Breast Augmentation
What is breast augmentation?
Augmentation of the breast consists of insertion
of a silicone bag (prosthesis) under the breast (submammary) or
under the breast and chest muscle (subpectoral) and then filling
the bag with saline (salt water). This prosthesis expands the
breast area to give a fuller breast (increased cup size), give
a better contour, and give more cleavage.
How is the incision made?
The incision (cut) may be placed at various locations
such as: under the breast at the breast fold; periareolar which
is at the edge of the areola (brown area consisting of nipple
and areola); within the areola; in the armpit (axillary); or in
the umbilical area.
The thinnest scar is usually in the areola. The umbilical
incision approach is used with an endoscope (tube with a light
for visualization and placement of the breast implant).
What are smooth and textured implants?
The smooth surface implant requires a large pocket
and is associated with a 10% incidence of capsule contracture
(tightening of the scar around the implant causing firmness or
hardness). The smooth implant has only an occasional occurrence
of rippling or wrinkling which gives the overlying skin a wavy
appearance.
A textured (roughened surface) implant is associated
with a 3% incidence of capsule contracture but has a 7-9% occurrence
of rippling.
What are the choices of implant positions? The easiest
surgical placement of the implant is under the breast tissue (submammary).
A slightly more difficult surgical placement is under
the chest muscle (submuscular or subpectoral) but this position
is associated with a lower incidence of capsule contracture and
slightly less occurrence of rippling. There is more pain
postoperatively than with a submammary placement.
What are the options for implant size?
The ultimate size of the breast is mainly a personal
decision by the patient. Cup size is an inexact estimate of the
final size since cup sizes vary with the bra manufacturer and
how tight or loose the patient wears her bra as well as how much
breast tissue is already present. Describing the preferred cup
size does aid the surgeon, but it also helps to look at pictures
or photos to show the physician the desired final look.
The most accurate method of estimating the implant
size (in ounces) is to fill a plastic bag with measured amounts of water
and place in a bra with the patient's estimated cup size. One
can see with the bra on and covered by a sweater what the final
result will approximate.
Patients most often comment that, "I wish I
had gone larger," although there is a rare patient who feels
she is too large.
Next: What are risks and complications of breast augmentation? »
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