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What is breast augmentation?
I am glad you asked that question. Breast augmentation is when an implant or artificial prosthesis is placed under breast tissue in an effort to give the overall breast shape a better younger look. Most patients who come in and are considered for breast augmentation complain that because of age or because of having children that their breast shape and contour has changed dramatically. With breast augmentation, they wish to regain the shape, the upper pole fullness, the “perkiness,” of their old breasts.
What types of implants are there?
There are several types of implants to consider. First in regards to types of implant construction, there are silicone and saline implants.
Silicone implants were routinely done in the past. However, back in 1992 the Food and Drug Administration chose to ban silicone implants from being routinely implanted into human beings after there were concerns voiced about silicone implants causing immunological diseases. After the moratorium was established, the FDA started and concluded multiple studies retrospectively looking at patients with silicone implants. They found no increased incidence of cancer, immunological disease or reactive conditions.
Silicone implants then went through several generations of development. The most recent is the “gummy bear” implant. It is called this because it feels like gelatin. More importantly from the surgical standpoint is that it is very safe. The construction of the bag is far superior to earlier implants. Also when the implant is cut with a knife, its contents do not ooze out. They stay in place. This ensures that if there was a cut that the silicone does not disperse throughout the breast space. This is a wonderful new innovation.
As of the 17th of November of 2006, silicone implants have been approved for use in the United States. There are a few stipulations for overall use. However, the FDA had reviewed and approved the implantation of the new silicone device.
As opposed to the silicone implants, the saline implant is much more flexible. Its use has been commonplace since silicone was removed from the market in 1992. Saline implants are made of a silicone elastomere shell filled with saline. So if there is a problem, if there is a deflation, the saline simply leaks out and the implant goes flat. There is no concern about the implant contents leaking and moving about the breast space. Saline is simply salt water and is common in the human body. It is absorbed without any complication.
Implants can come in many shapes. The shape of the breast implants has been variable in the past. Multiple types were constructed and multiple generations of implants are routinely seen. Two types of implants are most commonly used now. They are the smooth round implants and the tear-drop or “anatomical” implants.
What size can I be?
Size is a curious question. Most patients, women, have an idea of what size they wish to be. However, most have to be cognizant that they have to also be realistic. If for example, a patient asks to be enlarged to a size D from an A, I would have to say that she is being unrealistic. More importantly, she may run into problems with her skin being too taught. The patient must remember the role of the surgeon is to suggest to her what is feasible and safe. Doing such a drastic size change would not be in the interest of the patient. That being said, a patient can be a variety of sizes. Most importantly, this size change or augmentation will need to be discussed with the surgeon. Together the patient and the physician should come up with a compromise of what is realistic and safe and ideal for the patient.
What size should I be?
Again this is a hard thing to judge. One must see what they believe they want to be and then they have to discuss it with their doctor to see what is reasonable and safe.
What is the biggest I can be?
Terrible question. The job of the patient is not to see how far you can push the limit. By the same token, if this question is asked, it is the job of the surgeon to educate the patient to the parameters, and issues at hand. Once the patient understands the issues, more than likely she will realize that the size that best fits her body is the maximum she should try for. With this logic in mind, a breast augmentation will do much to enhance the patient’s overall body shape and will more than likely leave the patient with a very comfortable end result.
What does it mean to go “above the muscle” as opposed to “below the muscle”?
The plane into which breast augmentation prosthesis are placed are either below the muscle or above the muscle. This “muscle” refers to the pectoralis muscle, the chest muscle. Many surgeons choose to place the implant above the muscle. This has certain advantages and disadvantages. The first is that the muscle is not affected. This gives the patient much less of a traumatic surgery and a much shorter recovery time. There are problems however with this placement. The chances for capsular contraction are much higher. Also if a patient looses weight, the overlying breast tissue tends to thin out and then shows the contour of the implant. There is more rippling and wrinkling.
