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Breast augmentation (enlargement) using breast implants is one of the most common plastic surgery operations performed in the United States and the number of women seeking breast enlargement continues to increase. In 2007, there were approximately 350,000 breast augmentations performed by plastic surgeons. The continued popularity of breast augmentation is a testament to the high patient satisfaction with the operation.
Breast augmentation is a safe procedure with several studies showing a very high satisfaction rate (95% at 6 years). Even though patients who undergo breast enlargement come from a variety of backgrounds, many describe feelings of improved self-image, increased self-esteem, and better interpersonal skills after surgery.
Women may elect to undergo breast augmentation for many reasons. Some women merely want to increase the size of their breasts. Breast implants can dramatically change a woman’s appearance and self esteem by enlarging the size of the breasts to give a fuller or more youthful appearance. Breast augmentation may improve how a woman looks in clothing or in a swimsuit. Other women may be self-conscious of their breast size or shape following pregnancy, breast feeding, or massive weight loss. In these situations, breast implants can help restore the natural volume and contour of the breast.
Several choices confront the patient who is thinking about breast augmentation. Depending on who your surgeon is, Dr. Jerome Liu or Dr. Tom Liu will walk you through the decision making process and help you select an implant and operative procedure to help you achieve your goals. The pre-operative decisions can be divided into: implant type (silicone gel versus saline), implant size, pocket placement (above or below muscle), and incision (inframammary fold, peri-areolar, or axillary).
Breast augmentation patient may choose between silicone gel or saline breast implants. Silicone gel implants have an elastic silicone rubber shell and are filled with a cohesive silicone gel. Saline implants are made from an elastic silicone rubber shell and filled with sterile saline (saltwater). Silicone gel implants are FDA approved for primary (1st time) cosmetic augmentation in patients over the age of 22. Saline implants are FDA approved for primary cosmetic augmentation in patients over the age of 18.
Silicone gel implants were temporarily removed from the market in 1992. However, an extensive review of the available evidence by the Institute of Medicine of the National Academies of Science found no evidence linking silicone breast implants to any systemic diseases. As a result, silicone gel implants returned to the market in 2006 and have been increasing in popularity since then.
Institute of Medicine of the National Academies of Science (Safety of Silicone Breast Implants).
Patients often prefer silicone gel breast implants because they feel and resemble natural breast tissue. Also, cohesive gel implants tend to have less rippling and are less palpable than their saline counterparts. Silicone gel implants, however, are more expensive than saline implants. Also, cohesive gel implants come prefilled from the manufacturer and require a slightly longer incision to place. Saline implants are an excellent alternative to gel breast implants for patients who do not like the idea of using silicone. Although saline breast implants may sometimes be palpable, they are less expensive and can be placed through a smaller incision.
Choosing an implant size is an important decision. Although there are many ways to estimate the effect of an implant, nothing is more important than having a detailed discussion with your surgeon, either Dr. Jerome Liu or Dr. Tom Liu. We also have a variety of sample implants in the office for you to feel and examine.
Our goal is to help you select an implant that will produce a natural appearing breast without the stigmata of being over done or over the top. A properly selected implant will improve the fullness of the breast and augment the cleavage without causing distortion. On the other hand, an implant that is too large will look unnatural and cause distortion of the breast. Furthermore, an over-sized implant may have long term effects on the surrounding breast tissue leading to thinning skin and tissue as well as increased stretch and sagging of the breast.
Breast implants can be placed above or below the muscle. The location of the implant is often referred to as the “pocket dissection.” A subglandular implant is placed under the breast but above the muscle, whereas a submuscular implant is placed below the breast and below the muscle. There are advantages to each approach.
There are several advantages of a submuscular implant. First, there is a slightly lower risk of capsular scarring around the implant (hardening) that might occur with time. Second, there is less rippling or palpability of the implant because it is placed beneath the breast and the muscle. Finally, mammograms are easier to perform and are easier to read in patients who have submuscular implants (compared with subglandular implants). Subglandular implants may be ideal in some patients. They are a little bit less painful during the first couple of days following surgery. In patients who are extremely athletic or are body builders, subglandular implants will not distort or move during contraction of the muscle. Finally, a subglandular implant can be used to provide a “mini-lift” in women with sagging breasts, therefore avoiding a larger operation.
There are several incisions that are commonly used for breast augmentation: inframammary fold (breast crease), peri-areolar (nipple), and axillary (armpit). Selecting an incision for the placement of a breast implant depends on several factors and not every patient is a candidate for each incision.
Your initial consultation will take approximately one hour. During this time, Dr. Liu will take a thorough medical history, help you with the decision making process, and answer all of your questions. You will also have an opportunity to see and feel sample silicone and saline implants. The goal of the consultation is for you to obtain all the information you need to make an informed decision regarding breast augmentation surgery.
Approximately 2 weeks prior to surgery, you will have a pre-operative appointment. At this time, you will sign the surgical consent, have photos taken, and receive an information packet. The pre-operative packet includes detailed instructions for before and after surgery. It is important to avoid aspirin, ibuprofen, and other blood thinning medications for at least two weeks before surgery. Also, do not eat or drink anything after midnight on the evening prior to surgery.
Breast augmentation surgery typically takes around 1 hour and is an outpatient procedure. The operation is performed under general anesthesia with an anesthesiologist present. Having an anesthesiologist present allows Dr. Liu to concentrate on attaining the best cosmetic result possible instead of dividing his attention between the operation and monitoring the vital signs of the patient. Dr. Liu always performs breast augmentation surgery using the latest surgical techniques to achieve a natural appearing result.
Patients go home on the same day as surgery but should have a responsible adult stay with them for 24 hours. The recovery period ranges from 3 days to 1 week with most patients feeling very well by 4-5 days. Strenuous activity should be avoided for 2 to 3 weeks. Dr. Liu will follow you closely during the recovery period and will let you know when you can resume full activities.
Whatever the reason, breast augmentation surgery can provide psychological, aesthetic, and personal benefits for the right candidate. To find out if breast augmentation (breast implants) is right for you, please make an appointment with Dr. Jerome Liu or Dr. Tom Liu.