Breast Enlargement

Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include correction of breast volume loss after pregnancy, balancing breast size difference, or as a reconstructive technique following breast cancer surgery.

Augmentation mammoplasty is done as an outpatient and usually under general anesthesia. A breast implant is composed of an outer silicone shell filled with saline. Silicone rubber is a non-reactive material, used in many medical device, and has never been suspected to cause health problems. If it leaks, the implant collapses and the saline is harmlessly absorbed. Silicone gel, however, is a completely different material with a much more controversial history. It has been used as a filler for breast implants because it feels a lot like breast tissue. In 1993, concerns over its safety were raised, so the FDA restricted the use of silicone gel implants. Exhaustive studies were performed by independent scientist looking for a connection between silicone gel leakage and systemic health problems, but no link has ever been demonstrated. Nonetheless, silicone gel leakage can cause severe local problems like scar formation. Accordingly, the FDA continues to restrict silicone gel use. Dr. Wigod only implants saline implants at this time. New types of silicone gel implants are currently under investigation and someday will be a reasonable alternative for properly selected patients.

The implant outer surface is usually smooth and the shape round. While shaped implants are available, Dr. Wigod (as well as a majority of Plastic Surgeons) is not convinced that their purported benefits (a more “natural” shape) outweigh their problems. Studies have shown that properly filled and placed round implants mimic the natural breast as well as shaped implants when the patient is upright. When the patient is flat, the round implant spreads like a natural breast while the shaped implant maintains unnatural upper pole fullness. Shaped implants may rotate and require re-operation to correctly orient them. To help minimize the chances or rotation, shaped implants are textured, but this makes them thicker and easier to feel through the skin. Finally, the cost of a shaped implant is double the cost of a round one.

Dr. Wigod and his staff make great efforts to ensure that you select the correct implant size. Most women think in cup sizes, but Plastic Surgeons think in cc’s (milliliters). In general, approximately 150 cc’s equals one cup size. Ultimately, the final cup size is not as important as choosing the best implant to optimize the beauty of your breast. Implant makers have tables of implants which vary in the number of cc’s, base diameter, and projection (profile). The main factor is your chest width. The larger the chest width, the larger the implant which can be appropriately placed. Selecting an implant base diameter about .5 cm above or .5 to 1 cm below your measurement is usually acceptable. Next, a low (rare), moderate (most common), or high profile implant type is selected. As the profile becomes higher, the implant becomes larger and rounder. Some women want as little rounding (fullness) in the upper breast while some want as much as possible. Examples of different sizes and projections are shown to demonstrate the difference. There is no right or wrong answer, only what is anatomically appropriate and what you like best. Once Dr. Wigod has narrowed down the options to a few implants, you and a nurse will use breast sizers to finalize the exact implant you need to best achieve the look you desire.

The Procedure

An implant (prosthesis) must be placed through an incision. The incision can be made under the breast or around the nipple. Dr. Wigod will help you determine which approach would best for you. Dr. Wigod does not offer the under arm approach for several reasons. First, scars may be visible while wearing tank tops or bathing suits. Second, accurate placement may be more difficult from such a remote approach. Third, nerves supplying sensation to the breast and to the upper inner arm may be damaged. Fourth, a re-operation for almost any purpose would have to be done through another incision.

Dr. Wigod places the vast majority of implants under the pectoralis muscle. When the implant is placed sub muscularly under the breast, there is a lower chance of contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable. There is also less risk of visible or palpable implant edges. However, in some select instances, the implant would be more appropriately placed under the breast gland but above the muscle. This is most commonly performed in a woman with moderate droop to her breast, who does not desire a lift, and who has a thick enough layer of breast tissue to cover the implant.

Post Operative Information

You must have someone drive you home and stay with you for 24 hours after surgery. You will experience some pain the first day or two that is controlled with pain pills. Some tightness in the breast area is also normal as your body adjusts to the implants. You will most likely be able to return to work within a few days, but may feel easily fatigued.

Your breasts will be dressed with tape (to define your inframammary fold), a soft bra, an elastic strap called a bandeau (to prevent movement of the implants), and an ACE wrap. The dressing should not be removed until you return for your first post-op visit. You may then start light massage exercises (light pressure in all directions once or twice a day) and continue to use the bandeau as instructed. During the first 3 weeks after the operation, you should wear a tube top or loose sports bra. During the second 3 weeks, you may wear a regular soft bra without underwire. After 6 weeks, you may wear an underwire bra for short periods and progress to longer periods over the next month.

Moderate exercise such as walking or stationary biking is allowed after the first week. Vigorous exercise such as jogging or aerobics may be resumed at 3 to 4 weeks. Heavy lifting or exercises using your upper body should be avoided for 6 weeks.

Your breasts will feel swollen for 2 to 4 weeks. Gradually they will “settle” until they look and feel more a part of your body. Within a few weeks, the actual shape and size will be evident. You may notice some asymmetry. This should not be unexpected as studies show approximately 90% of women have significant breast asymmetries both before and after operation. Some women have changes in their nipple sensation which usually resolves. Your breasts will continue to change with time as implants do not stop the natural aging process. You may require surgery in the future such as implant exchange or mastopexy (breast lift). Dr. Wigod will maintain your records and be available to help with any problems.

Complications include, but are not limited to, implant deflation, capsular contracture, bleeding, infection, skin rippling and contour problems.

For more information, go to

http://www.plasticsurgery.org ->Augmentation Mammoplasty<-