When an implant is placed underneath the muscle, it tends to cause significant pain. This makes sense if you think about it. If you lift a
large muscle and then place a large object underneath it to stretch it, it will cause pain and muscle spasm. Because of this, the recovery time is longer with implants placed under the muscle. There are however significant advantages also. First, the chances for capsular contraction are much lower. The implant has more coverage over it with the muscle bellies. It is thought that the implant also is at a lesser risk for infection.
What are the possible complications of breast augmentation?
Like any surgery, there are risks and complications. With liposuction, the most common risks and complications are bleeding, infection, seroma, hematoma, perforation, and contour irregularity. Bleeding can happen if the local epinephrine solution has not had time to work. A seroma is a fluid collection that can develop in the space created by the liposuction. To help prevent this complication, patients are given contour garments that apply pressure to the operative area, to allow collapse and closure of these opened spaces. Contour garments are worn religiously for about 4 to 8 weeks depending on the area suctioned.
Perforation is a possible complication of the procedure when the suction catheter inadvertently invades one of the body cavities. This may cause injury to the chest organs or the abdominal organs, depending on which area the liposuction is being done. In all of my years as a plastic surgeon and in my years training as a plastic surgeon, I have never seen this occur. However, it can occur. To prevent it from happening, we simply choose to be meticulous and overtly careful about the extend of liposuction and the catheters used. Again I have never had this complication and do not expect to ever see it.
Contour irregularity occurs when liposuction/lipocontouring is done and there is an asymmetry. This means that the two sides liposuctioned do not appear to be even. This may happen and needs to be addressed carefully. Most often we are very careful to inject the same amount of anesthetic solution and saline into each area prior to suctioning off the excess fat. We are also very careful to extract the same amount of fat from each side. In this way we try to keep everything symmetric. However, sometimes this does not give us the symmetric look we hope for. If there is an area that is uneven, we then wait for a few months to allow the tissue and the swelling to subside. At that point if the tissue is still irregular in shape, we then go back to surgery and address both sides and make them even.
How painful is the procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain. Most of the pain seen with liposuction/lipocontouring is due to the bruising and the swelling involved. In fact most complain more about the soreness and aching sensation than actual pain. To help with the pain, we regularly give patients oral and intravenous pain medicines in the
post-operative period. Upon their discharge from the hospital, we supplement this with oral pain medication. It must be noted here that at the time of the surgery, the incisions are infiltrated with local anesthetic medication that lasts six hours, in an effort to help with
How long do I have to take off from work?
Great question. Most often I suggest to patients that they consider taking about 2 to 3 weeks from work. Let me elaborate. Once liposuction/lipocontouring, the area involved becomes swollen and in many cases becomes extremely bruised. This area then slowly goes through healing. We have patients wear contour pressure garments to help with the swelling. This also helps with the postoperative pain as the swelling is controlled. We have patients start walking on post-operative day #1. They are usually walking comfortably by day#3. Most patients note that they are comfortable walking regularly by day#7. Additional time is taken off to help patients heal from all the bruising. However, in some cases the patients are comfortable to return to their work or activities by week#2. We advise against patients going back to their workout routine until week#6. The logic here is to prevent patients from doing so much exercise as to cause additional swelling. If and when additional swelling develops, the tissues and the body parts are more apt to become more asymmetric in contour. If the patient waits until week#6, the chance of having contour asymmetry is much less because the underlying tissues have had time to settle and the spaces where fluid can collect have closed off.
Can I combine this procedure with any other procedure?
Yes and no. Like any surgical procedure, there are limits
to what can be done and what is safe. As for the yes, it can
be combined with some other procedures. For example, I routinely
do this procedure with an texas tummy tuck. In fact, texas liposuction
and lipocontouring can help make an abdominopalsty much more
smooth. In this way, the overall result is much more improved
than with an abdominoplasty alone. Other procedures that are
routinely done along with liposuction are breast augmentation
or breast lifts. Any procedure that may be too long or too
arduous and place the patient at risk for significant bleeding
or significant anesthetic exposure would have to be deferred
and done in two stages. Please understand I say this without
knowing exactly what you, the patient, may have in mind. I
can only speak from my experience.
Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body and
their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local amarillo