Popularity of Breast Augmentation

Breast Augmentation is a very popular procedure performed for hundreds of thousands of women ( singles and mothers…and grandmothers even ) very year.

Are You A Candidate For Breast Augmentation?

Many women desire a change in the size and/or shape of their breasts. Breast augmentation can increase the size of a women’s natural breasts or “fill up” (replace the volume of) the breasts after they have deflated from pregnancy or breast feeding. Some women desire breast augmentation because they have asymmetry and one breast is noticeably smaller than the other.

How Is The Breast Augmented?

Breasts can be augmented or enhanced with implants or fat grafting. Both can effectively make the breasts bigger, but fat grafting is often limited to 1-1.5 cup sizes. Until recently, saline and silicone breast implants were the only commonly used options for increasing the breast size. Fat Grafting or Fat transfer was occasionally used for mild asymmetries. To prevent or treat implant wrinkling, fat transfer can also be effective for increasing the “thickness” of the breast tissue (for better coverage over an implant) in very thin patients with minimal natural breast tissue.

What choices do I need to consider?

Access Incisions

Breast Augmentation can be performed through several common incisions. The most frequently used incision is in the Inframammary Crease (IMC). This is the most direct approach to creation of the pocket and does not involve cutting through any glandular breast tissue. For this reason, the IMC incision also allows the lowest contracture rate and the best visualization during creation of the pocket whether the implant is placed over or under the muscle. The second most common incision is the PeriAreolar Incision. It is made along the edge of the areolar pigmentation and is desirable because it can be less conspicuous. This incision usually involves 1/4 to 1/3 of the areolar border depending on the size of the areola. Dissection must proceed through the breast gland to create the implant pocket which increases the chance of a contracture especially in women with cystic glandular components. The third incision is the TransAxillary (Armpit) Incision. Although popular in the past be- cause it removes the incision from the breast, it is a “blind” procedure associated with more bleeding and thus, a higher contracture rate unless the endoscope is used. Even with the endoscope, visualization of the entire pocket is compromised and correction of any asymmetries is more difficult. Although, Dr. Short was trained in Endoscopic TransAxillary Breast Augmentation, she feels the armpit area is not as sterile and the pocket access is not as good. And because of the higher contracture rate with PeriAreolar (PA) and TransAxillary (TAx) incisions as well as an increased incidence of “high riding” implants with the TAx incision, she prefers the IMC inci- sion. Dr. Short can and will perform whatever incision her patient chooses as long as the patient understands the pros and cons of each incision. Dr. Short does not perform the Umbilical (belly button) approach for several reasons. Most importantly, she feels this incision is associated with more complications and the subjective benefits are not worth the potential risks.

Implant Pocket Location

The implant can be placed over the muscle and under the breast glandular tissue OR under both the breast gland and under the pectorals muscle (chest wall muscle) OR under the breast gland and under the Muscle Fascia (thin muscle covering tis- sue) but over the muscle. The far more common approaches are the first two. Sub- fascial placement is reserved for patients who body build or lift weights/work out aggressively and want to try and avoid the movement of the implants with flexion of the Pectoralis Major Muscle but don’t have enough breast tissue to allow adequate coverage of the implant if placed under the gland and over the muscle. If the fascia is thick enough to be lifted, it provides a bit more coverage without the implant movement associated with flexion of the chest muscles.

The Submuscular (SM) pocket separates most of the implant from contact with the breast gland and “massages” the implant when the muscle is activated both of which are thought to result in a lower contracture rate. The SM pocket is ideal for patients with minimal breast tissue because they need the muscle thickness to to provide extra coverage for the implant and the upper part of the implant is also soft- ened so the breast appears less round and more “sloped” and natural. The breast will take on the shape of the implant if the breast volume is mainly from the implant. In general, if the breast volume is 50% or less from the implant and 50% or more from the natural breast tissue, the breast shape will look more natural. Placing im- plants above the muscle and under the breast gland, or Subglandular (SG), requires more natural breast tissue if the patient prefers a less round and more natural look.

Saline or Silicone Implants - How do I choose?

Saline is simply a salt water solution (IV fluid) which is normally found in the body, so it is safely absorbed if a leak should occur. Saline implants are folded and placed in the surgically created breast pocket through a small incision and filled with fluid from an IV bag of fluid. Dr. Short uses a closed system for filling saline implants. The fluid in the implants travels directly from the bag of fluid through sterile tubing into the implant with minimal or no exposure to the air and potential contaminants. Saline is an excellent choice for patients who already have a generous amount of breast tissue and therefore, plenty of coverage for the implant so any wrinkling of the implant will not be obvious. Patients who like a more round, less natural look or who prefer a very firm, (almost “bouncy”) feel may prefer saline implants. If a pa- tient has connective tissue disease or immune illness (lupus, rheumatoid arthritis, psoriasis, Raynaud’s, etc.) or even a family history of CTD and/or psychological or emotional based fear of developing CTD may do better with saline implants or even no implants at all.

Typically patients who have the opportunity to have both saline and silicone im- plants at some point in their life will prefer the look and feel of the silicone implants.

Silicone implant technology has progressed and the later generation implants that are currently available are pre-filled with COHESIVE SILICONE GEL as opposed to the early silicone implants filled with LIQUID silicone. The SHELL of these implants is also thicker so there is no “gel bleed” through the solid silicone envelope holding the gel inside. The gel is now so cohesive that the implant can be cut in half and the gel will not drip or come apart even when the two halves are held upside down.

These implants look and feel more like natural breast tissue and often it is hard to tell if someone has implants with well placed appropriately sized silicone implants. Many mothers who feel their breasts have “deflated” in the process of having chil- dren desire natural looking breasts but need a “fill-up”. They just want to have “what I started with” before pregnancy.

