Breast augmentation is consistently one of the most common cosmetic surgical procedures performed annually in the United States and around the world. Breast size can easily be increased by one or more bra cup sizes, depending on patient desires. Breast augmentation can also provide desired “cleavage” that would otherwise not be possible. Breast augmentation can also correct breasts of different sizes in order to achieve better symmetry. By increasing the fullness and projection of the breasts, breast augmentation can greatly enhance self-image and self-confidence. The patient satisfaction with this surgery is extremely high (over 93 percent).
If you would like to find out whether you are a suitable candidate for breast augmentation surgery, we encourage you to meet with double board-certified plastic surgeon Erik Miles for a confidential consultation at your earliest convenience. Please contact North Charlotte Plastic & Reconstructive Surgery today to schedule your initial consultation.
A Brief History of Breast Augmentation
Female breasts have historically reflected a woman’s femininity and sexuality in cultures around the world. The curvaceous feminine form has been admired throughout the centuries in art, literature, and the media. With the social emphasis that has been placed on the breasts, it is not surprising that so many women seek breast augmentation. This demand continues to increase based on statistical information regarding breast augmentation surgery. The safety and affordability of the procedure have now made it available to a much broader patient population. There is also no longer the stigma related to cosmetic procedures that existed in years past. Breast augmentation is a highly individualized procedure and a patient should never undergo the surgery in order to fulfill someone else’s desires or to try to fit any sort of ideal image.
Medical and surgical descriptions of breast augmentation techniques have been documented in the medical literature since the early 1900s. Early breast augmentation methods involved the injection of substances such as paraffin or silicone which was fraught with complications. Prosthetic implantation has been used since the 1950s, and the earliest silicone breast implants were first used in the 1960s. The science and surgical knowledge related to breast augmentation surgery has evolved immensely in recent decades. The technology of implant material has also changed drastically over the years. Although complications can arise with any surgical procedure, these factors have resulted in a historically low rate of complications related to breast augmentation surgery. In the United States, the FDA has currently approved the use of breast implants from three different companies (Mentor, Allergan, and Sientra).
Patient’s currently have more options than ever for breast augmentation. The procedure can be performed through several different incision locations. Most patients opt for an inframammary incision which is underneath the breast, but incisions around the areola or in the axilla (underarm) are also options. Breast implants can be placed in a subpectoral position underneath the muscle or in a subglandular position above the muscle. There are also options for silicone or saline implant types. Within these breast implant types there are further options regarding implant shape and projection. Textured or smooth shell implants are further options. Dr. Erik Miles will spend a great deal of time during the consultation process discussing these options in order to determine which of them will best fulfill a patient’s goals and desires. Patients will be able to see and feel the different implants during the consultation.
How is breast augmentation performed?
The goal of breast augmentation surgery is to enlarge the size of the breasts while achieving breast symmetry and an aesthetically pleasing shape. Therefore every breast augmentation procedure is tailored to meet the needs of the specific patient. Dr. Miles places great importance on the surgical consultation and spends a great deal of time with patients prior to surgery. He will listen to patient’s desires regarding breast size and other concerns related to the appearance of the breasts. As with any elective surgical procedure, safety is of utmost importance and appropriate prescreening and safety measures are always followed. A patient’s medical and surgical history is thoroughly evaluated prior to surgery.
There are various techniques that are used for breast augmentation surgery. The breast augmentation procedure is typically performed under general anesthesia as an outpatient procedure. Incisions are made in inconspicuous areas to minimize visible scarring. Breast augmentation can be performed through an inframammary incision (underneath the breast), a transaxillary incision (in the axilla or underarm area), or a periareolar incision (around the areola). Dr. Miles does not perform breast augmentation procedures through an incision around the belly button. This procedure is referred to as a TUBA, or transumbilical breast augmentation, and has not gained widespread acceptance. More predictable and satisfying results can be achieved through the other incisional approaches. Dr. Miles will discuss which incision option is most appropriate keeping in mind your desires and goals. The type of implant used, the degree of breast enlargement desired, and a patient’s prior surgical history are all factors that are important to consider when discussing incision location.
Patients can now choose between saline and silicone breast implants. Both implant types are very safe and have been approved for use by the Food and Drug Administration (FDA). Currently the FDA has approved saline breast implants for augmentation in women 18 years of age and older, and silicone breast implants for augmentation in women 22 years of age and older. Either implant can be used for reconstructive purposes regardless of age.
