There are FOUR CHOICES you must make prior to having a breast augmentation:
1) Choose what type of incision the surgeon will use to insert the implants
2) Choose whether to have the implants placed “over” or “under” your chest muscles
3) Choose the type of implant you would like (silicone or saline, round or “shaped” implants)
4) Choose the size of the implants
Breast augmentation can be performed using one of three types of incisions: Transaxillary, periareolar, or inframmamary incisions.
A two to four centimeter incision in the hair-bearing area under your arms.
A two to four centimeter incision at the lower edge of your areola.
A two to four centimeter incision in the fold under your breast.
All three options are safe and effective. However, your surgeon can help you determine which one is most beneficial to you.
Implants can be placed under the chest (pectoralis) muscles or over them. The benefits of placing them under the muscle include a lower chance of seeing “rippling” in the upper portion of the implant, in some cases a lower chance of having a “capsular contracture” (see below for explanation), and in some patients, a more natural appearance.
Implants should be placed over the muscle in patients who are bodybuilders, gymnasts, or serious weightlifters, where powerful use of the chest muscles can shift the implant position during contraction.
A breast augmentation takes about 45 minutes to an hour to complete. We perform the entire operation via a 2-4 centimeter incision, through which we create a pocket (under or over the muscle) for the implant. Once the pocket is made, we sometimes use “sizers” (temporary implants) to determine which final implant size looks best for the patient. The sizers are removed immediately and the final implants are placed in the pockets. After confirming a nice, symmetric result, we close the incisions with absorbable stitches that are placed deep to the skin, leaving only a fine line at the incision site. At the end of the operation, we place small, waterproof dressing over the incisions so that the patients can shower at their leisure. After awakening from anesthesia, our patients are brought to the recovery room and are cared for by a dedicated recovery room nurse. Once the patients are comfortable and ready, they are brought home by a friend or family member. We provide everyone with antibiotics and pain medication for a few days.
The technical name for a breast-lift is “mastopexy.” Patients who have excess breast skin and whose breasts sag significantly often benefit from a breast-lift at the same time as the augmentation. While the implant does fill some of the extra skin, any excess must be addressed by doing a breast-lift at the same time. The benefit is a much-improved shape and better nipple position, resulting in perkier breasts. At the time of consultation, your surgeon can determine whether or not you would benefit from such a procedure
We perform all breast augmentations under general anesthesia, and patients are completely asleep during the operation. This provides the safest and most comfortable environment.
For the first 48 hours, patients may experience some discomfort and are encouraged to take the prescribed pain medication as well as a 5 day antibiotic course. Showering is allowed immediately after surgery. The first post-operative appointment is typically 48-72 hours after the surgery. Implant “massage” (only for certain types of implants!) is demonstrated to the patients at this time. Patients can choose whether or not to wear a bra. The decision is based solely on their comfort. As for restrictions, patients can begin their daily lives as soon as they are comfortable, provided they avoid exercise, strenuous activity, or heavy lifting. Most patients will schedule a week to 10 days away from work. Most restrictions are lifted four weeks after the date of surgery, at which time low-impact cardio exercise can resume. There are no limitations after eight weeks. Follow-up appointments are scheduled at two days, two weeks, three months, one year , and every four to five years thereafter. The current recommendation from implant manufacturers is that all breast augmentation patients get an MRI of their breasts every few years to check the integrity of the implants.
Patients are often concerned that their breasts will look “fake” after a breast augmentation. We reassure everyone that a natural-looking breast augmentation can be achieved. It all depends on technique and the choice of implant. Whether our patients want full, perky breasts or a subtle increase in size will determine how we perform the operation and what implant to use. These important details are discussed at length with all of our patients during the consultation.
Silicone and saline breast implants both last about the same amount of time before they “break.” Contrary to popular belief, there is no such thing as a breast implant that lasts forever. In fact, we tell all of our younger patients that their implants will likely have to be changed some time in the future. The chance that a breast implant breaks is about ½ percent a year. This means that, ten years after surgery, there is a 90-95 percent chance that the implant is intact.
If an implant does break, it should be removed and can replaced through the same incision.
It is a misconception that breast implants affect breast-feeding. Patients who undergo breast augmentation can expect to breast-feed normally, with no effect whatsoever on the breast milk or the baby.
The VECTRA 3D imaging system allows us to capture a patient’s face, breast, and body images in ultra-high resolution and show them the possibilities of their esthetic procedure. For our breast augmentation patients, we use their own image to explore possible outcomes (showing them how different implant styles and sizes may look), educate them about their options, explain limitations, and set appropriate expectations. It is a tool that has earned rave reviews from our patients!