All About Breast Augmentation
Breast Augmentation, also known as augmentation mammoplasty or breast enhancement, is a surgical procedure to enhance the overall size of the breasts. If you or your friend are considering Breast Augmentation or if you are only interested in more information about the procedure, please call us at (714) 500-0050 for a consultation with Dr. Luu Doan. You can also email us by clicking here to schedule a consultation.
Breast Augmentation is a surgical procedure to enhance the size and shape of a woman’s breasts for several reasons:
To restore breast volume that is lost after pregnancy, progressive aging, or weight loss.
To enhance breast size and shape, thereby giving a woman greater self-confidence in her body image.
To balance a woman’s proportions by augmenting her breasts to be more proportionate to her shoulders, hips, or thighs.
To enhance the size and shape of the breasts in conjunction with a breast lift when breasts have sagged and lost volume due to aging, pregnancy, and weight loss.
To achieve better breast symmetry in women born with asymmetric breasts.
To reconstruct the breast that has been removed or disfigured from
breast cancer treatment, traumatic injury, or congenital abnormalities.
Deciding on Implant Size
The most important aspect of Breast Augmentation is deciding on breast implant size. There is no such thing as the perfect size for anyone, but there is an appropriate range of sizes for everyone. Dr. Doan and his staff have an individualized protocol to help every woman choose the best implant for them. This protocol begins in the consultation room with Dr. Doan who will listen to the patient’s desires regarding breast size and make a recommendation on a narrow range of implant sizes that is most proportionate for them. Patients will then be escorted to the implant sizing room to try on sizers and will be able to take full advantage of the knowledge and expertise of our professional staff. They will then view Dr. Doan’s very extensive photo gallery of breast augmentations to help with sizing.
Incisions for Breast Augmentation
There are two incisions that are most popular among patients, the areola incision and the crease incision, also referred to as the inframammary fold. Dr. Doan’s philosophy, shaped through years of experience performing thousands of breast augmentations, is that the crease incision provides the most overall advantages.
Inframammary Crease Incision
The inframammary crease incision is placed in the fold beneath your breast. This
location can accommodate every size and shape of implant, is cleverly
concealed in the deep crease, and is known for fast recovery times. An inframammary crease incision gives your plastic surgeon the most precise access to where your breast implant will sit after surgery. The scar cannot be seen unless the breast is pulled upwards.
The periareola incision is performed on the border of the dark skin around your nipple.
It is known to have fast recovery times, but does not accommodate every size of silicone gel implant, especially in women with very small diameter areolae. The scar tends to heal very thin since the areola skin is very thin. However, the scar can be more noticeable in women who have an irregular or faded edge of the areola.
Scar Visibility: The crease incision is buried deep into the crease or fold of the breast after augmentation, so it tends to hide a scar better than the more visible lower border of the areola. If a woman has any potential for thick scarring, then the areola scar would certainly be more visible than a scar in the deep crease of the breast.
Nipple Sensation: The crease incision tends to cause less nipple numbness than the areola incision as reported by our patients, although the significance of the difference is not known.
Breast Feeding: The crease incision does not cut through milk ducts and minimally cuts through any breast tissue so it theoretically has less interference with breast feeding. The areola incision, however, cuts directly through breast tissue and milk ducts on the path down to the eventual breast pocket. Therefore, the areola incision has much greater potential to interfere with breast feeding in young woman who are planning to have children.
Capsular Contracture: The crease incision is thought by some plastic surgeons to have a lower risk of capsular contracture than the areola incision, although this has never been proven in large scientific studies. The theory behind the higher risk of capsular contracture with the areola incision is that it allows bacteria from the nipple to be dragged down to the breast pocket. The bacteria trigger more inflammation and scar tissue formation, which is referred to as the capsule.
Silicone Gel vs. Saline Breast Implants
Silicone gel implants and saline (salt water) implants have their advantages and disadvantages. The difference lies in both the shape and feel produced by either implant.
Saline has the advantage of lower cost and the option to overfill the implants with more saline in the future under local anesthesia to increase size or to correct residual asymmetry. Silicone gel, although more expensive, is a clearly superior implant. Firstly, the soft feel of silicone gel is like that of a natural breast as opposed to the slightly more firm feel of saline implants. Secondly, the feel of silicone gel is very smooth in contrast to the wavy, rippling sensation along the lower and lateral part of the breast caused by saline. Thirdly, silicone gel lasts longer than saline with a much lower leakage rate than saline. Finally, as demonstrated below, silicone gel implants maintain their shape better than saline implants when patients are in the standing position. This is due to the cohesiveness or stickiness of the silicone gel versus the loose flaccid consistency of the saline implant.
There is no difference in the safety of saline implants versus silicone gel implants. Neither implant causes breast cancer or any other diseases like lupus, rheumatoid arthritis, scleroderma, Reynaud’s disease, etc. This has been very well proven time and time again in multiple large scientific studies.
Choosing the Right Style and Profile of Implant
Breast implants come in two different styles: round and anatomic (tear-drop shape). The vast majority of surgeons use round implants which give greater upper breast fullness. The tear-drop shaped implant may sound appealing in terms of giving a more natural shape to the breast. However, the disadvantage is that it produces a breast shape that lacks fullness in the upper breast.
Round implants come in several profiles: low profile, moderate profile, and high profile. Low profile implants are rarely ever used because they produce a wide, flat breast shape. Moderate and high profile implants are most commonly used because they have a smaller diameter (width) and more implant projection. This produces a breast with greater fullness in the upper breast and less fullness laterally into the axilla.
