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Breast Augmentation

Breast Augmentation or enlargement is a way of achieving a more proportional figure. Many of my patients say that before breast augmentation their clothes did not fit and hang well on them. They could not fill out their tops. Either their tops fit too loose on them, or their bottoms were too tight. Others lose breast volume after pregnancy. Their breast may have also sagged. They look at breast augmentation as a way of regaining their youthful figure.

Breast Augmentation has evolved through out the years. Breast implants have changed and now there is a variety available. The following will give you some insight into breast augmentation, your choices, and what to expect. You should know that this article is only an introduction and you should discuss this procedure with your surgeon in detail before embarking on breast augmentation.

The first thing you should think about is what do you really want? In other words, what is it that you hope that 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 loose? Breast skin loosens after pregnancy, age, or with cyclic weight gain and loss. How much breast you have to begin with, will affect the way your implants will look on you.

What IMPLANT SHAPE is best for me? Round, Teardrop, Anatomic, ….In my opinion, the answer to this question is an individual one. Round implants in general are wider and will give you a stronger cleavage. They also enhance the upper part of the breast tissue more fully. This might be an advantage for some one who is missing breast volume over the upper pole. On the other hand there are some women that want the implant to emphasize the lower part of their breast. For this group a Teardrop, or “anatomic” implant might be more appropriate. Please know that there is no such a thing as an “anatomic” implant. It all depends on what you are missing and where.

Textured vs. Smooth implants….Textured implant have a rough surface and smooth implants have smooth surfaces. According to most medical studies textured implants tend to stay softer and have less chance of having capsular contracture which meaning forming a hard capsule around them. This also depends on the location of the implant, meaning behind the muscle or over the muscle. Some surgeons also believe that textured implants do not sag as much with time.

UNDER or OVER the muscle…. This refers to where the implant is positioned; under the Pectoralis Major (chest) muscle or over it; which places the implant only underneath the breast tissue. There are two important issues about this. First, sub-pectoral placement (under muscle) of implant in general result in a significantly less chance of capsular contracture. Therefore, there is a much less chance for your implants to get hard. The second issue is about how they will look. In general 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 much breast tissue to begin with, this padding will camouflage the implants well and will make them look more natural. On the other hand if you don’t have any, sub-muscular placement will give you the padding that you need. You should know that sub-muscular placement is more painful, but it might be worth it.

Saline or Silicon 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 silicon breast implants do not increase the risk of cancer and do not contribute to autoimmune diseases. Nevertheless, those who decide to have silicone implants must fit certain criteria and have to enrole in national studies. Use of saline implants which are filled with salt water (saline) is not as nearly restricted. If an implant leaks in your body the saline just gets absorbed, like the saline fluid that you will receive in intravenous fluids during surgery. On the other hand released silicone from a ruptured implant will need to be manually removed with surgery.

You should know that the risk of implant rupture is very very low and that silicone implants in general have a more natural feel.

Do implants intefere with breast cancer detection…Breast mass detection by self-examination is possible after breast augmentation. Submuscular placement of 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 “Eklud’s displacement mammography technique” which visualizes your breasts better than the normal technique.

Incisions; Inframammary, Peri-areolar, Trans-axillary, …

Inframammary incision is placed near the under-breast fold, while the peri-areolar incision is made like a half-circle at the outer edge of the areola or the colored area around the nipple. Trans-axillary incision is placed in or near the armpit, and the trans-umbilical incision is made through the umbilicus. In making your decision about which incision is best you should consider many things.

First of all scars heal differently on different people. Scar camouflage is not only a function of the way you heal but also dependents 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. There are other important issues as well. 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.

You should also know that in general some surgeons could achieve a better result through one incision than through others. It is shown that in general trans-axillary incision is the least favored among surgeons. Those that do not like this approach feel that it does not give them the most symmetrical result with the strongest cleavage. On the other hand, they are those that feel that with the use of an endoscope they can get a great result with the trans-axillary approach.

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 but there are some that also have it done under sedation. In any case, you should have your surgery performed in a licensed, or accredidated surgery center and under the care of an experienced or board certified anesthesiologist or nurse anesthetist.

How much pain? Of course, I cannot tell you personally, but I have seen many patients and friends through their recovery phase. According to these women most of the discomfort is during the first two days. During this time if you rest with your back elevated you will feel a lot better. After that you should be gradually 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, and it differs among people depending on their pain tolerance and their work routine. After your surgery, you should refrain from doing any arm rising, or pulling for approximately 10-14 days. Your surgeon will examine you after the surgery and will give you specific instructions depending on the type of your implant and the type of your surgery.

Risks and Potential Complications… Every thing we do in life and of course every surgery has risks and potential complications. Plastic surgery is elective surgery and you should understand its risks carefully before deciding to undergo surgery. It is also important to have a surgeon who is apt at dealing with and correcting any potential complication that might inevitably occur. The following are most and not all of the potential risks and complications that you should familiarize yourself with:

• 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 I discussed earlier it could depend on the incision any were from 0% to 15%.
• Scarring: all people scar differently, but there is always a scar even though it might be very faint.
• Asymmetry, Displacement: No two breast are identical before surgery, and no matter how much your surgeon tries to make them similar their 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 silicones. 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 implant (sub-muscular) are placed the more the implants are camouflaged and the less you will possibly see or feel any rippling.
• Implant rupture: Since the type of implants used and their structure has changed during the past few years no body knows the true statistics about the rupture rate of new implants. Nevertheless, it is known that implant under-filling increases the risks of implant fatigue and rupture. National implant brands such as McGhan and Mentor warranty their implants. We provide these implants to our patients.

Los Angeles Breast Augmentation famous Dr. Younai will review your treatment options for breast augmentation, including pros and cons of each procedure, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. There are also many before-and-after pictures and high resolution images of breast augmentation available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.