Of all cosmetic procedures performed in medicine today, none provides more patient enthusiasm than breast augmentation. In all cases, the goal is a surgical result that appears natural and non-operated. The stereotypical “round” or “fake” look is completely avoidable in all women, provided that body proportions are respected. Shoulder size, chest wall width, cleavage proportion and native breast size all influence the final result. At the Carlotti Center for Cosmetic Surgery, Drs. Carlotti will discuss with you in detail the influence of these factors in the context of your desired result.
As a part of your initial consultation, Drs. Carlotti will discuss in great detail your medical history and, as a general rule if you are over the age of 30, they will order a mammogram or breast ultrasound in order to rule out any undiagnosed breast disease. They refer all of their patients to BreastNet for this comprehensive pre-treatment examination for your safety.
Drs. Carlotti will also discuss the details of incision placement and implant placement during your consultation. Today in cosmetic breast surgery, there four incision placements for access to allow breast augmentation: periareolar (around the nipple), inframammary (beneath the breast), transumbilical (around the belly button) and transaxillary (in the arm pit). Periareolar and inframammary incisions leave scars on the breast itself and may be fraught with problems if poor healing occurs. The transumbilical approach leaves few noticeable scars, however often yields a breast asymmetry.
The transaxillary approach (arm pit) allows a concealed approach and when the incision has healed, is often completely unnoticeable. It is considered to be the premiere Minimally Invasive Technique for breast augmentation today.
Breast implant placement varies as well amongst surgeons. Considering that the chest wall is composed of skin, breast tissue, fascia of the pectoralis muscle, the pectoralis muscle and the ribcage, there are several options for the placement of a breast implant. The most common approach today is “under the muscle,” or underneath the Pectoralis Major muscle. The primary advantage to this technique is that for thin patients it allows a thick covering over the implant diminishing the chances for rippling and migration of the implant downward. The final technique is the “sub-fascial” approach which allows placement of the implant beneath the thick covering over the Pectoralis Major muscle. This is the preferred technique for muscular, thin patients who want to avoid distortion of the implant during contraction of the Pectoralis muscle (especially for body builders). Dr. Carlotti will help you choose whether the sub-fascial or sub-muscular technique is best for you.
There are three types of available breast implants today: saline filled, cohesive silicone filled and a hybrid of saline and silicone filled implants (typically reserved for breast reconstruction in post-mastectomy patients and not used in cosmetic surgery).
Saline Implant Breast Augmentation
For women desiring primary breast augmentation (a woman who has not had previous breast augmentation), saline filled implants are the only FDA approved option today. The implant is placed unfilled into the pocket created during the procedure and is then filled to the desired volume in order to achieve symmetry via a port tubing. Women often ask whether or not saline breast implants need to be replaced and as a rule, they do not. In very rare instances the valve may slowly leak saline causing a deflation of the breast implant. The most common reason for replacement of saline implants is to allow the patient to increase the size of their breasts.
Cohesive Gel Silicone Breast Augmentation
In 2007 the FDA lifted its restrictions for the placement of silicone gel breast implants. Conclusions from the FDA study showed no increased risk for women who had silicone breast implants for auto-immune diseases, breast cancer or other medical problems. The advantage of a silicone implant is that the viscosity of the gel implant is much closer to that of natural breast tissue. Meaning, the implants look and feel more natural with less rippling than saline implants. In our practice, we place primarily silicone implants becaues of patient demand and satisfaction.
Because silicone implants come pre=filled, we feel that it is best to place them through an imframammary or peri-areolar approach. For implants smaller than 300 cc’s we can still place them safely through an axillary (armpit) incision.
Method of Breast Augmentation Surgery
After discussing with you in detail, your imlant size will be pre-planned at the time of your preoperative appointment. On the morning of your surgery, pre-operative markings will be made to help conceal your incision. The first thirty minutes of the procedure involve sterilization and preparation for the procedure. The breast augmentation procedure itself is performed in about one hour. You will be monitored for a minimum of 2 hours following the procedure and then you may be discharged home.
Breast Augmentation Recovery
Depending on the amount of increase in size you desire, you will feel tight in the chest for several days. Adequate pain medication will be provided to help you be comfortable. We will help you chose the size of Natori bra that you will wear for the months following surgery. The Natori bra can be purchased from Nordstrom and is a comfortable, adjustable support bra.
We recommend that patients limit their high impact athletic activity for 3-4 weeks following breast augmentation, although they may begin low impact exercise at 2 weeks. It is normal for breast implants to appear to be high on the chest for the first 1-2 months and then they will drop into the desired position as swelling resolves. For this reason, we recommend that our patients refrain from purchasing expensive undergarments or bathing suits until the 3 month time frame following surgery.
Submuscular saline implants do not impair the ability of mammography to detect breast cancer or other breast tissue abnormalities. In addition, breast implants will not impair your ability to breast feed your baby. You may want to visit our breast cosmetic surgery page for additional implant and cosmetic surgery information.