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.
Why Women Choose Breast Augmentation
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.
Patient Choices and Operative Techniques
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).
Here at Liu Plastic Surgery, we offer the latest silicone and saline implants in a variety of shapes and sizes. We aim to deliver results that exceed your expectations while maintaining a very natural look. Our plastic surgeon will discuss all of your options with you, and a large part of the initial consultation will be focused on describing the implants, answering your questions, and helping you determine which size and type of implant is the best option for your needs.
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 natural-appearing breasts without the stigma of being “overdone” or “over the top.” A properly selected implant can improve the fullness of the breasts 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.
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.
The most common incision used in the United States is the inframammary fold incision. This is often considered the best incision because it is associated with the lowest rates of capsular contracture. The breast crease incision also provides the best avenue to control implant placement, position, and symmetry.
Implant Placement – Above Versus Below the Muscle
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. In patients who are extremely athletic or are body builders, subglandular implants are less likely to distort or move during contraction of the muscle. Finally, a subglandular implant may be used to provide a “mini-lift” in women with sagging breasts, therefore avoiding a larger operation.
Your initial consultation will take approximately 45 minutes to 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.
About the Operation
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.
Breast Augmentation FAQs:
Am I a good candidate for breast augmentation?
Breast augmentation involves the placement of a saline or silicone filled implant behind the breast and muscle to increase the size of the breast. The only effect of the breast implant is to increase the volume of the breast. Therefore, good candidates for breast augmentation are patients who would like an increase in size without the need to raise the nipple or the breast from a position that is too low. The ultimate goal is to fill the breast to provide a more youthful appearance without damaging the skin and tissue.
How do I choose between high, medium, and low profile implants?
Breast implants come in all different sizes and shapes. Ultimately, during the consultation, we will find the implant(s) that fit your body the best. The profile of the implant indicates how projecting the implant is relative to the base width. In general, the moderate profile (generally known as a moderate plus) is the most versatile and widely used implant for primary augmentation. This implant strikes a good balance between offering projection and volume while maintaining a natural appearance. High and low profile implants are sometimes used depending on specific circumstances for a patient. Low profile implants are more likely to be used in someone who only wants a small augmentation and high profile implants tend to be used more commonly in revision or secondary surgery.
How can I achieve a natural aesthetic result?
No two breasts are the same. Therefore, there is not one implant that is perfect for everyone. We now have many shapes and sizes of implants available today that patients can achieve a natural shape and feel with implants. These include newer 5th generation silicone round implants, anatomic-shaped “gummy bear” implants and the new, structured IDEAL saline implant. The board-certified plastic surgeons at Liu Plastic Surgery aim to achieve the patient’s goals while maintaining a natural look. At a consultation appointment, you will have a customized evaluation, bio-dimension analysis, and measurement to determine which implant is right for you to create a natural aesthetic result and feel.
How do I decide which incision is right for me?
There are several incision locations available for breast augmentation surgery. The location is dependent on a patient’s anatomy and the type of implant. The most common and most advantageous incision is the inframammary fold (breast crease). Most importantly, the breast crease incision is associated with the lowest rates of capsular contracture. Furthermore, this incision is hidden in the fold with minimal visible scarring. The cease incision also gives direct access for implant placement and gives the surgeon the most control in the operation to achieve the best results. The breast tissue is not disrupted because the implant does not need to go through the breast to get behind the breast and muscle. Other incision sites include periareolar (nipple) and transaxillary (armpit). The periareolar incision is associated with higher rates of capsular contracture and patients can experience loss of nipple sensation. Per manufacturer guidelines, the transaxillary incision is limited to saline implants only. Both of these latter incisions (periareolar and transaxillary) decrease the surgeon’s ability to be precise with the operation.
How do I know if I need a breast lift or just an implant?
Breast augmentation involves the placement of an implant to enlarge the breast. However, breast augmentation does not change the shape of the breast. If the breast shape has changed with gravity, time, or pregnancy, a breast lift (mastopexy) may be needed to restore the shape of the breast. This would involve additional incisions to raise the position of the nipple and remove some of the extra skin on the breast. A simple way to determine whether a breast lift would be needed is to examine the position of the nipple relative to the breast crease (where the breast meets the chest wall – where the underwire would sit). If the nipple is below this line, then a breast lift (mastopexy) might be needed. If the nipple sits above this line, then it is likely only an implant would be needed.
A breast lift with an implant, also known as an augmentation-mastopexy, can be performed at the same time in good candidates. This would involve one trip to the operating room where both an implant is placed under the muscle and the breast shape is adjusted by lifting the nipple and removing any excess and damaged skin. Only a consultation with a board certified plastic surgeon could tell you if this would be the best option for you.
When is the implant supposed to be in the right position?
The implant pocket and the implant should be in the correct position immediately after surgery. Even though the implant is correctly placed, sometimes they appear high because the lower pole of the breast has not had time to stretch out and there is post-surgical swelling in the upper part of the breast. Post-operatively, the pocket can stretch a little bit until the breast capsule matures. Most surgeons believe that the breast capsule stabilizes between 3-6 months. After 6 months, the capsule is likely mature. Although there is long term remodeling, if the implant is not in the ideal position, a revision surgery to remove or manipulate the capsule is likely needed after the 6 month mark. Every patient is unique so there can be patient-to-patient variation. There are also differences in the amount of expected maturation between silicone versus saline, textured versus smooth, and round versus shaped implants.