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Breast Augmentation View Photos

Breast augmentation, also known as augmentation mammoplasty, is a surgical enhancement procedure to accentuate the size and shape of a woman's breasts. While breast augmentation will make the breasts larger, the surgery will not move the breasts closer together or lift sagging breasts.  Breast augmentation is tremendous help to patients who desire a fuller profile, who have lost breast volume due to pregnancy or nursing, or who have undergone breast reconstruction and want to gain a more natural look again.

Reasons for Considering Breast Augmentation:

  • Enhance body shape if breasts are too small.
  • Increase breast volume after pregnancy and nursing.
  • Equalize a difference in breast size (cup size) to gain breast symmetry.
  • Reconstruct breasts following a mastectomy or injury.

Breast augmentation is one of the most common cosmetic operations done in the United States. In assembling this information sheet, we have tried to answer many of the common questions patients ask us during consultation. At Aesthetic Surgery Associates, our emphasis is on educating patients so that they can make the best possible decision for their care.

Q & A

There is a lot of information of the web, how do I know what is accurate? The two web sites at the bottom of this page have helpful information that covers many “basics” of breast augmentation. It can be difficult to “sort things out” given the volume of material (both right and wrong) available on the web that is made available by both proponents for, and opponents of breast augmentation. Please also be aware that many sites are “sales oriented” and refer you to surgeons that pay to be listed on the site. Surgical referrals on the web have become a major industry, and the cost is passed on to patients. Many excellent surgeons are not listed simply because they do not wish to pay for the privilege. Your personal “filter” should put information to the test of some simple questions:

1. Does it make intuitive sense? The information should be easy to understand and based on explanations, not opinions. The opinions should be your own after you have been educated.

2. Do I feel that they are trying to sell me something? If you have this feeling, it is probably accurate. A good doctor is not a good salesman, but rather a good counselor and educator. You should leave a web site with the feeling that there is a genuine interest in helping you make the right decision for you.

3. Do I feel as though there is some other “agenda” on the web site? Some web sites present augmentation in a very blithe and overly positive light. This can be a genuine attitude based on happy patients and good results. Similarly, there are sites that are highly negative and are based on a clear agenda to dissuade patients from undergoing an augmentation. These can also be based on genuine attitudes that have arisen from bad experiences or poor outcomes. The truth lies somewhere between, so try to balance your information.

4. Does the site refer you to other reputable third-party sources of information? There should be links to sites with information from the government or reputable societies to help balance the perspective.

What is the best source of information about Breast Augmentation? The answer is simple! You should ask for feedback from women whose opinions you value, and who have the same outlook on lifestyle and appearance that you do. Many women are hesitant to invade the privacy of friends and acquaintances. Surprisingly, most patients are very forthcoming about their augmentation, and are usually happy to answer questions that are not overly intrusive.

What are the most important “issues” I need to understand that will help me make the correct decision? Your decision to undergo breast augmentation involves a list of long-term “issues” related to implants. Failure to be informed of these issues is one of the principle causes of dissatisfaction among patients who are unhappy with their augmentation.

1. The need for future surgery. Over a lifetime, a significant percentage of women will need additional surgery on their breast which can include changing the size of their implants, “lifting” the breasts (mastopexy), or correcting problems with the implants or the scar capsule that naturally forms around them (hardness, leaking, or asymmetry). Additional surgery can be necessary due to changes in the breasts caused by pregnancy, large changes in weight, or skin laxity with aging. You must be aware of this potential to intelligently decide if an augmentation is right for you.

2. The potential for capsular contractures. Any artificial device placed in the body that cannot be broken down and absorbed forms a thin layer of scar around it termed a “capsule”. This is true of shunts for hydrocephalus, artificial joints, implantable pumps or catheters. With breast implants, the scar capsule can shrink with time, which is a potential of all scar tissue. Shrinkage can be aggressive in some women resulting in “hardening” of the implant. The implant is actually normal, but the constricting scar tissue makes it feel hard. You can demonstrate this at home by placing a water balloon in a pillowcase, then twisting the loose pillow case until it “squeezes” the balloon. If you twist it tightly enough, the balloon will feel as hard as a baseball. There is nothing wrong with the balloon. Surgery is necessary to correct this problem if it occurs with breast implants.

