About the Breast Augmentation Procedure
Breast Augmentation is a cosmetic procedure that enlarges and shapes a woman’s breasts through the placement of implants. You may be a candidate for breast augmentation if you want to enlarge naturally small breasts, restore breast volume lost following pregnancy or weight loss, or improve symmetry.
Breast Implant Placement
Four different incisions have been described for breast enlargement:
Around the Areola
The incision is made around the lower part of the areola (the darker area around the nipple). These scars typically heal very nicely and are difficult to see. However, if the areola is small it may be difficult to perform the procedure through this area.
Base of the Breast (Inframammary)
The incision is made under the breast just above the natural crease and provides a technically easier route for implant placement. The scar, however, because of its location, has a greater risk of being wider or thicker. In patients who have large breasts to start with, the scar may be well hidden.
The incision is made within the armpit (axilla). The scars in this area typically heal very well and are hidden and at the end look like a fold in the armpit. Implant placement via the armpit is performed with the help of an endoscopic camera for appropriate placement of the implants. This means that the breast tissue is never touched which then does not create scars in the breast tissue that could interfere with mammograms.
The incision is made at the upper portion of the belly button and placement of implants is done by feel. The results of this method certainly depend on the experience of the surgeon but this is a blind method and Dr. Yousif does not believe this is a desirable method. There are several factors to consider when choosing the location of the incision such as the type of implant to be used, degree of enlargement, patient anatomy, and patient and surgeon preference.
Types of Breast Implants Location
Breast implant placement can be sub-glandular or submuscular.
The breast implants are placed directly behind your breast tissue. If there is adequate breast tissue to cover an implant, sub-glandular placement can be done. However, if there is limited breast tissue, it may be better to hide the implant beneath the muscle layer.
Advantages of Sub-glandular Placement
Sub-glandular placement of implants may have less pain after surgery. This may allow for more central placement of the implants, giving more cleavage. When there is some sagging of the of the breast, sub-glandular placement may help to push the nipple upward slightly but in most cases a breast lift will do that better.
Disadvantages of Sub-glandular Placement
Implants may be more visible and ripples may be more prominent. Mammograms may be harder to perform because of the proximity of breast tissue to the implant. Breast hardening (capsule contracture) may be more frequent.
The breast implants are placed beneath the chest muscle.
Advantages of Submuscular Placement
Implants less visible especially when there is limited breast tissue. Breast hardening (capsule contracture) may be less frequent. Mammograms are easier to perform. Looks natural. Results remain longer.
Disadvantages to Submuscular Placement
Sub-muscular placement maybe more painful right after surgery. There may be movement of implants with muscle contraction. Not helpful in breasts with slight sagging to lift the nipple.
Types of Breast Implants: Silicone or Saline
There are 2 types of breast implants; silicone or saline. Implants are all made with a vulcanized silicone shell filled with either liquid silicone or sterile saline. Each implant has different advantages and disadvantages and those should be thoroughly discussed prior to making your choice as to which type of implant is best for you.
The early implants were filled with liquid silicone. Silicone implants were taken off the market in the early 1990’s for cosmetic surgery and then placed back into the market in 2006. The reason for that is that there was a question of whether silicone implants could cause various types of autoimmune reactions in the body. Most large studies have not shown that association but some questions may still persist. That is an important discussion to have with your surgeon. The advantages of silicone implants are that they may be softer to the feel than saline implants. They may also have less visible rippling especially if they are placed above the muscle in a person who has very little breast tissue.
All implant shells have a potential for rupture. The FDA states that silicone rupture rates are 1% per implant per year. That means that after 10 years 10% of silicone implants would potentially be ruptured. Unfortunately, silicone implants have what’s called a “silent rupture.” That means that even though the implants maybe ruptured it may not show changes in the volume of the breasts. Silicone implant rupture is best diagnosed with an MRI. In fact, the FDA recommends that a patient with silicone implants should have an MRI 3 years after placement of those implants and every 2 years after that.
Saline implants are the same vulcanized silicone shell but filled with sterile saline. Some people say they do not feel as soft as silicone implants and may be more visible if the patient has very little breast tissue and the implants are above the muscle. The issue here is that silicone implants may feel more natural outside the body but if done well, saline implants can feel very natural. To make saline implants feel natural the pocket needs to be different than the one for silicone implants. If your surgeon has experience with saline implants they can look and feel very natural. Saline implants have the advantage that they can be placed through a very small incision. They also do not require serial MRI to diagnose rupture since if they do rupture, the breast will lose volume. Replacement of a ruptured saline implant is simple and can easily be done with local anesthetic. This is in contrast to a ruptured silicone implant which requires a much larger surgery.
When considering Breast Augmentation three key components need to be decided – type of implant: silicone or saline, size of the implant and where the incision will be made for placement. We spend the time it takes to help answer all of those questions so you receive the best possible outcome from your Breast Augmentation Surgery.
Breast implant should not change your need or requirement to doo monthly breast exams or mammograms when outline by your physician. All current breast implants, however are cloudy on mammograms but the mammographer should be able to see all areas of the breast so tell your mammographer that you have breast implants so that they can evaluate all areas of the breast. Mammograms should not increase the risk for implant rupture and can usually be done safely just a few months after implant placement.
The FDA states that “Breast Implant Associated Lymphoma (BIA-ALCL) is not breast cancer – it is a type of non-Hodgkin’s lymphoma (cancer of the immune system). In most cases, BIA-ALCL is found in the scar tissue and fluid near the implant, but in some cases, it can spread throughout the body. An individual’s risk of developing BIA-ALCL is considered to be low; however, this cancer is serious and can lead to death, especially if not treated promptly. In most patients, it is treated successfully with surgery to remove the implant and surrounding scar tissue, and in some patients, also treatment with chemotherapy and radiation therapy.” The total number of identified cases has only been 573 individuals at the time of this report. Considering that worldwide almost 1 million patients have implants placed, the risk of that cancer is very low. 83% of those cancers have been associated with Biocell type texture implants. Those implants have since been removed from the market. Diagnosis is made by direct biopsy but the patient can have symptoms such as swelling or unrelenting pain. In most cases, complete removal of the capsule cures the cancer. The FDA is not currently recommending removal of Biocell implants without associated symptoms.
Breast Implant Illness
Breast implant illness (BII) is a term that sometimes used to refer to a wide range of symptoms that can develop after undergoing reconstruction or cosmetic augmentation with breast implants. It is also sometimes referred to as autoimmune/inflammatory syndrome induced by adjuvants (ASIA). Although more frequently noted with silicone implants BII can occur with any type of breast implant, including silicone gel-filled, saline-filled, smooth surface, textured surface, round, or teardrop-shaped. Symptoms can vary and be wide ranging, including malaise, joint and muscle pain, chronic fatigue, memory and concentration problems, breathing problems, depression, anxiety or gastrointestinal problems. If you have implants and a constellation of these issues that do not resolve you should discuss this with your plastic surgeon.
What to Expect
Anesthesia and Surgery Facility
Breast augmentation is most comfortably performed under general anesthesia in a surgery center or hospital setting. Operative time for breast augmentation is 1.5-2 hours.
The body surrounds every implant with a “capsule”. That capsule helps keep the implant in place and protect you from the implant and the implant from you. Unfortunately, that capsule can sometimes become very tight around the implant and that is called “capsule contracture” and the breast can feel hard. Capsule contracture is graded from 1 to 3 grades of capsule contracture. Grade 1 is only light tightness, grade 2 is when the breast feels firm and grade 3 the capsule can be so tight that it can displace the implant out of position.