Breast Augmentation or breast enlargement is a way of achieving a more proportionate figure. Many of Dr. Funt's patients say that before breast augmentation their clothes did not fit well and hung on them. Others lost breast volume after pregnancy. Their breasts may have also sagged. They look at breast augmentation as having regained their youthful figure. Breast Augmentation has evolved throughout the years. Breast implants have changed and now there is a variety available. As you consider your options, there are many facts to consider and Dr Funt can be a great resource. The following will give you some insight into breast augmentation, your choices, and what to expect.
The first thing you should think about is what do you really want. In other words, what is it that you hope breast implants will do for you? Do you just want to be bigger or do you want to fill out the upper part of your breasts, which might have emptied after pregnancy or with age. Are your breasts uneven in size and shape and are you looking to make them more symmetrical? Are your breasts sagging and your priority is to have them lifted and made to look “perky”?
There are other questions that are also important. Is your skin tight or lose? Breast skin loosens after pregnancy, age, or with cyclic weight gain and loss. How much breast tissue you have to begin with will also affect the way your implants will look on you.
What implant shape is best for you?
Round, Teardrop, High Profile? The answer to this question is an individual one. Round implants in general are wider and will give you a more prominent cleavage. They also enhance the upper part of the breast tissue more fully. This might be an advantage for someone who is missing breast volume over the upper pole. On the other hand there are some women that want the implants to emphasize the lower part of their breast. For this group a Teardrop implant might be more appropriate. It all depends on what your goal is.
Under or over the muscle?
This refers to where the implant is positioned, under the Pectoralis Major (chest) muscle or over it. There are two important issues about this. First, sub-pectoral placement (under the muscle) of the implant in general results in less chance of capsular contracture. Therefore, there is a less chance that your implants will become hard. The second issue pertains to how the implants will look. In general the more padding you have over the implants, the smoother their periphery will look. Think of some of the women that you might have seen where the upper circumference of the implant is very sharp and the breasts look like they have been stuck on. If you have sufficient breast tissue to begin with, this will camouflage the implants well and will make them look more natural. On the other hand, if you don’t have substantial breast tissue to begin with, sub-muscular placement will give you the padding that you need to avoid the "stuck on" appearance.
Saline or silicone implants?
Both of these implants are currently available for use in the United States. Despite media and courtroom controversies most recent scientific studies have shown that silicone breast implants do not increase the risk of cancer and do not contribute to auto-immune diseases. You should know that the risk of implant rupture is low and that silicone implants in general have a more natural feel.
Do implants interfere with breast cancer detection?
Breast mass detection by self-examination is possible after breast augmentation. Submuscular placement of the implant allows better visualization of breast tissue with mammography. You should notify the mammography technician that you have implants so that they can perform the “Eckland displacement mammography technique” which visualizes your breasts better than the normal technique. If you choose silicone implants, we recommend an MRI every other year to examine the implants and breasts.
Incisions: inframammary, peri-aerolar, trans-axillary, trans-umbilical
Inframammary incision is placed where the breast meets the chest and is usually well hidden. The peri-areolar incision is made in the shape of a half circle at the outer edge of the areola, the colored area around the nipple. The Trans-axillary incision is placed in or near the armpit, and the trans-umbilical incision is made through the umbilicus, the "belly button". In making your decision about which incision is best you should consider many factors. Scars heal differently on different people. Scar camouflage is not only a function of the way you heal but also depends on your skin color, texture, and the way you dress. For example, a trans-axillary incision on a woman who wears tank tops, sleeveless shirts, or raises her arms during aerobic exercises might show more than an incision by her areola or under her breast fold. On the other hand, some women do not want any scars around their breasts no matter how faint they might be. In general, the closer an incision is to the nipple, the more chance it has of affecting nipple sensation. If you have a small areola and are very particular about not having your nipple sensation altered you might consider an inframammary or trans-axillary approach. Considering this, an incision around the areola is still a good option in those women who do not have a small areola.
Anesthesia, recovery, and restrictions
Safety of anesthesia is not just dependent on the type of anesthesia but more importantly on your health and smoking habit. Most women have their surgery under general anesthesia. Dr. Funt performs this surgery at our licensed and accredidated aesthetic surgery center with a board certified anesthesiologist at our Woodmere office.
How much pain?
Most of the discomfort is during the first three days. You will be given pain medication to be taken at home. During this time you should rest with your back elevated. You should gradually be able to do some things at home and in less than a week you should be able to return to work. This is a generalization. It will depend on your pain tolerance and your work routine. After your surgery, you should refrain from raising your arms or lifting for approximately 10-14 days. Dr Funt will examine you after the surgery and will give you specific instructions.
Risks and potential complications
- Bleeding or hematoma (blood Collection) formation: In general most people lose the amount of blood equal to one or two test tubes with their surgery. The risk of major bleeding or blood collection is about 3%.
- Wound Infection: This risk is less than 2%. Most patients receive intravenous antibiotics during the surgery and go home on antibiotic pills in order to minimize this chance.
- Altered nipple sensation: There is a chance of reducing nipple sensation or in fact making it more sensitive or hypersensitive. As discussed earlier, it could depend on the incision and range from 0% to 15%.
- Scarring: All people scar differently, but there is always a scar even though it may be very faint.
- Asymmetry, Displacement: No two breasts are identical before surgery, and no matter how much your surgeon tries to make them similar there will still be some differences between them depending on how closely you look. Implant displacement is possible after the surgery, but we minimize this by having the patient wear a special bra and/or binder in the immediate post-operative period.
- Implant rippling: Saline implants in general show more ripples than silicone. This rippling is also more pronounced if the implants are under-filled. It might have to do with the texture of the implant, but this is controversial. The more breast tissue you have and the deeper the implants (sub-muscular) are placed, the more the implants are camouflaged and the less you will possibly see or feel any rippling. Replacing saline implants with silicone can often improve the appearance of rippling.
- Implant rupture: Since the type of implants used and their structure has changed during the past few years, the true statistics about the rupture rate of new implants is not known. Nevertheless, it is known that implant under-filling increases the risks of implant fatigue and rupture. National implant brands will provide a warranty for your implants.
Dr. Funt will review your treatment options for breast augmentation, including pros and cons of each procedure, potential risks and complications, recovery, pre and post operative instructions, and aesthetic outcomes. This will enable you to make the choice that best suits your lifestyle and goals.