Breast Augmentation

Breast Augmentation Surgery

For the woman who, for personal reasons, feels that her breast size is too small or not properly contoured, cosmetic breast surgery can be the answer. Breast augmentation surgery, or augmentation mammoplasty, restores or adds volume to a woman’s breasts to give her a more proportional figure. This can be used to balance out an uneven “pear-shaped” body or to fill out and lift deflated breasts. Breast augmentation may also help women who have lost a significant amount of weight or who have experienced stretching of the breast skin after pregnancy and breast feeding to achieve fullness again. Breast implants may also be used to reconstruct the breasts of women who have undergone a mastectomy or lumpectomy for breast cancer, or who have suffered from other traumatic injuries to the breasts.

In women who have sagging of the breasts, from breast feeding or weight loss, breast augmentation can be combined with a breast lift to create a larger, lifted, fuller and more youthful appearing breast.

There are many other benefits of breast augmentation surgery that you may experience. Not only can it increase the size breasts, but it can balance out your figure making you appear slimmer, taller, and more confident. That increase in confidence can make you seem more approachable to others and make you appear more attractive to the opposite sex, including your spouse. Many patients who have breast implants report increased self-confidence and a better outlook on life, thus enjoying more positive experiences in their day-to-day lives. Consider also, that balancing out the top half of your body can help you feel and look better in form-fitting clothing and allow you more opportunities to look good in the types of outfits you’ve always wanted to wear.

Preparing for your Breast Augmentation Consultation with Dr. Rosenthal

Before coming in for your initial consultation, be sure that you are healthy and in good physical condition. It is best to be about the weight you want to maintain since a large weight gain or weight loss may change the size and shape of your breasts, even after surgery. If you are a smoker, try to stop at least two weeks before you breast augmentation, since surgery is safest for non-smokers. You will also want to avoid aspirin, NSaids (advil, motrin), and herbal supplements two weeks before and after surgery since they may increase the chance of postoperative bleeding. If you are 35 or older, or have breast abnormalities, Dr. Rosenthal may request that you obtain a mammogram before your surgery.

Breast Augmentation – Choosing Silicone Gel or Saline Implants

For breast augmentation, Dr. Rosenthal inserts silicone gel filled or saline (salt water filled) implants either partially beneath the chest wall muscle or over the chest wall muscle (subglandular) depending on the patient’s individual needs.

Patients will have the opportunity to choose whether they want silicone gel or saline implants. The advantage of silicone gel implants is that many people think they feel and look more like a natural breast. They tend to have less potential for visible or palpable ripping than saline implants. One disadvantage of silicone gel implants is that the incision for insertion of the implant may have to be made slightly longer to accommodate the pre-filled implant.

Another issue to consider with silicone gel implants is that, unlike saline implants, they will not deflate when ruptured so a rupture will not be immediately apparent. For this reason, the FDA recommends that women with silicone gel implants undergo an MRI of the breasts three years after implantation and every two years thereafter to check for rupture of the implant.

The advantage of saline-filled breast implants is that if they rupture, the implant will deflate either partially or completely. Then it will be obvious to the woman and her physician that her implant has ruptured. Another positive aspect of saline implants is that implants of a particular size can be variably inflated to correct small differences in symmetry between the breasts. Finally, because saline implants are deflated prior to insertion and are inflated inside the breast pocket that has been created to accommodate them, the incision can be smaller than with a silicone gel filled implant. At your consultation Dr. Rosenthal will assist you in selecting the proper implant type for you.

Breast Augmentation – Smooth or Textured Implants?

Both saline and silicone gel implants can have a smooth or textured (rough surfaced) firm silicone outer shell. There is some research that suggests that patients with textured silicone gel implants may have a somewhat lower chance of capsular contracture (hardening of the breasts due to scar tissue).On the other hand, because they tend to “stick” to the overlying tissue there may be a slightly higher chance of visible or palpable rippling with textured implants. Smooth-surfaced implant will move within the breast pocket, while textured implants are likely to stay in one position.

Shaped implants are necessarily textured to keep the implant in the desired orientation for a particular shape.

Breast Augmentation – Form-Stable (“Gummy Bear”) Shaped Implants

In recent years the FDA has approved the use of form-stable or “Gummy Bear” implants for breast augmentation. These implants are silicone gel-filled, have a textured outer shell, and are produced in various shapes to simulate natural appearing breast contours. These implants contain highly cohesive silicone gel. This means that if they rupture, very little silicone gel will extrude from the implant. Form stable implants tend to be somewhat firmer than round silicone gel implants (which may also contain cohesive gel but sometimes to a lesser degree). All form-stable silicone gel implants have a textured surface so they “stick” to the surrounding tissue to maintain the right position and breast shape.

At your consultation you will have the opportunity to see and feel different implant types. Dr. Rosenthal will assist you in selecting the most desirable implant type for you.

