What Is Breast Augmentation?
Breast augmentation, also known as breast enlargement or enhancement is one of the most frequently performed plastic surgery operations. This is because, in addition to having been shown to be safe, breast augmentation has been performed in the United States for over 50 years. Today, there are many different types of breast implants available. Silicone implants are the more commonly chosen option. Scientific studies have shown silicone breast implants to be a safe and natural feeling. Saline-filled implants are also available and can lead to excellent results in patients who qualify. In addition, there are many different types of silicone gel that fills with form-stable implants, shaped implants, and implants of varying base and projection.
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Breast Augmentation With Implants
Silicone-filled breast implants have been available in the United States for well over 50 years. Saline implants have also been used with confidence for over 50 years. Although there was concern about women’s health issues regarding silicone implant ruptures, scientific studies have shown women with silicone implants to have no greater risk of any disease or symptom than women who have never had breast implants. If a saline implant ruptures (leaks), the saltwater is absorbed by the body and there is generally a very rapid loss of volume. If a silicone implant leaks, the silicone tends to stay in the general vicinity, although there is a risk that some of the silicone can lead to inflammation or enlarged lymph nodes.
Who Is A Candidate For Breast Augmentation?
A woman who wants to increase the size of her breasts, to fix asymmetrical breasts, or to restore lost volume to her breasts is a candidate for breast augmentation. She must have fully developed breasts, be physically healthy, and have realistic expectations about the outcome of the surgery.
Breast Implant Placement
Implants are placed behind the breast. Depending on the woman’s anatomy and discussion with Dr. Roth the implant might be placed over the muscle on the chest wall or under the muscle. The operation usually takes one to two hours. It is generally performed as an outpatient procedure either under general anesthesia or utilizing local anesthesia and intravenous sedation. Incisions are typically placed either around the nipple-areola complex, underneath the breast, or occasionally in the armpit. These areas typically lead to favorable scars that are inconspicuous and often hard to see after maturation of the scars. There is a risk of hardening of the tissue around the implant, also known as capsular contracture, although with state-of-the-art breast implants, hard capsules occur very infrequently.
behind the chest wall
Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around the implant) and less interference with mammograms. Disadvantages include possibly increased initial discomfort, the possible need for drainage tubes, and a longer recovery period.
beneath breast tissue
Advantages of implant placement beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles and that slight breast sagging may be corrected. Other types of implants include form stable “gummy bear,” round, smooth, and textured.
Breast Augmentation With Fat Transfer
Breast augmentation with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Breast augmentation with fat grafting is appropriate for women who are not looking for a dramatic increase in breast size and want breasts that look and feel as natural as possible.
For a number of weeks prior to breast augmentation, tissue expanders may be placed below the muscles of the chest wall to expand the breasts, and increase the amount of fat they can hold. When the tissue has expanded enough, augmentation using fat transfer can begin.
The first step in the procedure is to have fat removed using liposuction. At the start of the liposuction process, a cannula (a thin, hollow tube) is inserted through small incisions and moved back and forth to reduce excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified and injected into the breast through small incisions. The procedure takes approximately 2-3 hours.
Is It Better To Have Breast Augmentation With Implants Or Fat Transplantation?
Which procedure is more appropriate depends on the particular patient and the goals of the surgery. Breast augmentation using implants is appropriate for women who want to significantly increase breast size. Breast augmentation using fat implantation is appropriate for women who are not looking for a dramatic increase in breast size and want breasts that look and feel as natural as possible. In some cases, implants and fat transplantation are used together.
Recovery after Breast Implants
After breast augmentation with implants, drainage tubes may be inserted; incisions are stitched, taped, and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days post-surgery, some patients feel tired and sore, but many returns to work within a week. Stitches are usually under the skin and dissolve on their own; post-operative pain, swelling, and sensitivity typically diminish over the first few weeks. Scars begin to fade in a few months.
After breast augmentation with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction.
What Are The Risks Of Breast Augmentation?
In addition to the risks associated with any surgery and anesthesia, those related to breast augmentation using implants include the following:
- Capsular contracture
- Implant leaks and ruptures
- Implant deflation or shifting
- A temporary or permanent change in nipple/breast sensation
- Irregularities in breast contour/shape
- Partial or total loss of nipple/areola
The risks related to breast augmentation using fat transplantation include those related to liposuction, as well as the following:
- Fat embolism
- Fat necrosis
- Oil cysts
- Loss of volume
- The firmness of the breasts
Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are occasionally necessary. Injections can be performed using local anesthesia.
Is there Scarring After Breast Augmentation?
During a breast augmentation using implants, incisions are made in inconspicuous places (in the armpit, in the crease on the underside of the breast, or around the areola), which minimizes scar visibility. During a breast augmentation using fat transplantation, there are no incisions because fat is injected, so scarring is rarely an issue.
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