Women who want to improve the size, shape and symmetry of their breasts, including those who have lost volume after weight loss or pregnancy, can benefit from breast augmentation surgery. This procedure uses saline or silicone gel implants placed above or beneath the pectoral muscle for fuller, firmer breasts that look and feel natural.
There are many reasons women choose breast enhancement. Common reasons to consider this surgery include:
• Asymmetrical breasts
• Small breasts
• Lost breast volume and/or after pregnancy or weight loss
• Poorly fitting clothing
• Depletion of breast volume due to aging
• Unhappy with results from previous surgery
• Low self esteem due to body image
• To create a more proportionate figure
Am I a Candidate For Breast Enhancement Surgery?
Many women can benefit from this procedure, which is a solution for women who are unhappy with the shape, size or symmetry of their breasts. Most women in good physical health with realistic expectations are good candidates for this surgery, although some women may need a breast lift as well to produce beautiful results.
You can determine if you will need a breast lift as well by viewing your profile in a mirror. Note the position of the nipple compared to the crease of the breast, also known as the inframammary crease. If the nipple is higher than the crease, implants alone will achieve beautiful results. If the nipple is level with the crease, it is still probable that implants alone will produce great results, but a lift may be necessary. If your nipple is lower than the crease, a breast lift will be combined with the augmentation to produce the best possible results.
A Guide to Breast Implants: Decisions to Make
Once you have chosen a breast enhancement procedure, there are many important decisions to make, including the implant type, placement, size and more. This information will guide you in these decisions. Dr. Shapiro will also walk you through the choices that must be made and help you attain your desired results during the consultation.
Saline Breast Implants
Saline breast implants are made from a silicone shell filled with saline (saltwater) once it is placed in the breast. Because they are not pre-filled, saline implants require a smaller incision with minimal scarring after you recover. These implants are also easy to change by adding or taking fluid if there is any asymmetry or you later want to change the volume.
A concern with any breast implant surgery is some degree of uncertainty over what happens in the case of implant rupture. With saline implants, you can enjoy peace of mind. While it is very rare for a saline implant to leak or rupture, if it does, the fluid is safely absorbed by the body with no negative health consequences.
While saline is more affordable than silicone implants, they do have downsides as well. These implants typically feel firmer and look less natural than silicone. Patients with little body fat sometimes experience rippling along the sides of the breasts as well, which can be treated by switching to silicone gel.
Silicone Breast Implants
Silicone gel implants come pre-filled with three layers of shell that surround the filler. This greatly reduces the chance that the implant will leak or rupture, compared to outdated models. This type of implant requires a larger incision during surgery to place the implant. If the patient later wants to change the size of the implant, it must be removed completely, unlike saline options.
Some patients are still hesitant to choose silicone due to the controversy over its safety, although this has been largely put to rest over the last few decades. Many studies have proven that silicone implants are safe and do not play a role in health problems like lupus or autoimmune diseases, as was alleged. Both silicone and saline breast implants have been connected to some localized complications, although they are proven safe and effective and they have been FDA approved as such.
Silicone offers several advantages over saline counterparts. This type of implant produces a more natural shape and feel, although this comes with a higher cost and a longer incision.
The size of the implants is another major decision. Dr. Shapiro will help you make this decision. He has decades of experience performing this procedure and will help you decide on an implant size by communicating with you what you want to achieve with your surgery. Keep in mind the same size of implant can look very different on different people, and the size range that will look natural on you will depend on many factors, such as the size of your ribcage, the size of your chest, your weight and the width of your sternum. Size also depends on the amount of breast tissue you have, volume, base dimension and more.
During your consultation, Dr. Shapiro will have you wear a bra with a temporary implant inside to help you get an idea of the best volume. You will need to add about 10-20% more volume to the size you liked, particularly if it will be placed under the pectoral muscle.
Implants may be placed beneath the breast tissue and over the pectoral muscle (subglandular placement), or under the breast tissue and pectoral muscle (submuscular placement). Most patients choose to have the implant placed beneath the muscle, and Dr. Shapiro prefers this placement because more natural tissue will cover the implant for a more natural feeling and appearance. This decreases the chance of rippling, and implants placed under the muscle have a lower rate of complications, including capsular contraction, in which hard scar tissue forms a capsule around the implant.
While the submuscular placement is typically the best choice, Dr. Shapiro finds there are some cases in which the subglandular placement is a better option. This includes women with adequate natural tissue that will sufficiently hide the implant shape, or patients with very developed pectoral muscles.
Implant projection affects the profile of the breasts and the fullness at the top of the breast. An implant that has a high profile will make the breast seem spherical with equal fullness at the top and bottom, while a low or medium profile implant will create a teardrop shape with more fullness at the bottom. Both silicone and saline implants are available in a wide array of profiles and shapes.
The incision to place the implants may be made in several ways. The choice of incision depends on the type of implant, the amount of enlargement, the patient’s anatomy, and the choice the surgeon and patient make together.
Incisions may be made around the areolas (periareolar incision), in the underarm (transaxillary incision), or under the breast at the fold (inframammary incision). Dr. Shapiro prefers placing the incision at the crease for greater control of the breast volume and shape. This results in a scar that is well hidden as well. Dr. Shapiro will happily discuss any preference you have during the consultation.
Breast Augmentation Recovery
As with any surgical procedure, patients can expect a gradual recovery after breast enhancement. Most patients experience some discomfort or pain that is controlled with pain medication for the first two or three days after surgery. Dr. Shapiro typically prescribes Valium for the first few weeks to treat muscular discomfort and to help the implants descend to the final position.
Most patients resume work and normal activities about five days after surgery. After one to two weeks, light exercise may be resumed. About four weeks after surgery, patients may resume impact exercise, and upper body exercise may be resumed after six weeks.
During the recovery period, the breast tissue will slowly stretch to accommodate the implants. During this time, swelling will dissipate and the breasts will begin to look much more natural. It is common for the areolas to stretch along with the rest of the breast tissue. Patients with large areolae may choose to have them reduced during the surgery to prevent unnaturally large areola from developing during recovery.
Final results of breast implant surgery is visible in two or three months once the swelling has resolved itself.
Risks and Complications
Breast augmentation complications are uncommon, but may include inflection, bleeding, rupture, scarring, loss of nipple sensation, asymmetry and capsular contracture, or the formation of hard scar tissue around the implant. Dr. Shapiro will discuss these risks during your consultation, as well as ways in which they may be mitigated. Quitting smoking before and after surgery can reduce the risk of complications.
About 20% of women who receive breast implants have them replaced during the first decade, although saline and silicone implants are made to last for a very long time. There are many reasons women choose to have implants replaced, including visible rippling, capsular contracture, rupture, implant displacement or the decision to change the size.