Breast Augmentation
Cosmetic Surgery to Increase Breast Size
The decision to have one’s breasts enlarged or enhanced is a personal one. Many women desire larger breasts so clothing fits better and their bodies are more proportional.
Other women may wish to regain fullness and/or perkiness lost to pregnancies, breast feeding, or because of weight loss. Or maybe you have just always wanted larger breasts. At your consultation with Dr. Proffitt you will be invited to watch a DVD on breast augmentation and view an extensive selection of before and after photos. Dr. Proffitt will also take a thorough medical history and discuss your desired result. After an examination and further discussion, you will receive his recommendations and a written quote for your individualized surgery. Consultations last about an hour.
How is Breast Augmentation Performed?
The surgery itself involves placement of an implant behind the breast mound either in front of or behind the chest wall (pectoral muscle). Dr. Proffitt places the implant behind the muscle the majority of the time for two reasons. First, the muscle adds a layer of tissue between the implant and the skin surface of the breast. This helps camouflage the contour of the implant and soften its external appearance. Second, there is evidence that when placed under the muscle, the scar tissue (capsule) that develops around the implant stays thinner and more pliable, making it softer to the touch.
Before and After Breast Augmentation in Mobile, AL
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There are four options as to the incision site for access in placing the implants. The inframammary and inferior periarealar incision are Dr. Proffitt’s preferred approaches.
- Incision in the arm pit: Dr. Proffitt doesn’t use the incision under the arm because it requires use of an endoscope which adds to the cost of the surgery.
- Through the belly button: Dr. Proffitt does not use the trans belly button incision called the TUBA (transumbilical breast augmentation). This method also uses special equipment which adds to the cost of the surgery and also does not allow for direct visualization.
- Along the lower edge of the dark area around the nipple (areola) Periarealar Incision: The scar along the lower edge of the areola heals and blends in well. However, if the areola is small in diameter a silicone implant may not fit through this incision since silicone implants are prefilled and thus require a longer incision; making an inframammary incision (number four) necessary. This is not a problem with saline implants as they are placed in the sub muscularly position before being filled with saline. Frequently, patients have concerns regarding nipple sensation when the incision is close to the nipple. This is unfounded. Decreased sensation can occur no matter where the incisional approach is. Fortunately this complication occurs infrequently.
- In the crease under the breast, Inframammary Incision: Historically the inframammary incision has been used the most and is an excellent choice for either saline or silicone.
Which Breast Implants: Silicone or Saline?
The choice of implants comes down to two options with some variations. Saline and silicone implants have been around since the 1960’s. Silicone was not available for cosmetic breast augmentation from 1992 until the FDA declared them safe and unrestricted for use in October 2006. During the years from 1992 until 2006 they were not "taken off the market”, but rather a moratorium limiting their use in cosmetic breast enlargement alone was imposed. They have always been available for use for reconstruction or in conjunction with a breast lift.
Saline implants are composed of a silicone shell with a valve integrated in the implant. After the air is removed by inserting fill tubing through the valve, the implant is placed into position and filled with saline. Saline solution is the same as what is used in an “IV” at the hospital. Once filled, the fill tubing is removed and the one way valve is closed. Silicone as mentioned comes pre-filled adding to the cost of silicone implants as compared to saline.
Determining which implant to choose depends on many factors. Silicone has a more natural feel while saline implants can sometimes be felt through the breast easier, especially in thinner women or those with less breast tissue covering the implant. Many women are more “comfortable” with saline rather than silicone due to lingering misconceptions about silicone. If a saline implant leaks the implant will deflate over a few days. The saline solution is absorbed harmlessly by the body, and the volume loss will become obvious.
Replacing the implant with a new one is required. If a silicone implant leaks it may not be obvious. Usually the silicone gel remains contained within the scar tissue around the implant (capsule.) Since leakage may not be evident to the patient, the FDA recommends having an MRI of the breast three years after implantation and every other year thereafter. An MRI can detect approximately ninety percent of leaks in silicone implants, whereas mammograms and ultrasound can positively detect leaks in only about twenty percent. Patients also choose implants based on their age. The FDA, as of Oct 2006, placed a restriction for saline implants on women under age eighteen and for silicone implants the recipient must be of at least twenty-two years of age.
What Shapes and Surfaces of Breast Implants are Available?
The surface of an implant can be either smooth walled or textured. In Dr. Proffitt’s practice he prefers smooth walled implants for two reasons. With textured walled implants there is some evidence of a higher leakage rate, and they are more palpable. There are two different shapes of implants as well, round and tear drop. Dr. Proffitt prefers the round implants as opposed to a tear drop shaped implant due to the fact that all tear dropped shaped implants are textured. Outward appearance of tear-drop implants, both by observation and radiographically, is indistinguishable from round shaped implants.
The manufacturers of implants have developed varying profiles for each volume or size of implants. The higher the profile for a given volume the smaller it is in diameter. Consequently the projection or “profile” is higher. When deciding on which profile of implant is better the diameter of the breast and chest wall is important. Determining this along with desired volume helps decide whether a lower or higher profile implant is appropriate.
Where and How is Breast Augmentation Performed?
Dr. Proffitt performs breast augmentation as an outpatient procedure. The patient is administered anesthesia by a board certified anesthesiologist. The surgery itself takes approximately one hour. The patient remains at the facility and will be monitored for one to two hours until the anesthesia has worn off sufficiently enough to allow the patient to go home. A bandage will remain in place two to four days depending on the day of the week the surgery is performed. The dressing will be removed at the patient’s next office appointment at which time patient is fitted and placed into a support bra.
Once the bandaged is removed the patient is free to shower. The support bra should be worn at all times except when the patient is showering. After another week the sutures will be removed and the small steri-strips or tape will remain over the incisions to help protect it further. These can be removed after one to two weeks. For three weeks after surgery no lifting of more than ten pounds is important. Six weeks following surgery the majority of the swelling will have dissipated. At this point the patient is free to resume normal daily activities including exercise.
What are the Risks of Breast Augmentation?
There are risks with any surgery and most are not unique to breast augmentation. Fortunately, excessive bleeding and infection are very infrequent with breast augmentation surgery. Capsular contracture is an event that is unique to this particular surgery. This is when scar tissue develops around the implant and becomes thick or tight. This can distort the shape of the breast, make the breast firm to touch, or cause pain. Breast massage, certain medications, and time will help to soften the breast. However, if the breasts remain firm long-term, corrective surgery may be necessary. Breast Augmentation is a life changing procedure for many women. Breast implants require a lifetime commitment of self-examination, mammograms, and/or MRIs as well as consultation with Dr. Proffitt regarding any concerns.
Contact us for a consultation about breast augmentation in Mobile, Alabama