Breast Augmentation

Who is a candidate?

Breasts are a focal part of a women’s femininity and sexuality, and changes in breast size or shape can often affect a women’s self-esteem and confidence. Common reasons for having breast augmentation include:

  • Preference for larger breasts
  • Wanting to restoring volume lost with age, pregnancy, and/or weight loss
  • Correcting asymmetry between the breasts
  • Reconstructing breasts after cancer or trauma (please see Breast Reconstruction section for more details)

Saline versus Silicone?

Implants in the U.S. come from one of 3 main manufacturers: Allergan, Mentor, and Sientra. They are available in saline or silicone, which describes what the implant is filled with.

Both saline and silicone implants have an outer shell that is made of silicone. Saline implants are filled with saline (salt water), and silicone implants are filled with silicone gel.

Both types are safe. Reasons women choose saline include lower cost and more obvious rupture if it were to happen (and no need for MRI surveillance). Reasons women choose silicone include more natural feeling, more natural appearance, less visible wrinkling or rippling.

For women with a moderate-large amount of their own natural breast tissue, either type of implant can give natural looking results.

For thin women with little breast tissue, often silicone implants give a more natural shape, look, and feel. Ultimately once the patient understands all the benefits and risks, the choice of silicone versus saline is up to the patient.

Under versus over the muscle?

In general Dr. Patel prefers placing implants under the muscle for 2 reasons:

  • Lower risk of capsular contracture than above the muscle
  • Looks more natural since it adds an additional layer of tissue over the upper aspect of the implant, giving a smoother transition along the border of the implant.

Please note that technically there are 4 types of placement described- over the muscle (aka subglandular, retromammary, just under the breast tissue), partially under the muscle (aka subpectoral, submuscular, just under pectoralis major muscle), completely under the muscle submuscular (under both pectoralis major and serratus anterior muscle, completely covered by muscle) and bi-planar or dual plane (upper half under the muscle, lower half under breast tissue). Dr. Patel typically chooses partially submuscular or dual plane techniques.

Incision types?

There are 4 main incision types: peri-areolar (along the bottom of the areola), inframammary (along the fold beneath the breast), axillary (through the armpit), and transumbilical (through the belly button).

Of these types, Dr. Patel feels the inframammary and peri-areolar techniques offer the best outcomes. The axillary incision is suboptimal due to visibility of the scar (at least in Southern California due to the warm weather and sleeveless tops), and “blind” surgery since the dissection is not done under direct vision, but rather tunneled into position.

Number of cc’s versus profiles

Breast implants are defined by the volume of the implant and the profile of the implant. The volume is how many cubic centimeters or milliliters of saline or silicone are in the implant.

While there is no exact conversion, approximately 150-200 cc adds a cup to your bra size. So for example, if you wear a B cup bra and get a 300 cc implant, you will likely be a full C or small D.

Keep in mind the cup size measurements are totally different depending on the brand of lingerie, so you may wear a B cup in one brand and a C or D in other brands. This is why any talk of cup size is relative, not exact. The profile describes how far from your chest wall your implants or breasts will project.

There are numerous profiles, but in general terms there are  low, moderate, moderate-plus, high, and ultra-high.

These range from flatter and wider, to rounder and narrower. For most patients, the most aesthetically pleasing profile is either moderate-plus or high profile. Moderate plus profile implants achieve a natural looking, yet fuller profile, and high profile gives even more volume for any given breast width.

Breast lift at same time?

Breast implants will increase the size of the breasts. The amount of lift provided by filling up the skin envelope with an implant is minimal, and for the majority of patients does not take the place of having a lift.

If your breasts are drooping now, will implants they will just look larger and droopy. In other words, if you need a lift, you need a lift.

Breast lifts can be done with small incisions for a small lift, or larger incisions if you need a larger lift. In general, the nipple should sit at the fullest or most projected part of the breast. This tends to be approximately mid-way between the shoulder and elbow for most patients. Please see the Breast Lift (Mastopexy) section for more details.

Risks of having implants?

