Breast augmentation continues to be one of the most popular plastic surgical procedures performed nationally. Since 2006 it has ranked in the top 5 among all plastic surgery procedures performed, according to the American Society of Plastic Surgeon’s annual reporting. If you are considering breast augmentation surgery, there are a number of things you may want to consider.
First, it helps to understand the purpose of breast augmentation and that is to enlarge the breast, provide volume in the upper pole of the breast and allow a patient to feel more comfortable and confident. This is different than lifting the breast, a procedure called “mastopexy”. A lift can generally be performed at the same as an augmentation, if indicated, in a procedure called “augmentation mastopexy” and I will discuss this procedure in a later blog post. So if you are looking to enlarge your breasts, breast augmentation may be the right operation for you.
Far and away, the most common way to augment the breast is by way of breast implants. There are two types of implants: silicone vs saline. The vast majority of patients select silicone for their breast implants because they are much more natural in their appearance and their feel. While there is nothing wrong with saline implants, they are essentially water balloons filled with salt water and thus less natural in appearance and feel.
Silicone breast implants are safe. Patients will often ask about implant rupture and concerns for silicone leakage into their tissues. Rupture of a silicone breast implant is uncommon, but the risk does increase with time. The silicone that fills a breast implant shell is cohesive (some are more cohesive than others) in that if there is a rupture, the silicone itself does not bleed out of the implant like motor oil would out of a can. It largely stays in place and is typically contained by a fibrous shell your body forms around the implant called a capsule. Regardless, if there is evidence of implant rupture we recommend the implant be removed and replaced.
The scar for breast augmentation goes under the breast where an underwire would lie. This is a very well-tolerated scar and is hidden in clothing and bathing suits. For most patients, we aim to place the implant under the major chest muscle called the pectoralis major. There are a few benefits to this approach. First, it allows for an extra layer of the patient’s own tissue to overly the implant, thus creating a more natural look and feel. Second, there is some evidence (albeit somewhat old at this point) that it reduces a complication of breast augmentation called “capsular contracture”. This is a visible and at times painful scar formation around the implant.
Evaluating a patient for breast augmentation always starts with an assessment of your overall health. As it relates to the breast itself, it is important for your surgeon to know if you’ve had breast surgery in the past, if you have any family history of breast cancer and if your mammogram (if applicable) is up to date. He/she will then examine you. Part of this examination involves taking some measurements. These measurements are critically important, as they help to determine (among other things) a range of sizes which may be appropriate for your body size. It is very important for patients to understand that implants have a footprint to them called “base width”. It is critical that the base width of an implant selected does not exceed the base width of your chest. If it does, the implant will fold on itself, migrate under your arm, or migrate across your chest. As implant sizes increase, so does their base width.
To help determine the best implant size for you, I think it is important for the patient to determine their own personal size goals. To help with this, I use a Mentor sizing system in our office. These are samples that simulate implants each patient can place in their bra to get a sense of how different size implants look on their body while in clothing. Each of these sample implants have a size in “cc’s” stamped on them. Thus a patient can determine what size they like. Your surgeon can determine the base width of that size implant and see if it is appropriate for the measurements of your chest taken in the office.
Overall, if done properly, breast augmentation is a safe, effective, reproducible operation with a relatively low complication profile and high rate of patient satisfaction. Down time is minimal and you can be back in the gym without lifting restrictions within 4 weeks.