3. The amount of soft-tissue coverage present on your chest. Breast implants are covered by the soft-tissues of the chest. These include skin, fat, muscle (if the implant is placed below the muscle), and existing breast tissue. Thin coverage of the implant can make it difficult to camouflage the breast mound created by the implant. This is why very thin women with small breast have a more “obviously augmented” look. An artificial-appearing result is even more common if larger implants are placed in a thin patient. Thicker subcutaneous fat layers, or a more generous amount of native breast tissue yield a more “natural” appearing result.

4. The need for procedures to raise the nipple position and reduce excess skin in addition to an augmentation. Some breasts have been “stretched out” by pregnancy or massive weight gain. In these patients, the nipple has descended and typically points toward the floor. Augmentation alone is not sufficient to raise the nipple to a more natural position. In this circumstance, surgery must also be done to raise the nipple position and remove excess skin (mastopexy). These operations leave a scar around the areola, and sometimes on the breast below the nipple. If you are unwilling to accept these scars, an augmentation alone will not give you a satisfactory result, and a second procedure to “lift” the breast will be needed.

5. Do I plan future pregnancies? Nothing changes the female form as dramatically as pregnancy. During pregnancy, existing breast tissue increases in size and weight and stretches out the skin. After delivering the new baby, the breast volume and weight decreases leaving “hollowness” of the upper part of the breast, and causes the nipple to hang loosely and lower. If you undergo an augment and have subsequent pregnancies, the same changes can occur in the breast tissue over the implant. This may result in the need for a breast “lift” after completion of child-bearing.

6. What is the underlying shape of my chest and native breast tissue? Some women have that are located low on the chest. Since the implant needs to be centered on the nipple, it too will be low on the chest. The width of the implant determines how high on the chest the upper border of the implant is located. If its location is low on the chest, it will not create the fullness of the upper chest that some women desire. Similarly, if the fold that the breast makes with the chest at the lower extent of the breast (the infra-mammary fold) is close to the nipple, the fold will need to be lowered so that the implant is centered on the nipple. The point here is that a women’s individual anatomy plays a large role in determining how the augment will appear.

All of these issues should be addressed in some form during a consultation for breast augmentation. It is an excellent idea to ask how they apply to your particular case during the interview with your doctor. You should have a clear idea of how they apply to you prior to making the decision to proceed. Once you decide to have an augmentation you will need to make some choices.

1. Where do I want the scar placed? A scar is needed to allow access to the breast and insert the implant. There are several choices:

a. Infra-mammary fold. This scar is slightly above the crease the breast makes with the chest and upper abdomen, and well below the nipple and areola. This is the most commonly used location, and is typically used for secondary procedures if the scar capsule needs to be removed. It is also the scar of choice for placement of silicone implants since they need a slightly larger opening for access due to the larger size of the implant (saline implants are inflated after they are inserted and can thus be placed through a smaller incision).

b. Peri-areolar. The scar with this technique is at the border of the areola. It is typically a cosmetic scar, but is still a scar on the breast. Silicon implants can be placed using this approach.

c. Trans-umbilical. This is termed a TUBA, or Trans Umbilical Breast Augmentation. A small incision is made in the umbilicus (belly button), and a tunnel made from the umbilicus to the lower part of the breast. A special balloon dissector is placed in the breast to stretch out a pocket for the implant. A saline implant is then substituted for the balloon dissector and subsequently inflated. The entire procedure is done “blindly” (no visualization of the pocket being made). It can be very difficult to control bleeding if it occurs with this approach due to the lack of visualization. It is also difficult to precisely place the implant below the muscle due to the distance between the incision and the pocket.

d. Trans-Axillary. The axilla is the medical term for the arm-pit. With this technique, small incisions are made in the natural skin crease in the armpits, and a short tunnel is made to the breast, or under the chest muscle. A pocket is made under direct visualization using a special operating telescope (endoscope), and a saline implant is placed and subsequently inflated. The muscle can be very precisely released with this technique, and any bleeding can be controlled. The scars are not on the breast, and are difficult to see even with the arms raised. It is not suitable for silicone implants due to their greater volume. This is our preferred approach at Aesthetic Surgery Associates.

