Breast augmentation, involves the use of implants placed beneath the breast to increase breast size. The procedure, in very much its current form, has been performed successfully since the early 1970’s. Nearly 300,000 women undergo the procedure annually.
Breast implants are made of silicone envelopes filled with either saline solution or silicone gel, which some people may find worrisome. The fact is that silicone is everywhere, and silicone gel implants have been extensively studied by government groups and scientific panels, and are deemed fully safe for use. This is good news. In my practice I favor silicone gel filled implants over saline filled, as they provide a generally more natural result.
The implants push the natural breast forward and enlarge its projection and width. This can be achieved by placing the implant on top of the pectoralis muscles, in a natural plane just beneath the breast, or under the pectoralis muscles themselves. Why choose one over the other? The most common complication of breast augmentation is fibrous capsule formation. This happens when the body reacts excessively to the foreign body (the implant) and forms a thick internal scar around it. The result is a firm feeling breast. In order to mask this firmness, many surgeons place the implant beneath the pectoralis muscles. In effect, to hide the firmness with the muscle padding. To my way of thinking this placement is less anatomical, and too often results in a significant double hump deformity. I choose to place the implants above the muscle. If there is significant capsule formation it is usually easily dealt with, but the incidence of capsule formation requiring surgery is small. Neither method is perfect, but under the best of circumstances I find placing the implant under the breast and on top of the muscle to give undetectable, natural results…and that, after all, is our goal.
Incisions can be placed under the breast, near the inframammry fold, around the areola, or under the arm. Usually, the inframammary incision offers the best access, and is best tolerated.
After surgery a surgical bra is worn as a dressing. There is pain or discomfort for 24-48 hrs, and most patients return to work in a week.