Silicone implants have not been found to be a cause of greater risk of connective tissue disease, and do not cause an increased risk of breast cancer. Also, current evidence does not suggest higher risk of problems with pregnancy, fertility, or breastfeeding.

Standard risks of having breast augmentation with implants includes: Pain; bleeding; infection; scarring; painful or hypertrophic scarring; hematoma; seroma; injury to vessels, nerves, any surrounding structures; change in nipple sensation; change in breast-feeding ability; capsular contracture; implant rupture, leak, extrusion; poor cosmetic result; asymmetry; visible rippling; need for further procedure; risks of anesthesia.

Breast implants do not increase the risk of breast cancer. However, they may lead to an increased (though still very low) risk of anaplastic large cell lymphoma (ALCL is a cancer of the immune system, not a cancer of breast tissue).

In the patients with ALCL, the tumor was found adjacent to the implant and within the capsule. In a 2011 report, the total number of published cases of women with implants with ALCL was 34, whereas the total number of women with implants was estimated at between 5-10 million worldwide.

For further details regarding the above information, please read more on the FDA website.

Monitoring for implant leak or rupture:

If saline implants rupture, the effect is noticeable because the breast deflates and your body absorbs the saline fluid.

If silicone implants rupture, you do not necessarily have outward signs of this. For this reason, the FDA recommends monitoring the breasts with silicone implants with an MRI of the breasts 3 years after they are first placed, and then every 2 years thereafter to check for “silent rupture”.

Mammograms after breast implants

Mammograms taken after breast augmentation require additional views (Eklund views), in order to adequately visualize the breast tissue.

It is often easier to visualize tissue when implants are below the muscle as opposed to below the breast tissue. When going for mammography, you must disclose to the imaging center that you have implants, and they can set the mammography up accordingly. Regarding timing, if you are age 40 or greater, or have a family history of breast cancer, you should obtain a baseline mammogram prior to breast augmentation surgery.

If you already get routine mammograms, it is recommended to wait 6 months after surgery to get your next mammogram in order to allow time for healing, and then resume your normal screening schedule.

What is the lifespan of implants?

Implants are not a lifetime device. The longer they are in place, the greater the chance of rupture, capsular contracture, need for reoperation.

The general recommendation is to have implants changed out every 10 years. This is not an exact rule, and it is not mandatory to swap them out at 10 years.

However, if you are around the 10 year mark and do not have problems, changing the implants out is a straight-forward procedure. If you are having problems, or want a lift at the time, this can be addressed at the same time.

Postoperative follow-up visits

Visits following breast augmentation surgery typically occur the day after surgery (for dressing change and making sure there was no bleeding, fluid collection, or blood supply issues overnight), the week after surgery (for removal of drains if present, inspection of incisions, and instructions on how to massage the implants), 2 weeks after that, and then spread out less frequently thereafter.

The schedule is adjusted based on doctor/patient preferences and needs.

Recovery time

Walking the day of surgery is recommended. You may shower 24 hours after surgery, preferably with a watertight dressing over the incision during the shower.

No baths, soaking in tubs, hot tubs, or swimming pools until incisions are fully healed. Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incision is okay.

Massaging of the implants in the breast pocket generally starts 1 week after surgery in an upward and inward direction, to be performed several times a day during the early postoperative period. Dr. Patel will give specific instructions on massaging at the one week visit, as it may vary patient to patient. Scar gel may be used starting 2 weeks after surgery or once incisions have no open areas, crusting, or scabs.

A soft, supportive (snug but not too tight), non-underwire bra that zips or fastens in the front is recommended for the first 6 weeks following surgery.

In general, Dr. Patel recommends avoiding exercise for 6 weeks following surgery, at which time you can ease back into your workouts. Light activity that does not involve the upper body may be okay around 3 weeks after surgery. You may return to work the week after surgery, depending on your pain level, stamina, and activities required in your occupation.

You may drive once you are no longer taking pain medications or muscle relaxers, and allow a 24 hour minimum window between your last pain medication or muscle relaxant dose and driving. All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient.