Breast Enhancement Surgery
For the women who, for personal reasons, feel 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.
What is Breast Augmentation Surgery?
Breast augmentation increases the fullness, size, and/or projection of a woman’s breasts. To achieve this, implants filled with either silicone gel or saline are implanted either under the breast tissue or under the pectoral muscle. There are many choices involved with breast augmentation, everything from the incision location to the implant type. Dr. Rosenthal will provide you with the information you need and help you with these decisions before proceeding with the procedure.
Who is a candidate for breast augmentation?
Different women have different reasons for wanting to augment their breasts. The one common theme should be this — the decision is being made for her, not for a partner, spouse, or anyone else. Whether you’ve felt your breasts were never proportional with the rest of your body; whether you feel as if your breasts have lost volume and fullness after pregnancy and subsequent breastfeeding; whether your breasts are asymmetrical; or whether you’d simply like to have larger, rounder breasts — there are plenty of great candidates for this popular procedure.
Is Breast Augmentation Surgery Safe?
Many research studies have been performed on both silicone and saline breast implants. These studies have yet to find a link between breast implants and autoimmune or other systemic diseases.
Still there are risks involved with augmentation:
• Capsular contracture
• Change or loss of nipple sensation
• Problems with the implant position
• Implant rupture
• Implant rippling
• Breast milk production
Dr. Rosenthal will discuss these risks with you during your consultation.
Is Breast Augmentation Surgery Painful?
Breast augmentation is surgery, but your recovery is not as difficult as you might assume. For the first few days, you will have some discomfort, but it doesn’t usually require serious pain medication. Your chest will likely feel tight, but this is perfectly normal as the tissue needs to stretch and the implants need to settle into place. When you first look at your new breasts, they may appear too high on the chest. But this is also normal, as settling will bring the implants down somewhat.
Most patients can return to work in just four or five days. You can begin non-impact activity in a week or so, but impact exercise needs to wait for at least one month. Specific upper body exercises can resume in six weeks.
How long will my recovery take after breast augmentation?
After your surgery, your breasts will be wrapped in gauze dressings and you’ll be in a support bra to minimize swelling and provide support. You’ll need to take it easy for the first several days. Any acute pain typically subsides after from one to five days, but you may have some occasional soreness and swelling for a few weeks. Early one, your chest will feel tight, but this is perfectly normal as the tissue needs to stretch and the implants need to settle into place. When you first look at your breasts, they will appear to be too high on the chest. This is also normal, as the implants will settle downward into the pockets created for them.
Most patients can return to work in four or five days. You can begin non-impact activity in a week or so, but impact exercise or activity needs to wait at least one month and maybe longer. Specific upper body exercises can resume in six weeks.
How Long Does Breast Augmentation Take?
The procedure takes one to two hours. This doesn’t include prep time before and time after to come out of the anesthesia.
Are Breast Implants Permanent?
A rule of thumb is to expect 10 years for your implants to last. That isn’t a hard and fast rule, as they can last longer or shorter than that. Implants will eventually rupture and this is the time to have them removed and replaced. Implant durability is continually improving, so longevity should continue to increase
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 breast 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 – Should I Get Smooth or Textured Breast 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 implants will move within the breast pocket, while textured breast implants are likely to stay in one position.
Shaped breast 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 breast 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 your most desirable implant type for your breast enlargement.
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. Regina Rosenthal will guide you in selecting whether to place your breast implants under or over the muscle.
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.
What anesthesia is used for breast augmentation?
Breast augmentation is performed with the patient under general anesthesia.
How will breast augmentation affect pregnancy?
Implants are made of medical grade silicone outer shells filled with either saline or medical grade silicone gel. These materials are non-reactive in the body, and they pose no risk to normal pregnancy in any way. On the flip side, the body changes caused by pregnancy do not affect the actual implants either. The woman’s breasts will grow with pregnancy, but this doesn’t involve or affect the implants themselves.
In most cases, breastfeeding is not affected by augmentation. This is especially true if the implants are placed under the chest muscle because this provides an extra layer of separation between the implants and the milk ducts. Breast lifts with augmentation are more likely to cause disruption of the milk ducts because the nipple/areola complex usually is moved.
Augmented breasts are actually more resistant to the loss of volume and shape that occurs in most non-augmented breasts after pregnancy and breastfeeding. Augmented breasts maintain more of their volume because the implant volume does not decrease.
Can Breast Implants Cause Cancer?
There is no direct evidence of breast implants causing breast cancer. There was some news in 2017 potentially linking breast implants and the development of anaplastic large cell lymphoma (ALCL), a rare cancer of the immune system. However, the FDA didn’t say that implants cause ALCL, only that there is an “association.” The risk of this appears extremely low, and the cure rate is over 90 percent, so it is important to keep things in perspective.
There hasn’t been any evidence that breast implants cause breast cancer.
How long before I can shower after my augmentation surgery?
Dr. Rosenthal asks patients to wait for 48 hours before showering after this surgery. However, baths and submerging the incisions should be avoided for about one month.
Preparing for your Breast Augmentation Consultation with Dr. Rosenthal
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 our office in greater San Jose. 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 breast implants to be used.
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 your 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.
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 “General Anesthesia” , meaning you are asleep during your procedure. Your breast enlargement surgery will be performed at an accredited San Jose area 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.