Saline breast implants are filled with sterile saline (salt water). They can be filled with varying amounts of saline which can affect the size, shape, firmness and feel of the breast. Minor asymmetries can often be corrected by using different amounts of saline on each side. Because saline implants are filled after they are inserted into the body, a slightly smaller incision can often be made as compared to a silicone implant which has a prefilled volume that cannot be adjusted. In the rare instance that a saline breast implant leaks, the shell will collapse and the saline will be absorbed by the body and naturally expelled.
Silicone breast implants are filled with a soft, pliable silicone gel. The gel is designed to move and feel much like natural breast tissue. These implants are placed through the incision using a recently developed funnel system (Keller Funnel) that allows for a smaller incision and eliminates the requirement to physically touch the implant. This process is thought to reduce infection and capsular contracture rates. Breast asymmetries are corrected using silicone implants of different sizes. If the silicone implant ruptures or leaks, the gel is usually contained within the breast implant pocket. Because the implants feel so natural, an MRI study is sometimes recommended to assess their condition. There are currently three approved manufactures of breast implants in the United States. These companies are Mentor, Allergan, and Sientra.
Silicone and saline breast implants come in many shapes and sizes. Some are wider with less projection and some offer a higher breast profile. Textured shells are also used at times. Finally, patients can choose between round or anatomically shaped “teardrop” breast implants. The scope of implant choices is complex. The type of implants that will best suit your goals is dependent on your desires, breast anatomy, skin elasticity and body type, and can best be determined after a thorough consultation with Dr. Miles. Patients can touch and feel these implants during their consultation to give them a better understanding.
After the incision is made, the breast implant pocket is created. Most of the time, the implant will be placed into a pocket under the pectoralis major muscle. This is called a submuscular position. Other times it can be placed on top of the muscle, directly behind the glandular breast tissue. This is called the subglandular position. This is also an important decision that will be made during the preoperative planning process. Incisions are closed with layers of absorbable sutures. There are no sutures to remove after the procedure. Skin adhesive or surgical tapes are used over the incisions. The incision lines generally heal very well and will fade over time.
What are realistic expectations for a patient undergoing breast augmentation?
Breast augmentation patients are overwhelmingly very satisfied with their results. However, patients need to honestly discuss their expectations prior to surgery to avoid disappointment. The ideal implant size for a particular patient is determined not only by the patient’s desired size increase, but also depends on breast anatomy, skin elasticity and body type. Many patients are not suited for very large breast implants. Breast asymmetry can be greatly improved by breast augmentation, however it is unrealistic to expect a perfectly symmetrical correction. Remember that breast implants simply augment or enlarge the existing breasts. Breast augmentation also does not correct breasts that are severely drooping, or “ptotic.” Some patients will require a breast lift, or mastopexy, in conjunction with breast augmentation to achieve the optimum results. Breast lifting can sometimes be performed at the same time as the augmentation or it may require a separate operation. These issues will be discussed thoroughly during the consultation with Dr. Miles and he will make recommendations about how to best meet a patient’s goals.
Patients should be aware of both the benefits and risks of breast augmentation before committing to undergo the procedure. Potential complications include reactions to anesthesia, hematoma (blood accumulation) around the implant, infection, implant malposition, and capsular contracture. All patients are given antibiotics and infections are very rare; however, an infection that does not resolve may require temporary removal of the implant. Although usually temporary, changes in nipple or breast sensation may result from breast augmentation surgery. The scar tissue that naturally forms around breast implants is known as the capsule. The capsule may sometimes tighten around the implant, causing the breast to feel firmer than normal. This is known as a capsular contracture and can occur to varying degrees. If severe, it can cause discomfort or changes in the breast’s appearance. In such cases, more surgery may be recommended to modify or remove the scar tissue, or perhaps remove or replace the implant. Breast implants are not lifetime devices and cannot be expected to last forever. Implant rupture is very rare, however when it occurs the implants s should be replaced. Serious complications are rare, especially if patients follow Dr. Miles’ post-surgical instructions carefully during their recovery from breast augmentation surgery.
The results of breast augmentation surgery are generally long-lasting. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman’s breasts. Some women seek further surgery after a period of years to once again restore their breasts to a more youthful appearance. Others chose to combine breast augmentation with breast lift surgery in order to rejuvenate and enhance their breasts simultaneously.
Learn More about Breast Augmentation by Contacting Our Charlotte Practice
If you would like to schedule a complimentary consultation to discuss breast augmentation, please contact our Huntersville office, serving patients throughout the greater Charlotte area, today. You can also call our practice at (704) 896-5556. We would be pleased to answer any questions you might have and assist you in scheduling your initial appointment.
Our Service Area Includes Huntersville, Mooresville, Lake Norman, Cornelius & Charlotte