Breast Augmentation Mobile, AL
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.
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.
More information about Breast Augmentation – by Dr. Randy Proffitt
Breast augmentation is one of the most common procedures performed by plastic surgeons in the United States as well as worldwide. It is the most definitely the most requested procedure in my practice.
Breast augmentation refers to the enlargement of the breast through the addition of either a saline or silicone implant. There is currently one standard way and one experimental way of doing this. For the last 40 years, the standard procedure is to place an implant underneath the breast tissue, either in front of or behind the chest wall muscle. I prefer performing the procedure with placement of the implant behind the chest wall muscle for two reasons. One is that I think it adds another layer of tissue between the implant and the outside skin, both camouflaging the feel and texture of the implant, especially a saline implant. The second is that there are some good studies that show that it helps decrease capsular contracture rate around the implant.
The experimental way involves fat injections to the breast and the jury is still out on this method. To date the amount of augmentation using this method has been smaller than the average size of implant most commonly used.
How long does it take to perform breast augmentation?
The way I like to perform the breast augmentation is with the patient asleep under general anesthesia. This is done under the direction of a board certified anesthesiologist and in a certified outpatient surgery center. The actual procedure, from the time the skin incision is made and until the dressing is placed, is usually about 45 minutes. After the procedure, dressings are applied and held in place with either tape or ace wraps. This bandage is left in place for 2-4 days, depending on the day of the week the procedure is performed.
The other nuance has to do with where to place the incision. Everybody always asks which technique is the best. There is no one single best incision for placement of the implants. The implant ends up in the same position no matter what incision is used to place it there. There currently are 4 separate incisions for a simple breast augmentation and these include the transaxillary (through the armpit), inferior periareolar (around the nipple), inframammary (the fold of the breast where your breast lies against your chest), and transumbilical incisions (through the belly button). The two that I prefer are the inferior periareolar or the inframammary incision. These two are the only ones that offer the ability to see directly into the area where the surgery is actually being performed. The transaxillary approach has to be done with an endoscope, which adds cost to the procedure, and in my opinion offers no benefit. There certainly are patients who are adamant that they don’t want any scar at all on their breast and for those patients the armpit might be a good choice.
My answer to those patients is that the scar resulting from an inferior periareolar or inframammary incision has excellent cosmetic results as far as scarring goes. The other question has to do with the size of the incision and the type of the implant that is being placed. A saline implant can be inserted through an incision and then inflated once it’s in place. Since it is inserted in the deflated state a small incision may be used, therefore if the patient has a fairly narrow or small diameter sized areola, the implant can be placed through this incision with a very excellent cosmetic result and without a very visible scar. The problem with silicone is that it comes prefilled and in a patient with a small diameter areola there may not be enough room to place the implant through this incision. In my experience I usually need 4-5 centimeters to place a silicone implant. In the patient’s consultation or preoperative visit, it can be determined whether that patient will be a candidate for placement of a silicone implant through an inferior periareolar incision or not. The other incision, which is the inframammary incision, is placed in the crease underneath the breast.
The incision is placed just lateral to the midline of the breast and once the implant is placed that incision is up on the breast approximately one centimeter so that when the patient wears a bra or bathing suit the scar is not visible underneath the edges.
Who is a good candidate?
Usually I see two types of candidates for breast augmentation: patients who never developed as full of breasts as they would like and patients who have lost fullness or perkiness due to age, pregnancy or weight loss. As with all types of plastic surgery the happiest patients are those who are doing the surgery for themselves.
Silicone versus Saline
Women frequently ask me, which is best saline or silicone? The answer to this question is: one type of implant does not fit all. Whether saline or silicone is best for you depends on many different factors. Each type of implant has its pros or cons. At your consultation all aspects will be taken into consideration.
Restrictions include no lifting more than 10 pounds or reaching above your head for three weeks. No driving for one week. NO strenuous activity for at least 6 weeks.
In my practice, breast augmentation is one of the surgeries where patients will report the greatest satisfaction.
When you’re ready to discuss breast augmentation surgery in Mobile, call the office of board certified plastic surgeon Dr. Randy Proffitt. You can reach us by email or by phone at 251-344-0322. Our practice is located at 6317 Piccadilly Square, Mobile, AL 36609. View a map to our office.