Written by Dr. Cross
Breast enhancement is a procedure that benefits a wide range of women. It can effectively help young woman feel more proportional, it can help someone who has seen changes occur to their breasts after having children, or it can be used when weight loss, age, or menopause have led to deflation and sagginess of the natural breast.
For years, breast augmentation was limited to changes that could be made with the use of breast implants. Today, implants, fat transfer (taking fat from other parts of the body and putting it in the breasts), or a combination of the two can be used to achieve ideal goals and results.
Breast implants come in a variety of shapes and sizes. Smooth, round, silicone filled implants are the most common type used, but textured surface implants that supposedly help prevent implant movement after placement, and anatomic implants that are pre-formed with a more “tear dropped” shape are also available. There was a period from the 1990’s to mid-2000’s when silicone filled breast implants were banned by the FDA over a concern that the silicone in the implants were causing strange autoimmune-like symptoms in women. During that time, only saline filled implants were available for routine breast augmentation. Studies on thousands of women who had silicon filled implants, saline filled implants, and no implants found that there was not an association between the implants and these symptoms, however, and silicone implants were brought back on the market in 2006. Currently, both are available, and while some patients still prefer saline breast implants, and excellent results can be achieved with them, a majority of patients in the United States choose silicone implants because of the more natural feel that they provide.
Breast augmentation with implants is performed by putting the implant either under a patient’s natural breast tissue (subglandular), or under the predominant muscle of the chest, the pectoralis major muscle (submuscular), illustrated here.
Both have their advantages. Dr. Cross will explain which option is ideal for an individual patient. Putting the implant above the muscle allows for the implant to help define more of the breast shape. This is important in patients with poor natural shape to their breasts. It also prevents movement of the chest muscles from affecting the movement of the implants. Putting a breast implant under the pectoralis muscle helps camouflage the implant in patients with very little of their own breast tissue, and makes future testing for breast cancer easier in high risk patients.
Breast implants can be placed using a variety of locations to gain access to the necessary area. Small incisions can be hidden in the lower fold of the breast, around the junction where the darker pigment of the areola meets the lighter skin of the breast, or through an incision placed in the armpit as shown.
While each of these have their role in certain patients, the approach with the highest likelihood of producing the most stable and precise result, is the incision that is placed in the under fold of the breast. If a lift is being performed at the same time as the augmentation, the incision that will be used for the lift can simultaneously be used to place the implant.
Choosing the right size and dimensioned implant is a meticulous process when performed in Dr. Cross’s office. A long discussion helps Dr. Cross understand what general desires each patient brings with them to the office. From there, an exam with measurements and imaging with the three dimensional Vectra Imaging System allows patients to see what their body will actually look like in three dimensional form. Patients try on various sized simulated implants. Finally, before and after pictures of Dr. Cross’s patients with similar body types and similar end result goals are reviewed.
Simulated results generated using Vectra Imaging.
Actual results demonstrating accuracy of achieving results that have been simulated.
Procedure and Recovery:
Breast augmentation is typically performed in an outpatient setting. The procedure itself takes between one and two hours, is performed under full anesthesia but with a technique that decreases the chance of nausea following the procedure, and in a way that leads to more rapid recovery from anesthesia. Patients usually return to work after a few days and may resume full exercising and activity by two weeks. There is generally minimal to moderate pain. When the implant is placed under the chest muscles, the chest will feel tight for a few days while the body adjusts to the presence of the implants.
Mammography of the breast is affected by the presence of a breast implant, and it is known that a portion of the breast is harder to visualize with a mammogram. For this reason, specialized mammographic images called Eklund views are performed. When thousands of women with and without implants were compared, there was no significant difference between the two groups regarding rates of breast cancer diagnosis, time at which the cancer was diagnosed, or risk of mortality from breast cancer.
Similarly, concern for breast feeding after breast implantation was studied and it was found that while breast milk in patients with breast implants may contain trace amount of silicone, it is significantly less than the levels of silicone found in infant formula and bottled milk. While breast augmentation may affect the ability to produce milk in some women, it appears that women who want to breast feed are able to do so; though small studies show that some may require supplementation, just like women without breast implants who attempt to breast feed.
Ultimately, breast augmentation is a wonderful way of creating or restoring balance and shape to an area that women cannot change on their own, allowing women to feel more comfortable with their proportion and appearance.