Breast Augmentation
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Breast augmentation is a procedure in which breast size is increased using silicone or saline breast implants. It is also referred to as augmentation mammoplasty, breast enhancement surgery, or breast enlargement surgery. Breast augmentation is the most common cosmetic surgical procedure performed in the United States and has a very high rate of patient satisfaction.
See what Dr. Forsberg’s breast implant patients have to say about breast surgery
What are the most common reasons to have breast augmentation?
Many women choose to undergo breast augmentation because they feel their breasts are not proportionate to their overall body shape. For some this is genetic, but for others, breast volume is lost after pregnancy, menopause, or weight loss. If you find that the clothes that fit your hips well are loose up top, if you feel self-conscious in swimwear or low-cut tops, or if there is a noticeable size discrepancy between your breasts, you may be a good candidate for breast implant surgery.
Pictured above is a 38-year-old female patient of Dr. Forsberg’s who chose to undergo breast augmentation with 350cc silicone implants after becoming dissatisfied with the small, deflated appearance of her breasts after nursing several children.
Dr. Forsberg discuss who is a candidate for breast augmentation.
What can I expect in terms of scarring?
In general, there are three options to consider for the location of the incision used to create the pocket for the breast implant. The final scar can hide within the lower fold of the breast (inframammary incision), along the outside border of the areola, which is the pigmented skin surrounding the nipple (periareolar incision), or within the armpit (axillary incision). While there are advantages and disadvantages to each technique the inframammary incision frequently provides the least visibility and best long-term result. Usually this incision fades away into the crease between the lower portion of the breast and the chest wall. It affords the surgeon the most direct accessibility to the pocket being created for the implant which results in the shortest incisions and most symmetric and accurate implant placement. Unlike the periareolar incision, the inframammary incision avoids dissection through the breast tissue, which can result in contamination of the breast implant with bacteria normally found within the breast ducts.
Incisions for breast augmentation are generally placed on the areola, in the arm pit, or in the bottom fold of the breast
Should the breast implants be placed over or under the muscle?
In general, most patients will be better candidates for placement of the breast implants underneath the pectoralis major muscle in the chest in what is referred to as a dual plane. There are two major advantages for placing the implants under the muscle. The first advantage is that implants under the muscle have a lower rate of excessive scar tissue forming around the implant, called a capsular contracture. The second advantage is that it provides an added layer of tissue over the implant and helps to conceal the shape and outline of the implant, particularly in the cleavage area. This second advantage is more relevant to thin women with less breast tissue.
Breast implants placed “under the muscle” sit partially under the pectoralis major muscle
Left: subglandular placement of implant; Right: submuscular placement of implant
Implants placed in the submuscular plane are generally only partial covered by chest muscles, referred to by plastic surgeons as a “dual plane.”
There are women who are better candidates for an implant positioned above the muscle, or a subglandular position. These include women with adequate breast tissue to camouflage the presence of the implant, women who have a slight droop to the breast but want to avoid the scars associated with a breast lift, or women such as body builders who participate in strenuous upper body exercise. Dr. Kelly and Dr. Forsberg also perform a procedure called “subfascial breast augmentation” where the implant is placed above the muscle fibers but below the dense layer of muscle fascia. Is some cases, this technique gives patients the best of both worlds!
Implants placed in the subglandular plane are above the chest muscles but below the breast glandular tissue.
What is the difference between saline, silicone, and “gummy bear” (form stable) breast implants?
Both saline and silicone breast implants are made of a silicone elastomer shell on the outside. The difference between them lies in the substance filling the implants. In saline implants, the filler material is salt water, while silicone gel is the filler material for silicone implants. Modern silicone gel implants have thick outer shells and the gel inside is more cohesive. This means that if a modern silicone gel implant ruptures, the gel inside is very unlikely to move far from the site of the rupture.
Round saline breast implant
Saline breast implants being filled during surgery
Many patients are still concerned about the safety of silicone gel implants as a result of their temporary removal from the marketplace in the 1990s. During this time, the safety of silicone breast implants was studied extensively. Researchers found no increased risk of autoimmune diseases, breast cancer, chronic fatigue syndrome, or depression in women who had silicone breast implants (even ruptured silicone breast implants) than in women who had never had breast implants. For this reason, silicone is one of the most commonly used materials in medically implanted devices today.
See Dr. Forsberg discuss the difference between saline and silicone breast implants
Form stable breast implants, sometimes called “gummy bear” implants, are the newest type of breast implants to be released on the market. The gummy bear breast implants are filled with a highly cohesive silicone gel, which is thicker and stiffer than a traditional modern silicone gel implant. These implants are made in an anatomic, tear drop shape. Because of the stiffness of the gel inside, they maintain this shape in all positions. This means the form stable implant will maintain its teardrop shape whether the woman is standing upright or lying down.
There are several potential advantages of form stable breast implants. For small breasted women who want a conservative increase in size, the gummy bear breast implant provides a more natural shape. Additionally, the cohesive gel inside the implant is less likely to migrate outside of the shell if the implant cracks or ruptures. The rupture rates and capsular contracture rates of these implants are the lowest of any breast implant ever developed. Potential disadvantages of these anatomically shapes implants are rotation within the pocket and a slightly firmer feel.
Each of the various implants has advantages and disadvantages. For this reason, it is important to have a detailed consultation with a board certified plastic surgeon with whom you feel comfortable prior to deciding which implant is best for you.
See Dr. Forsberg discuss the differences between round and anatomic breast implants
What is a “high profile” breast implant?
For a traditional round breast implant, there are three important measurements to consider: the width or diameter of the breast implant, the volume of the breast implant (measured in cubic centimeters or ccs), and the profile of the implant. When looking at an implant from the side, the profile refers to how much the implant will protrude from the chest wall. The diagram above shows 3 breast implants of equal volume. The implant on the right is a high profile implant. As you can see, it is narrower and will protrude a greater distance from the chest wall. The lower profile implant on the left has a wider base for the same total volume. In general, a higher profile implant will result in a more projecting or more “busty” look. In addition to preference, skin type is important for the surgeon to consider when helping you decide which profile breast implant will be best. Relatively loose, stretchy breast skin will more easily and naturally accommodate a high profile breast implant, whereas breast skin that is very inelastic and tight may not accommodate a high profile implant as well.
How do I pick the size of my breast implant?
A common misconception among patients preparing for breast augmentation surgery is that a certain implant size equates to a certain bra cup size, or that they can look at pictures or see a friend’s augmented breasts and choose their implant size based on what they see in other people.
Every patient has a different breast width, height, and a different amount of their own breast tissue that contributes to the final size and shape of an augmented breast. When the goal is to provide an appropriately shaped, natural result, the reality is that the volume of the breast implant is the least important when selecting the breast implant measurements. A qualified, board certified plastic surgeon will measure the width of your breast and select a breast implant with a base diameter that fits your chest appropriately. The projection of the implant is determined by your preferences for final breast shape, the amount of natural breast tissue you have before surgery, and the elasticity of your breast skin. After the ideal implant width and projection are determined, the volume of the implant is essentially defined.
The reality, however, is that it is much easier for patients to think and experiment with different sizes of breast implants. We encourage our patients to experiment with different breast sizing systems at home and in the office.
How do I know if I need a breast lift (mastopexy) or breast implants?
In general, breast augmentation increases the volume of the breast while a breast lift elevates the nipple and areola to a more youthful position on the breast and tightens loose skin. While a breast implant will help fill loose and deflated skin on the breast, it will not correct a breast with significant droopiness on its own. A good rule of thumb is that if the nipple lies below the level of the lower breast fold, a breast lift will be needed – with or without implants – to provide an optimal result.
Breast lift is generally needed if the nipple lies below the position of the lower breast fold.
Are complications possible with breast implants?
As with any surgical procedure, there are complications associated with breast augmentation. While rare, complications such as bleeding, infection, and capsular contracture (formation of thick scar tissue around the breast implant) do occur. It is also important that patients realize breast implants are not permanent. Overall, breast implant revisions are done on average about every 10 years, whether it’s done for a ruptured implant, capsular contracture, or an augmented breast that later needs a lift or other adjustment. Patients desiring excessively large breast implants should know that larger implants result in more thinning and stretching of tissues, have more frequent complications, and tend to require more frequent revision operations.
Watch Dr. Forsberg discuss how long breast implants last…
What should I expect during the healing process from breast augmentation?
While there is discomfort following breast augmentation surgery, it is routinely very well tolerated by patients. Your chest will feel sore and tight, but this can be treated with various pain medications. Generally, the worst of the pain is over within 48 hours, and most patients return to work 3-7 days after surgery, depending on the nature of their job. It is important to avoid quick movements or heavy lifting with the upper extremities after surgery for 4 to 6 weeks. You may have bruising and some swelling after surgery. Most swelling will be gone within 1 month. The breasts may appear too high and tight right after surgery, but during the first 1-3 months, the breast skin will stretch and the implants will soften and settle down to their final position.
Breast implants will soften and settle over the first few months following surgery.
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