2. Do I want the implants under the muscle, or on top of it? This choice depends principally on the amount of soft-tissue coverage that is needed (see above explanation). In thin patients, the thickness of the muscle will help to “camouflage” the upper and middle portions of the implant’s border, which will yield a less “obviously augmented” result. Placing the implant under the muscle can also reduce the likelihood of capsular contractures and the resulting “hardness” of the implant. Patients who choose placement under the muscle need to be aware that attachments of the muscle to the lower chest wall need to be released to allow the muscle to “re-drape” over the implant. In competitive athletes (tennis, golf), this can have performance implications but is not a noticeable difference is the vast majority of patients.

3. How do I decide on an appropriate size implant? This is strictly a matter of personal taste. Long-term problems are more common with large-volume breast augmentations, and the result appears more artificial with larger sizes. Since bra sizes are highly variable (as any women who shops for bras can tell you), it is difficult to precisely relate implant volume to cup size. The best way to approximate the appearance of an augment is to place various size implants in your bra, and inspect your appearance in a mirror with your shirt on. Alternatively, some surgeons use external breast prosthesis that approximate the volume of an actual implant to simulate the result. This is our approach at Aesthetic Surgery Associates. We encourage multiple visits to help decide what is right for you. At home you can fill plastic bags with different volumes of water and place them in your bra to make sure. The final decision is yours, and yours alone. We support our patient’s decisions once we are assured that they understand the implications of their choice.

4. Do I want saline or silicone implants? Silicone is a viable option, and is once again available since questions about their safety have been resolved. Many patients prefer them due to their texture when compared to saline. With older silicone implants, capsular contracture (hardness) was more common, and follow-up has not been long enough to determine if this is true with newer devices. The silicone implants are much more expensive (3 to 4 times the cost of saline) and require a larger access incision when compared to saline. Saline implants tend to project somewhat more than silicone, and are a bit more uncomfortable for patients who like to sleep on their stomach due to their firmer consistency. If saline implants rupture or leak, they are easier to replace and the saline that leaks out is the same as that used in IV solutions.

What are possible complications from the surgery?

Early Complications

a. Infection. As with all surgery, infections can occur despite meticulous technique and antibiotics. The incidence is less than 1%. If it occurs, the implant will need to be removed for at least a month to allow resolution of the infection. It can then be replaced. Attempts to treat the infection and salvage the implant are seldom successful.

b. Bleeding or Hematoma. Bleeding in the pocket with the implant can create collections of blood termed “hematomas”. These collections create significant bruising, and need to be evacuated in the operating room. Leaving a hematoma can predispose to capsular contractures and an abnormally firm breast. Post-operative increases in blood pressure due to pain, or inappropriate physical activity (sexual relations or athletic activity) can cause the bleeding. Bleeding should be suspected if one breast is significantly larger and more painful than the other after an augmentation.

c. Seroma. Rarely, collections of clear fluid can accumulate around the implant. This is most likely in patients who have had lymph-node dissections in the axilla on the side of the augment. They are more common in patients who are augmented after lumpectomy and radiation for cancer.

d. Synmastia. This complication is where the two implant pockets connect across the midline. It is due to over-aggressive dissection of the pockets combined with the choice of large implants. The two implants actually touch in the midline. It is a very difficult problem to correct even with additional surgery.

