Dr. Randy Proffitt, an experienced double-board-certified plastic surgeon, frequently performs breast augmentation for Mobile patients looking for an increase in breast size and projection.
The decision to have one’s breasts enhanced is a personal one. Many women desire larger breasts so clothing can fit better and their bodies can be more proportional. Other women may wish to regain fullness lost to pregnancies, breastfeeding, or because of weight loss. In numerous cases, women simply desire larger breasts.
Your Breast Augmentation Consultation
At your consultation with Dr. Proffitt, you will be invited to watch a DVD on breast augmentation and view an extensive selection of breast augmentation 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.
In certain cases, Dr. Proffitt may suggest a combination procedure known as augmentation mastopexy. Also called a breast augmentation with lift, this surgery pairs a breast lift and implants to create new volume and perkiness while reducing sag. It is a very comprehensive procedure that only requires a single recovery period.
For cases where the patient desires a reduction in sag but no volume enhancement, a breast lift without implants is often recommended.
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 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 periareolar incision are Dr. Proffitt’s preferred approaches.
Incision in the arm pit: This is also known as a transaxillary incision. This approach is an excellent incision to use if the patient desires to have no incision on the breast whatsoever. When it originally started to be used, it was a blind approach. This meant that the surgeon used an instrument through the incision to bluntly dissect the pocket in which the implant was to be placed. Here, the surgeon was not able to directly visualize the tissue as it was dissected. With the advent of the endoscope, direct visualization was able to be performed such that bleeding complications and malposition problems were all been eliminated. Dr. Proffitt prefers not to use this approach for several reasons. The first is that the incision directly goes through the skin where the glands of the armpit reside. These glands have higher bacterial content and thus higher risk of postoperative infection. Secondly, the added cost of the endoscope increases the overall cost of the operation. Lastly, there are some studies that show that there is a higher rate of loss of sensitivity in the nipple using this approach. If a shaped implant is used, certainly it is more difficult to orient the implant correctly.
Through the belly button: Also known as a trans-umbilical incision, this approach is probably the least utilized of all incisions. This definitely is a blind dissection from the umbilicus (belly button) through the subcutaneous tissue to the breast. Not many surgeons are trained in this technique; those that are frequently become very facile with it. The drawback is that you can only use a saline implant with this approach. Also, the manufacturer may not warranty the implant if it is placed using this approach, since the implant has to be grasped with an instrument to push it into position. The instrument may cause damage to the wall of the implant and increase in the risk of deflation.
Along the lower edge of the dark area around the nipple (areola) Periarealar Incision: One of the more common approaches places the incision on the lower half of the areolar margin or the dark area around the nipple. The incision is limited by the diameter of the areola and therefore may not be used in all cases. In general, a minimum 5 cm incision is required to place a silicone breast implant and a 4 cm size incision for a saline breast implant. The advantages to this approach are that you can see directly into the area of dissection without needing the aid of an endoscope. The implant can be placed either above the muscle or below the muscle from this approach. There are some people that are concerned that some of the ducts may be transected and the close proximity to the nipple may increase the risk of bacterial contamination and subsequent infection. Personally, I have been using this incision for 30 years with less than a 1% infection rate. It is a myth that this incision has a higher risk of decreased sensation in the nipple. The nerves that go into the breast come from either laterally or medially from nerves in the fourth intercostal space.
In the crease under the breast, Inframammary Incision: HThis is probably the most common incision for breast augmentation. It affords excellent visibility during surgery. It is away from the nipple and ducts, so it is considered the best incision for preventing postoperative infections. Implants can easily be placed above or below the muscle from this approach.
What Patient Are Saying About Their Breast Augmentation
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 1960s. 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, silicone breast implants 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 breast 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.
I wanted a breast aug for many years. I finally was able to get it and I’m so happy with my results! I can’t believe I waited so long. Dr. Proffitt was a great doctor and listened to what I wanted, and I couldn’t have chosen a better doctor. I went from A cup to a D cup. I’m 26 years old with four kids, and I never thought my breasts would look good again! Read More Testimonials
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 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 teardrop. Dr. Proffitt prefers the round implants as opposed to teardrop-shaped implants due to the fact that all teardrop-shaped implants are textured. The outward appearance of teardrop implants, both by observation and radiographically, is indistinguishable from round implants.
Breast implant volume is measured in cc’s, and many options are available. Some patients benefit from large breast implants, while others are better suited for small breast implants. The final choice is typically the one that is in proportion to the patient’s frame.
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 the implant is better, the diameter of the breast and chest wall is important. Determining this along with desired volume helps decide whether a low, moderate, or high profile breast implant is appropriate.
Dr. Proffitt is the first plastic surgeon to offer Sientra silicone breast implants. Sientra has the lowest leakage rates of silicone implants in several studies. They also now have the longest and all-encompassing warranties of all silicone implant manufacturers in the USA. Sientra silicone implants are only available for use by real plastic surgeons board certified by The American Board of Plastic Surgery. Sientra Silicone implants are all 5th-generation silicone (gummy bear) implants.
Gummy bear implants are filled with a highly cohesive form-stable silicone gel that is thicker than gels used previously. This allows the gummy bear breast implant to maintain its form even when a rupture occurs.
What Is the Healing Process Like?
After surgery, 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 the 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 during the recovery process, 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. The national center for health research has a website entirely devoted to information on breast implants (click here). Dr. Proffitt will go over any concerns you may have during your initial consultation and is always available for consultations regarding post-surgical concerns.
How Much Does Breast Augmentation Cost
Implant price, procedure length, and the techniques used all impact breast augmentation cost. To ensure that the procedure is as affordable as possible to patients, our office provides financing through CareCredit.
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, sometimes considered a more “natural” breast enlargement, 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.
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.
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 when choosing the best breast implants for your needs and goals.
In my practice, breast augmentation is one of the surgeries where patients report the greatest satisfaction.
Schedule Your Consultation
When you’re ready to learn more about getting a breast augmentation 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.