Placing The Implant Above (Subglandular) vs. Below the Muscle (Subpectoral)
Dr. Doan always places the implants under the pectoralis muscle, the muscle that lies under the breast and above the rib cage. There is very little controversy these days regarding the superior advantages of placing the implant below the pectoralis muscle as opposed to placing it above the muscle. Placing the implant under the muscle provides more soft tissue coverage over the implant and prevents rippling of the skin. The risk of capsular contracture is also significantly lower when the implant is placed under the muscle versus above the muscle.
Breast Augmentation Surgery
The Breast Augmentation surgery is performed as an outpatient procedure under general anesthesia in our medicare-accredited, state-of-the-art Newport Coast Surgical Center. The operation takes a mere 30 to 40 minutes to perform and you will be monitored by an anesthesiologist throughout the procedure.
The best method of inserting and positioning the implant depends on the patient’s particular breast anatomy. The Breast Augmentation procedure begins with the incision which is usually one inch long and can be placed in the crease of the breast, along the lower edge of the areola, in the armpit, or in the upper edge of the belly button. A pocket underneath the breast and the chest wall muscle (pectoralis muscle) is dissected to adequately accommodate the implant. The implant is then inserted and properly positioned. For silicone gel, the implant comes pre-filled and requires a slightly longer incision. For saline, the implant comes deflated and is filled after the implant is placed properly into the pocket. The skin incision is then closed with absorbable sutures. No drainage tube is required.
The choice between silicone or saline, implant size, and the need for breast lift is based on your breast anatomy, body type, your desired bra cup size, and your lifestyle. Only a thorough and candid discussion between you and Dr. Doan can determine the best options for you. Doctor Doan will discuss with you in detail every step of the procedure and he will review with you the possible complications of the operation. For a virtual demonstration of the operation, please click here.
Recovery From Breast Augmentation Surgery
You will likely feel achy pain, stretching of the skin, and a pressure feeling over your chest for several days after the surgery. Most patients say the pain was not quite as bad as they had expected. You should be up and about the next day to prevent blood clots from developing in the veins of your legs. You will be prescribed medication to control the pain, nausea, and possible chest muscle spasms. You will also be prescribed antibiotic pills to prevent infection. You need to wear a soft surgical bra for six weeks. Doctor Doan will instruct you on breast massage and will outline the activity limitations. The sutures are absorbable and do not need to be removed. Most women will be able to return to work in 5 to 7 days and will be able to return to their normal exercise routine by one month. Complete healing with resolution of the swelling and descent of the implant to a more natural position takes 2 to 3 months. The scar requires 12 to 18 months to fade, flatten, and soften. Doctor Doan and his staff will guide you through the entire recovery period to make sure that it is as smooth as possible.
Complications of Breast Augmentation Surgery
If you are a healthy candidate with no pre-existing disorders or diseases which may inhibit healing, the general risks of Breast Augmentation surgery are very low. However, since it is indeed surgery, there are inherent risks you must consider before choosing to undergo a procedure such as this. Potential complications associated with Breast Augmentation surgery may include the following:
Infection: Infection can occur if bacteria are introduced during surgery by contaminated implants or instruments. It can be caused by normal skin surface bacteria that survive the anti-microbial scrubbing of the skin. Infection can also occur if bacteria are introduced through an open incision or from pre-existing infections in the body (including disruption of mouth plaque).
Bleeding: Bleeding may occur 48 hours after breast augmentation if a blood vessel opens up spontaneously and begins to bleed. The other possibility is that the muscle or capsule is torn by sudden heavy lifting too soon after surgery and begins to fill the breast pocket with blood.
Rippling: Rippling can occur when there is either not enough saline filling the implant to stretch the shell, insufficient tissue to cover the implant, or internal scar tissue which is visible through thin breast skin.
Capsular Contracture (CC): When an implant or any foreign body is surgically implanted, your body forms a normal layer of scar tissue around the object. This is your body's natural way of decreasing inflammation. Some materials create significant inflammation, and others create very little, like the silicone shelled implants. Capsular contracture is when the body produces a thick layer of scar tissue around the implant. When this tissue contracts, the implant is distorted and it can also cause pain and even rupture of the implant.
Deflation of the Implant: An implant can deflate due to severe blunt or sharp trauma to the chest or a failure of the implant shell. The risk is very low and would require replacement of the implant.
Breast Tissue Atrophy: This is when the natural breast tissue shrinks due to the pressure of the breast implant. It is usually only noted if the patient chooses to have the implants removed and not replaced.
Bottoming Out: Bottoming out occurs when the skin and the underlying breast tissue at the breast crease separate. This can cause the implant to drop below the natural crease of the breast and form a second, unnatural crease.
Double Bubble: Double Bubble often occurs when a sub-muscular augmentation was performed without a much needed breast lift. The breast implant is held securely under the muscle higher on the chest wall. However, the natural breast tissue and excess breast skin sag below the implant. This creates the appearance of an augmented breast sitting above the natural breast.
Extrusion: Extrusion is very rare. This is caused by the breast basically pushing out the implant. The underlying cause is usually a very large implant in a very tight breast pocket causing internal pressure against the incision or an infection of the breast that causes the skin to open up.
Keloid and Hypertrophic Scars: This is usually hereditary and is based on your genetic potential for healing. This occurs when the scar tissue forms outside the area of the wound. It can result in thick, elevated, and wide scars.
Asymmetry: This occurs when one breast or nipple may appear higher or larger than the other breast.
Loss of Sensation (Numbness): Loss of sensation is common right after surgery. Nerve endings are cut during this surgery, so you must be patient until they regenerate and sensations begin to return. This can take up to a year but usually only takes several months for the sensation to return. However permanent sensation loss in the areola (nipple) area or breasts, in general, can and may happen.