Breast Augmentation – Choosing an Incision Site

There are three options a woman has for an incision site through which to place the implant. The transaxillary (underarm) incision is about one inch in length and is placed within a high crease in the underarm. The advantage of this incision is that it is well camouflaged high in the armpit. On the other hand, if another surgery on the breasts is needed in the future, another incision under the breast fold or around the areola may be necessary. Because they are deflated prior to insertion, saline implants are ideal for this incision.

The second type of incision is at the inframammary fold underneath the breast. This is probably the best for the silicone gel implants because they are fully inflated prior to insertion and must be placed through a somewhat larger (1 ¾’ – 2’) incision.

The periareola incision (around the lower border of the areola) has been quite popular in the past because it is camouflaged well by the color difference between the darker areolar skin and the lighter breast skin. Recently however, plastic surgery research has indicated that implants placed through this incision may be exposed to small amounts of bacterial contamination (called “biofilm”) when the implant comes in contact with the breast ducts to the nipple, which harbor bacteria. This may result in a slightly higher rate of capsular contracture (hard scar forming around the implant) than when the implant is placed through the other incisions. Less commonly, trans-nipple and transumbilical incisions have been used. The FDA has discouraged the use of the transumbilical incision (which can only be used for saline implants) since there may be a potential for damage to the implant while inserting it through the long tunnel between the umbilicus and breast pocket. At your consultation, Dr. Rosenthal will assist you in selecting the right incision for you.

Breast Augmentation – Subpectoral (Submuscular) or Subglandular Placement of the Breast Implant?

Silicone gel and saline breast implants can be placed under the chest wall muscle (subpectoral, submuscular), or above the muscle but below the breast gland (subglandular). The advantages of submuscular placement are:

  • More soft tissue coverage over the implant to prevent visible or palpable rippling.
  • Minimize capsular contracture (hardening of breast caused by scar tissue around implant)
  • More effective evaluation of mammograms since the muscle separates the implant from the breast gland.

The disadvantages of putting the implant under the muscle include:

  • More discomfort for about a week postoperatively.
  • Momentary movement of the implant upwards, sometimes with momentary “indentation” of the implant while muscle flexion is occurring while working out. This is usually not visible while the woman is clothed.

The advantages of subglandular implant placement are:

  • Less discomfort in the immediate postoperative period with less muscle spasm.
  • No movement of the implant when the woman flexes her pectoral muscles.
  • May have a better cosmetic appearance in women whose breasts are slightly droopy, but not enough to require a breast lift.

The disadvantages of subglandular placement are:

  • May have a higher rate of capsular contracture
  • High possibility of visible or palpable rippling since there is less soft tissue coverage over the implant.
  • Evaluation of the mammograms may be more difficult because the implant is just below the breast gland, not separated from it by the muscle.

Dr. Rosenthal will guide you in selecting whether to place your breast implants under or over the muscle.

Moving Forward With Your Breast Augmentation

Congratulations on deciding to move forward with your breast augmentation with Dr. Rosenthal! Now, with the help of her staff, you will select a date for your surgery and schedule a preoperative appointment. At that time, you will be given all your pre and postoperative instructions, and prescriptions for necessary postoperative medications. You will also have a “sizing” appointment (which can be done at the same visit) to make a final decision on the type and size of implant to be used.

Breast Augmentation – Choosing Your Breast Implant Size

At your initial consultation, Dr. Rosenthal will measure your breasts and based on that recommend a range of implant sizes that would be appropriate for your breast and body proportions.

Before your first consultation, you may find it useful to browse through Dr. Rosenthal’s “Before and After” photo gallery and take note of women who share a similar body size as you.

At the time of your preop appointment, you will have a “sizing” during which you will be able to take as much time as you need to “try on” different implant types and sizes until you feel comfortable with your size selection. Dr. Rosenthal and staff will assist you in this based on your measurements and your individual preferences. Finding the best size together will result in that great balanced and proportional figure you’re seeking.

Your Breast Augmentation Surgery – The Big Day!

The night before or the morning of your surgery, you will speak with your anesthesiologist. Most commonly, you will have a “General Anesthesia” , meaning you are asleep during your procedure. Your surgery will be performed at an accredited outpatient surgical center.

After your surgery is completed by Dr. Rosenthal (which takes about 1 ¼ -  1 ¾ hrs.), you are monitored in the “recovery unit” for about an hour until you are medically stable and ready for release to your designated caretaker (friend, family member, or nurse) who will take you home.

After Your Breast Augmentation

You will return to see Dr. Rosenthal during the next several days for a postoperative check. Further follow up appointments will be made at that time.

You can be up and about the day of your surgery, although it is best to wait about 4-5 days before working or driving. You will need to refrain from vigorous physical activity for 4 weeks. Dr. Rosenthal may recommend implant massage depending on the type of implant you have. Dr. Rosenthal will guide you as to when you may resume normal activities.

For breast augmentation in San Jose – Campbell area, contact female plastic surgeon Regina Rosenthal today.

 

View Dr. Rosenthal’s breast augmentation before and after gallery

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