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.
Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the U.S. and one of Dr. Wigod’s most popular services. Breast augmentation can give women with small, deflated, or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of saline or silicone implants beneath the breast. Patients undergo breast augmentation for many different medical and aesthetic reasons, including balancing breast size, compensating for reduced breast mass after pregnancy or surgery, and correcting congenital breast problems.
Dr. Wigod knows that every woman has a unique body shape and goals for improvement. Accordingly, Dr. Wigod and his staff take time during consultations to learn what each patient hopes to gain from breast augmentation surgery and to decide which implant type and implant placement is best. In this way, each patient enjoys a completely customized treatment plan designed for her specific goals.
Most women think in cup sizes, but Plastic Surgeons think in cc’s (milliliters). In general, approximately 150 to 200cc’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. You will be advised against choosing implants which are too large for your breast tissue to support as they may cause difficult to treat problems in the future.
Breast Implants: Saline or Silicone Gel, Round or Shaped, Smooth or Textured?
A breast implant is composed of an outer silicone rubber shell filled with saline or silicone gel. Both implant types are considered safe for implantation, but each offers its own advantages and disadvantages. After reviewing these points in detail, Dr. Wigod will help you decide which type is right for you. The FDA has allowed silicone gel implant use only after exhaustive studies were performed by independent scientists looking for a connection between silicone gel and systemic health problems. No link has ever been demonstrated. Most patients today choose silicone based on its superior fill and reduced rippling.
The implant outer surface is usually smooth and the shape round for breast augmentation. 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. While shaped implants are available, they are most often used in breast cancer reconstruction where their more firm features help resist changes of the thin skin envelope. Aesthetic patients who specifically want to minimize superior rounding or who have specific tissue envelope problems may be good candidates for these implants. Shaped implants may rotate and require re-operation to correctly orient them. To help minimize the chances or rotation, shaped implants are textured and a postoperative drain is kept in place for a few days. The cost of a shaped implant is more than a round one.
The Procedure: Incision Location, Above or Below Muscle?
Augmentation mammoplasty is done as an outpatient and usually under general anesthesia. An implant (prosthesis) must be placed through an incision. The incision can be made under the breast (inframammary) or around the nipple (peri-areolar). 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. Umbilical (belly-button) placement is also not offered because accurate placement is difficult and reoperation impossible.
Dr. Wigod places almost all implants below 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. For women with larger or more ptotic (droopy) breast, Dr. Wigod offers a bi-planar approach in which the lower breast is effectively spread over the implant while still maintaining upper muscular coverage.
Breast augmentation can achieve dramatic and beautiful results on its own as well as in conjunction with other cosmetic surgery or non-invasive procedures. Dr. Wigod sometimes recommends combining breast augmentation with other procedures such as a breast lift for more satisfying results.
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 may be dressed with 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 should then continue to use the bra and bandeau as instructed. Think of it as a cast for your breasts. For the weeks following your operation, an underwire or soft bra may be recommended, depending on your individual breast. Long term support is advised to help maintain implant placement.
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 4 weeks. Heavy lifting or exercises using your upper body should be avoided for 6 weeks. An effective sports bra is particularly important.
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.
Breast Augmentation Revision
As a woman ages, so does her breast. With time, the breast may hang off an encapsulated implant, the implant size may no longer be preferred, or the implant may have a deflation or leak. Breast augmentation revision surgery may be an opportunity to address the problem. Revision Surgery, however, is typically more challenging than primary surgery.
Options for revision surgery may include implant exchange (to a larger, smaller, or newer generation silicone device), capsulectomy (scar tissue removal), or implant removal with or without breast lift (mastopexy). Revision surgery has become as common as primary surgery in Dr. Wigod’s practice.