Implant Surface

Implants are available with smooth and textured surfaces. Texturing the implant surface is done several different ways and recently textured surface implants have come under review. One of the types of textured surfacing has been associated with ALCL, a type of cancer. Although ALCL is exceptionally rare, this particular type of textured implant was recalled in 2019 pending further investigation.

Other textured implants remain available. However, Dr. Short has used almost ex- clusively SMOOTH implants in her practice. For further information regarding tex- tured implants or ALCL, please refer to the ASAPS website surgery.com. The ASAPS Position Papers and statements for patient education are updated regularly.

Implant Profiles

Implants are now available in various profiles with different base diameter and pro- jection ratios. This originally included Moderate, Moderate Plus, and High Profiles. More recently, UltraHigh Profile implants were added.

Much more of a science than in the past, Breast Augmentation and Breast Implant choices now can be tailored more accurately to fit the chest anatomy of all types of patients, from very petite patients with a breast base diameter of less than 10 cm who want to get from an A to a D+ to 6 ft. tall patients with broad shoulders and a breast base diameter of over 14 cm who may only want to be a full C.

Even more recently, Mentor (one of the very first breast implant manufacturing com- panies which was later purchased by Johnson and Johnson) introduced the “Xtra” series of silicone implants in moderate plus and high profiles. These implants were added to provide an implant option with even less tendency to wrinkle.

Are Other Procedures Commonly Performed with a Breast Augmentation?

Many mothers who feel their breasts have “deflated” in the process of having children desire natural looking breasts but need a “fill-up”. They just want to have “what I started with” before pregnancy and child bearing. The changes in a women’s breasts are often accompanied by stretched or loose skin and stretch marks on the breast and abdomen. For this reason, combined procedures of the breast and abdomen are quite common. The “Mommy Makeover” is a frequently used term to describe a variety of combined procedures for women who have experienced the body changes that resulted from having those precious babies. Mommy Makeovers can include Breast Augmentation or Breast Lift (Mastopexy) or BOTH (Mastopexy Augmentation) along with a Tummy Tuck (Abdominoplasty) and/or Abdominal Liposuction.

A Mastopexy is usually considered when a woman feels her breasts are “sagging” and/or her nipples/areolas are too low. Adding volume will not LIFT the Breast. Adding volume (augmentation) will fill up the loose skin. This will make the breasts look similar to the way they looked when the patient was pregnant or breastfeeding – when the breasts were full of milk. If this is the look a woman desires, then Augmentation alone may be fine. However, if the patient says they prefer to look “perky” and more like they look in a “push-up” bra, then it is likely an Augmentation alone will not satisfy her goals. In fact, if she likes her size in a non-padded push-up bra, she might only need a lift and not implants at all. If lifting and repositioning of the nipple areolar complex (NAC) is desired, then a Mastopexy (Breast Lift) is necessary. For more information, see the Mastopexy page of this website.

Making Sure the Implants are the Best Match for Each Patient

In addition to the measurements taken during the consultation, Dr. Short finds the best implant for each patient by reviewing pictures prior to surgery and using “sizers” during the surgery. She raises the head of the bed to place the patient in an upright sitting position. This allows her to see exactly how the implants will look. The appearance of the implants in the upright position may be very different from the appearance when the patient is lying down. This must be carefully assessed at the time of surgery to obtain the best result in all positions.

Recuperation and Healing

Dr. Short uses the same “No recovery Technique” often advertised. However, she does not believe it is a good idea to use Ibuprofen immediately after surgery as she has seen patients who have experienced bleeding when Ibuprofen and other Non-steroidal Anti-inflammatory drugs have been used right after surgery. She also feels that patients have different pain tolerances and need to have pain medication available to them if they need it. She does encourage her patients to use as little pain medication as possible because of the side effects of sedation, constipation, and nausea that are frequently associated with any narcotic pain reliever. She also encourages early, slow, and gentle arm activity. Intense, repetitive activity like sweeping, vacuuming, dishes, or laundry is discouraged. It is also recommended to avoid lifting children or anything over 5 pounds early in recovery.

What You Should Know About The Recovery Process

  • Our Breast Augmentation patients usually are ready to leave our private recovery room within 1-2 hours after surgery. Most patients leave with their breasts wrapped with an ace bandage. Initial discomfort is described more as pressure than pain and this discomfort is controlled with oral medication. Patients are also given prescriptions for nausea, a muscle relaxer, and an antibiotic.
  • Patients are seen 4-6 days after surgery and will need a driver to bring them to this first appt. Sutures are usually removed at this visit.
  • Patients should not increase their blood pressure for one week after surgery to decrease the potential risk of post-op bleeding.
  • Light activities can be resumed after 1 week. Aerobic activities can be started slowly after 2 weeks. High Impact activities should be delayed for 4-6 weeks.
  • Moving or massaging the implants within the breast pockets during the postoperative period will expand the pocket forming around the implants so they will move and look more natural. At the first post-operative visit, our nurse will review and demonstrate how to massage your breasts so most patients find it is helpful to take their pain medicine before this visit.

Is This Procedure Covered by Insurance?

This procedure is considered cosmetic and therefore is not covered by insurance. The patient is responsible for payment. However, the consultation fee is applied to the cost of the procedure when a patient schedules surgery.

The specific risks and the suitability of this procedure for a given individual can be determined only at the time of consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.

Breast Augmentation Cost at The Gillian Institute for Plastic Surgery

$3,999

to

$5,999

  • includes anesthesia and surgical facility fees and all pre and post – operative care
  • depends on whether you choose Silicone or Saline
  • will be higher if in combination with a lift or other procedures

Take the intial step & talk with Dr. Short

Request Consultation