Breast Augmentation St. Petersburg

breast augmentationBreast augmentation is one of the most common plastic surgery procedures performed. There typically are two types of patients that seek breast augmentation. First, many women want to be able to shop for clothes that seem to be made for women with larger breasts. This person isn’t necessarily looking to appear augmented, but maybe their natural size is a bit smaller than average. Typically, this patient will request to be larger, but not so large as to appear fake at first glance. The other type of patient is one who not only wants to be augmented, but they want to appear augmented. Regardless of which patient you are, choosing to have breast augmentation is a personal decision that should be made by you without pressure from outside sources.

Type of Implants

There are basically two types of breast implants. Saline implants are silicone shelled implants that require filling with normal saline after the implants are placed into their location. For this to be possible, a valve is located on the front side of the implant into which a fill tube is temporarily placed at the time of surgery. Once the implant is filled to the desired volume, the fill tube is removed and the valve closes. This valve is the most common cause of saline implant leakage. Over time, tissue can grow into the valve causing it to open and leak saline. The saline implant then loses volume slowly and the implant must be replaced. Silicone implants also have a silicone shell, but the implants come prefilled with medical grade silicone. There are no valves in a silicone filled implant and therefore an almost nonexistent risk of spontaneous leakage. Silicone filled implants feel softer and more natural than saline filled implants. Just like water balloons, the more water you put into the balloon, the firmer it feels. Saline simply doesn’t compress like silicone and is therefore firmer. Because silicone filled implants come prefilled, a slightly larger incision is required to get the implant into the desired location.

Shape of Implants

There are two shapes of implants; round and teardrop. Round implants will provide more upper pole fullness than a teardrop implant, something that most women desire. Teardrop or anatomically shaped implants have a shape that is teardrop when viewed from the side and this shape does not change whether the implant is sitting on a table top or inside a patient. Because most breast augmentations are done by placing the implant beneath the pectoralis muscle, having a teardrop shaped implant doesn’t help the appearance of the breast except to give less upper pole fullness. Implants placed beneath the pectoralis muscle have a natural teardrop appearance from the muscle covering them. Remember, if a teardrop implant rotates, now the anatomical shape is not positioned anatomically correct and can lead to a distorted breast. Very few patients choose anatomical implants for breast augmentation. Teardrop implants are typically textured and create a firmer feel to the breast as well.

Placement

Where an implant is placed is a much-debated topic among plastic surgeons. The two most common locations are subglandular (above the muscle) and submuscular (beneath the muscle). A combination approach is how most augmentations are performed and is called Dual Plane Breast Augmentation. It’s called dual plane because part of the implant is beneath the muscle, and part is beneath the gland. In dual plane breast augmentation, the pectoralis muscle is released from its lower attachment to the ribs leaving it still connected to the breast bone or sternum. The implant is the placed into a pocket that is covered by the pectoralis muscle superiorly and the breast gland inferiorly. This provides support from the muscle to help avoid stretching of the skin of the breast that will occur in total subglandular breast augmentation. It also reduces contact with the gland that some believe will reduce the likelihood of capsule contracture. Subglandular breast augmentation is when an implant is placed beneath the breast gland, but above the pectoralis muscle. This approach to augmentation doesn’t provide the protection of having partial muscle coverage and may increase the risk for capsule contracture. Further, it can lead to a less natural look to the upper pole of the breast as the pectoralis muscle is not providing the natural taper (teardrop) appearance of a submuscular or dual plane breast augmentation.

Risks of Breast Augmentation

The most devastating risk of cosmetic breast augmentation is infection. Fortunately, infection is not the most common complication. Board certified plastic surgeon Christopher Newman, D.O., has never had a patient develop an infection after breast augmentation. Reoperation rates for breast augmentation are nationally quoted as 20% by 10 years (as stated in Adams, Jr., William, Mallucci, Patrick, “Breast Augmentation,” Plastic and Reconstructive Surgery 130: 597e-611e). What this means is that 20% of patients who have had breast augmentation will require reoperation for some type of reason whether that is infection, malposition, capsule contracture, rupture, etc. Modern implants have a rupture rate of approximately 1 to 2% in 10 years, a record that has allowed implant manufacturers to provide lifetime warranties on their implants. Capsule contracture occurs when the capsule that the body forms around all breast implants begins to get thick and firm. Over time the thick capsule can begin to contract and cause pain and distortion. Approximately 10% of all augmentations will develop capsule contracture. Avoiding bacteria laden incisions can help avoid this unwanted complication.

Incision Location

There are 3 incisions commonly considered in breast augmentation. The most common location is along the inframammary fold (IMF). Incisions along the IMF allow surgical dissection beneath the breast tissue, not through the breast tissue where the surgeon might encounter ducts that are non-sterile. Avoiding bacteria will reduce the risk of capsule contracture. The IMF approach also allows direct access to the pocket allowing better control for implant position. Peri-areola incisions, or incisions around the areola, can cause bacterial contamination of the implant due to cutting through non-sterile ducts and can lead to nipple and areola distortion and sensation changes. When a combination breast lift is combined with augmentation, however, peri-areola incisions are unavoidable. Lastly, transaxillary incisions are incisions near the armpit. The interest in this incision is to hide scars. However, incisions through apocrine glands that are non-sterile can lead to increased risk of infection and/or capsule contracture.

What to Expect

Patients want to know their downtime after breast augmentation. Downtime varies based on individual recovery time and what someone considers recovered. For instance, someone wanting to return to an office job at a desk may be up to returning to work in one to two days. However, if someone wants to return to a job stacking shelves or as a yoga instructor, there will be more downtime. Some patients have reported minimal soreness; others have reported moderate soreness. Choosing a very large implant can also be the cause of increased discomfort.

Ultimately choosing the correct implant type, position, and size is best accomplished with an experienced plastic surgeon.