higher incidence of rippling seen under skin
  • Silicone is a manufactured product, first used for breast implantation in the 1960’s. These implants are pre-made by the manufacturer so there is no filling during surgery. To shed light on the silicone controversy, it is important to understand its history with the FDA:
  • 1976 – assumed authority over implantable medical devices
  • 1991 – recommended further research to establish safety
  • 1992 April – voluntary moratorium on all silicone filled implants
  • Insufficient data to refute or support claims of safety – rheumatologic disease / scleroderma
  • 31 studies with 500,000 women found NO relationship between silicone and ANY disease
  • Meta-analysis of 87,000 women published in NEJM in 1995 with no association between silicone gel implants and connective tissue disease
  • 2006 November – reapproved use of silicone-filled implants, however had been used in European market since inception in the 1960’s.
  • For patients 22 and older only
  • Studies performed over the last few decades have shown no correlation with silicone breast implants and any health problems. There is NO evidence of increased risk of breast cancer, its treatment outcomes, or its detection. Silicone breast implants have shown to be safe during breast feeding. It does not interfere with lactation success nor levels of silicone in the milk.

Silicone implants are more difficult to detect if there is a leak or tear. However, with the new generation of implants, the silicone has a more solid consistency rather than a liquid that was used in the older generation types. If there is a leak, ideally the silicone would not travel within the tissue. Many are referring to them as “gummy bear” implants due to its similar characteristics. Leaks and tears for silicone implants are generally diagnosed with an MRI but can often be noted on an ultrasound.

  • Advantages: lighter, more natural/compressible feel, less rippling, better natural contour
  • Disadvantages: slightly larger incision, more involved reoperation if leaks, requires imaging study to determine leak/tear.

Implant shape: There are two shapes available for use. Round or anatomic shaped.

  • A round shaped implant is the typical traditional breast implant. The vast majority of patients pick a round shaped implant. The maximal projection of the implant is centrally. These are also used for the patients that want the “augmented” look
  • Ideal for patients who desire more volume without shape issues.
  • An anatomic implant (teardrop shaped) is best used in a subset of the population. The maximal projection is located in the lower half of the implant. The tapered upper half of the implant avoids excessive fullness in the upper breast. To maintain shape, implants are slightly more firm.
    • Ideal for patients with narrow breast width, thin, deficient upper breast tissue, who desire a larger volume.

Incision type: Different incision types can be used to place the breast implant. Whatever type you decide, the incision is a fine-line scar that is well hidden.

  • Inframammary (under the breast): traditional approach due to ease of technique and ability to visualize pocket creation and placement of implant. This incision also allows manipulation of the tissues around the implant, as often required in revision surgery. The incision is well hidden at the breast fold and cannot be seen in a bikini or normal brassiere. All types of implants can be placed using this approach.
  • Periareolar (around the areola): much less visible scar as it is hidden in the natural transition between the areola and breast skin. This technique can be used to reduce the size of a large areola at the same time. Due to the limited size of incision, all types of implants can be placed except for very large silicone implants since these are pre-made by the manufacturer. Because this gives direct access to the breast, any manipulation that is required for contour shape improvement, such as in tuberous breasts or as needed in revision surgery, can be easily performed. This approach has not shown to decrease nipple sensation.
  • Transaxillary (under the armpit): the incision is hidden in a crease located within the armpit, thus there are no scars on the breast. Again, due to the limited size of incision, all types of implants can be placed except for very large silicone implants since these are pre-made by the manufacturer.

Placement: After an incision is made, a space needs to be created to place the implant, called the pocket. There are three pockets that can be created.

  • Subglandular (under the breast gland, but above the muscle): Placement in this pocket typically involves a shorter operative time, decreased recovery period, and less pain. Another advantage is that if you have minimal ptosis (drooping of the breast), this can be corrected with only an implant placed in this location, without the need for a breast lift. Depending on how much native breast tissue is present, there could be increased implant palpability, implant show or rippling, interference with mammography, and increased risk of capsular contracture. Because an implant is being placed in an area where there was no space to begin with, it can cause stretching and thinning of the breast tissue above.
  • Submuscular (under the pectoralis muscle): Creation of this pocket typically involves longer operative time, increased recovery period, and more pain/spasms due to incisions that are made to release the muscle. However, there is a much less incidence of implant palpability and visibility due to extra tissue surrounding the implant. There is also less mammographic interference and a decreased incidence of capsular contracture. Of note, if you are an athlete, placing the implant in this location can create dynamic displacement, where during contraction of the pectoralis muscle, the implant could potentially move and be displaced. On relaxation, the implant migrates back to its normal position.
  • Dual plane (combination of above): This is the most commonly recommended placement as it combines the advantages of the other options. In this technique, the upper portion of the implant is covered by muscle, and the lower portion is covered by breast gland. This reduces implant palpability, implant show, capsular contracture, improves mammographic reading, and allows the breast gland to redrape over the implant allowing an improved longevity of breast shape over time.

For more information, photos, and videos, please refer to the American Society of Plastic Surgeons website for Breast Augmentation Surgery.

Tsai Plastic Surgery

Roger Tsai, MD
Board Certified
Plastic Surgeon