Late Complications

a. Asymmetry. Rarely, the implants can shift position, typically in association with capsular contracture. Asymmetry that occurs early in the post-operative course usually “settles out” during the first six weeks after surgery. Asymmetry that evolves later (six months to a year) will usually need surgery to correct.

b. Capsular Contracture. This is “hardness” of the implants caused by shrinkage of the scar capsule around the implant. The precise cause is unknown, but it is more common in smokers. Surgery is needed to remove the capsule (capsulectomy), or open the capsule (capsulotomy) to provide more room for the implant. This complication was more common with older silicone implants than with saline (15% life-time risk). Newer silicone implants have not been used long enough to determine if contracture is more common. Placing the implant below the muscle reduces the risk of this happening.

c. Rupture or leakage. For saline implants, the lifetime risk of this happening is approximately 4%. The incidence for newer silicone implants is unknown due to the limited follow-up time. If leakage occurs, the implant needs to be replaced soon after recognition of the problem.

d. Rippling or “folds”. These are visible creases that form as the implant “pulls” on the scar capsule. They are more common with saline implants, and also more common in thinner patients. The best means of correcting this problem is replacing the saline implant with silicone. Even this may not entirely resolve the problem.

e. Calcification. This is a fairly rare problem. Occasionally, the scar capsule can become calcified, similar to an eggshell. It is typically associated with capsular contracture and surgery is needed for correction.

What about “shaped” implants? Shaped or “anatomic” implants are offered by some surgeons as an option to the more typically used round implants that constitute the vast majority of breast augmentations. They are a controversial subject among plastic surgeons, some of whom believe strongly in their use. These implants are shaped more like a typical breast and the principle is attractive in concept. If shaped implants are used, the pocket needs to be very precisely dissected or the implant can rotate in the pocket. There is evidence that even minimal capsular contractures will make the implant assume a rounder configuration, thus eliminating the supposed advantage of their use. Anatomic implants are also significantly more expensive than round ones. Many surgeons use the option of anatomic implants as a marketing tool to differentiate their services from competitors. Suffice it to say that shaped implants continue to make up a small minority of breast augmentations.

Is there an advantage to “textured” implants? Implants are available with a “fuzzy” or textured coating. This coating is designed to reduce the incidence of capsular contractures by “breaking-up” the scar capsule. They are rarely used in primary breast augmentation, and are normally reserved for use in patients undergoing surgery for capsular contractures, or for reconstruction after surgery for breast cancer. The coating results in a thicker shell on the implant that can be palpable through the skin.

Is there an increase in my risk of cancer after an augmentation? Breast implants do not increase the chance of developing breast cancer. This issue has been well studied, and there is little question that there is no additional risk.

Will augmentation interfere with my mammograms? Mammograms after augmentation will require additional views of the breast to allow visualization of all of the breast tissue. Studies show that mammograms following breast augmentation are as effective as those performed on un-augmented breasts.

Will I be able to breast feed after breast augmentation? Since the implant is under the glandular tissue of the breast, they do not interfere with breast feeding.

Is it sufficient to be counseled only by the surgeon’s office staff? Although office staff are an excellent source of information and advice (some of whom have undergone augmentation), there is no substitute for adequate counseling by your surgeon. Your surgeon is in a unique position to determine which “issues” involved in augmentation are most important in your particular case. Never let discussions with office staff take the place of focused conversation with your surgeon.

What is the best approach to making my decision?

1. Talk to several other women who have undergone augmentation

2. Talk to more than one surgeon before deciding. This will re-assure you that you are choosing a surgeon that you are comfortable with. Remember, it is best to seek care locally with a board-certified plastic surgeon than to travel to a distant city to have your surgery. Complications can occur, and if they do, it is best to have continued care close to your home given the expense and logistical difficulty in continuing your care at a distance.

3. Do your homework ! Get as much information as possible from the web, from literature, and from your surgeon before deciding.

4. Never get in a hurry. Make your decision when you are sure it is right for you!

Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469