Breast Augmentation And Mammoplasty
Breast Augmentation And Mammoplasty
Steve Fallek (Plastic Surgeon & Medical Director, Face Focus Medical Spa, New York City) gives expert video advice on: How is a breast augmentation procedure performed?; What's the difference between "silicone" and "saline" breast implants?; What are the dangers of silicone breast implants? and more...
What is "breast augmentation"?
When you examine a breast, there's two components: there is the breast skin and the breast tissue. Breast augmentation is augmenting or improving the breast tissue. Classically, we call it either a breast augmentation or breast implants, where implants are put underneath the skin to augment the breast.
How is a breast augmentation procedure performed?
Breast augmentation is usually performed in one of two fashions. Breast implants are either put in above or below the muscle for safety reasons, and your doctor will determine that. In terms of incision sites, there are a variety of incision sites. Those include what we call the "Periareola", or incision around the nipple area, and the "Inframammary", or crease incision. Two other areas are the armpit or "Auxiliary" incision, and finally there is the incision through the "Umbilicus", where the breast implant is placed under the soft tissue and then into the breast. All of those lead to a small scar, all of which heal very nicely.
Who can get a breast augmentation?
A patient that is lacking in breast volume is a good patient for an augmentation. Often, patients come in where they're not quite sure whether or not they need an augmentation or a lift. You and your plastic surgeon should determine whether or not you are a good candidate for breast augmentation. Sometimes those procedures can be performed at the same time. Nobody under the age of 18 should really have breast augmentation and that is part of the rules of the manufacturer. With some of the new regulations for putting in silicone implants, no patient under the age of 22 is allowed to have silicone implants.
What's the difference between "silicone" and "saline" breast implants?
There are presently two types of implants that are available. The saline, normal saline or salt water implant, which has been available in this country for many years and has never been taken off of the market. This is an example of a saline implant, where the implant is placed into the breast and then saline or salt water is added to the implant during the procedure. The other type of implant now available in this country is what we call the silicone implant. Now, these were taken off of the market in 1992 due to health regulations. According to the Institute of Medicine, there has been no relationship between silicone breast implants and connective tissue disorders or other problems. So, within the last six months silicone breast implants have come back on the US market. Outside the United States, silicone implants have never been taken off of the market and these newer silicone implants are safer than the old implants.
What are the pros and cons of silicone breast implants?
Silicone breast implants have always been considered a softer, more natural feel than saline breast implants. The concerns have always been about any potential side effects of silicone implants. The other concern is that a silicone breast implant requires a larger incision than a saline breast implant when carrying out breast augmentation surgery.
What are the dangers of silicone breast implants?
With the reintroduction of silicone breast implants in this country, the FDA has proposed and made a guideline of potential complications associated with silicone breast implants. There are studies going on right now which will determine the long-term effects of silicone breast implants. As of right now, silicone breast implants have been determined to be safe and effective for cosmetic use in this country. They have always been used for reconstructive plastic surgery after breast surgery. At this point in time, the complications associated with breast implants are strictly incision or scar related.
What are the advantages of saline breast implants?
Saline breast implants have always been available in this country, and for over 30 years have proved to be a safe and effective method for breast augmentation in this country. They've never been taken off of the market, and the advantages are two-fold. Firstly: God forbid that there is a rupture, then we're talking about saline or salt water that ruptures (and this is very rare). The other advantage to saline implants is the fact that it requires a small incision for the implant to be put in safely.
What are the dangers of saline breast implants?
There are a variety of complications or side effects associated with saline implants. Number one is the risk of asymmetry, though the advantage of a saline implant is the fact that you can change the size of the implant during the case. Other disadvantages or concerns about saline implants are the scarring and the fact that there can be leakage. But in fact, if the saline implant does leak, it's saline or salt water that leaks out. The other complication or risk is what we called capsular contracture, where your body reacts and forms some scar tissue around the breast. These days we've really managed to eliminate the capsular contracture by putting the breast implants in a subpacked roll or submuslcular space, and that gives a more natural appearance.
Is breast augmentation painful?
The incision site with breast augmentation is not very painful. If your doctor chooses to put the breast augmentation implant underneath the muscle, the pectoralis muscle, he will need to cut the muscle. Usually he cuts it right on the medial aspect of the muscle, and that's the only painful part of breast augmentation. There are a variety of treatment options which can limit the pain associated with breast augmentation but in general, pain for a day or two, and a generally nice recovery.
What are the risks and complications of breast augmentation?
The risks of breast augmentation, either with silicone or saline implants, are the same. There's the risk of anesthesia, which for young, healthy females is relatively minimal. Most patients do not have problems with anesthesia for breast augmentation. The other concerns are scarring, and in general, those are rather minimal. The major concern with breast augmentation is capsular contracture. That's where your body forms scar tissue around the breast implant. By putting the implant in a sub-muscular, or beneath the muscle, approach, we've really managed to limit the amount of capsular contracture that takes place. Some of the other concerns are with regards to breast cancer and breast feeding. Patients who have breast implants are able to breast feed. Certainly, if that is of concern, you may want to choose an incision that does not include being within the nipple. The other concern with breast augmentation surgery that patients have is with regards to breast cancer. There are no increased risks of breast cancer with patients that have breast implants.
What incisions or scarring should I expect with a breast augmentation procedure?
Your plastic surgeon will determine which incision site he likes to use for breast augmentation and what is acceptable to you. There are generally four incision sites. There is the periareolar incision site, or the one within the nipple, which usually leaves a very small scar. There's also the inframammary incision, which is usually in the crease area of the breast. Two other areas are the auxiliary, or armpit, incision and the umbilical, or belly button, incision. In all procedures, the scars with breast implants should be rather minimal.
What should I expect after breast augmentation surgery?
When you wake up from your breast augmentation surgery, you'll have some amount of pain which will be treated by both your doctor and by medications. In general you'll have a dressing on for a few days and you'll be asked to wear a bra at all times for around a month. Your doctor will determine in terms of his incisions on how to take care of the individual incision sites after breast augmentation surgery. In general, it's going to be staying off of your chest, limiting exercise, chest exercise for about a month, and making sure that you wear some sort of support bra, either a surgery bra, a specialty bra or even a jog bra.
Will I have to take time off from work after breast augmentation surgery?
In general, the recovery time after breast augmentation is rather minimal. Patients can expect to go back to work in two or three days after the procedure. Again, some of that depends on what kind of work the patient is doing.
What are the costs associated with breast augmentation?
There are a variety of costs associated with breast augmentation surgery. First of all, there is your doctor's fee, which can range anywhere from $5,000 up to $10,000. Your doctor will also purchase your implants. Silicone implants will cost substantially more than saline implants. Two other costs of breast augmentation surgery are the anesthesiologist's fee and the facility fee. Depending on where you have the procedure performed, if it's in your doctor's office or in a surgery center, that cost may be all combined. If you're having the breast augmentation procedure done in a hospital, the hospital will have its own facility fee. In all regards, these procedures are same-day surgery or outpatient surgery, so you shouldn't expect to stay overnight.
Can I get other plastic surgery procedures at the same time I receive breast augmentation?
It's very common to have multiple body and breast surgeries preformed at the same time. Often a breast lift and a breast implant will be preformed at the same time. The fancy term for this is "augmentation mastopexy" where a breast lift and a breast implant are performed at the same time. Many patients have liposuction or tummy tucks also done at the same time as breast augmentation.