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Choices In Breast Augmentation

Breast augmentation is one of the most common procedures performed by plastic surgeons. Women choose to have breast augmentation for many reasons. A common goal in breast augmentation is the enhancement of one's self image. Some women are dissatisfied because their breasts never develop to a size that meets their expectations. Others wish to achieve proportion, symmetry or restoration of their natural breast volume, which may have decreased as a result of pregnancy, weight loss, or aging.

Various acceptable techniques are available to achieve the common goal: patient satisfaction. It is important that any individual seeking breast augmentation surgery have a clear understanding of the choices available.

Are breast implants safe?

Silicone gel-filled implants were taken off the market in 1992 due to a concern regarding potential medical complications. The silicone gel-filled implants, previously unavailable for use because of the implant controversy, are now approved for select patients. Extensive information is now available on the safety profile of silicone gel-filled implants and can easily be accessed online or through a search of appropriate, reputable periodicals.

In the United States today, most women having breast augmentation will receive saline (saltwater)-filled implants. The implants consist of a silicone based shell filled with sterile saltwater. Should the implant leak, the saltwater is harmlessly absorbed by the body.

Types of breast implants

Breast implants are designed with various shapes and surface textures. Implant shape is either round or anatomic ('teardrop'). The round implant is most commonly used in the patient undergoing breast augmentation. The `teardrop' implant shape is designed to more closely mimic the breast shape (flat up top and more full at the bottom), and is well-suited for use in breast reconstruction following mastectomy where the breast tissue has been removed.

The surface of the implant can be either smooth or textured The smooth implant is similar to the surface of a balloon. The textured implant has a surface that is `rough' or `gritty' similar to a high grade sandpaper. The smooth implants are used far more commonly in patients undergoing breast augmentation. I find textured implants helpful in patients who have persistence of a capsular contracture (firmness around the implant) after initial correction.

Adjustable breast implants were designed to allow the patient the ability to either increase or decrease the size of the breast after the surgery has been performed. Adjusting the implant size is done during a routine office visit, taking no more than 5 minutes to perform. Another advantage of the adjustable implant is the ability to achieve a more natural breast shape by temporarily over-expanding the implant and then removing the extra fluid, thereby relaxing the skin creating a more natural appearing breast.

Implant placement

The implant can be positioned either above or below the chest muscles. I favor subpectoral placement because I believe there is a lower rate of capsular contracture (hardening of the tissue around the implant) and less visibility and palpability of the implant. Placing the implants above the muscle (or just below the breast tissue) can be an appropriate option in some patients based on an individual's breast shape, aesthetic goals or implant choice.

Incisions

A number of incisions can be used in breast augmentation. The most common incisions are the inframammary (within the crease under the breast) or the periareolar (around the lower portion of the nipple/areola region). Other approaches include the transaxillary (armpit) and the transumbilical (around the belly button). These approaches are used much less frequently. The choice of incision can often be selected by the patient. At times, however, a particular incision that is most appropriate for your breast anatomy may be recommended.

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