Breast Augmentation
(Augmentation Mammoplasty)
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Breast Augmentation is for a woman who feels that her breasts are too small or if there is an imbalance in the size of her breasts. Breast augmentation provides a very effective cosmetic enhancement and instills new confidence in the individual.
To perform a breast augmentation with a mammary prosthesis is conceptually a very simple procedure to understand. Essentially you make an incision, dissect a space at some level below the breast, insert a prosthesis and close the opening wound with sutures. Obtaining the optimal cosmetic result with no change in sensation and have it look and feel like a beautiful un-operated breast is not simple.
If you look at the statistics collected from many plastic surgeons by the breast prostheses manufactures and given to the FDA in 2000 for the saline prostheses you see that a large number of patients required a surgical revision, had wrinkles from the prosthesis showing through on the skin, had unnaturally hard feeling breasts (fibrous contracture problems), etc.
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Compare that with my statistics for 10 years. Why are my numbers so different? The details of how I do the procedure are different from anyone that I know. When you are seen in our initial consultation I will explain in detail what these differences are and what I think they accomplish in giving you the result you are hoping to receive.
The following are some questions commonly asked by patients:
What is the prosthesis?
The prosthesis is a silicone rubber bag filled with saline that is placed beneath the breast, beneath the breast and the pectoralis muscle or beneath all the chest muscles below the breast.
What does it accomplish?
It increases the volume of the breast. Indirectly, of course, this changes the shape of the breast to make it more perky.
Am I a good candidate?
Physically, if you do not have any general medical contraindications you may be a good candidate. Of course, Dr. Bartlett's evaluation of your viability as a good candidate is an important factor as well.
Should I choose a saline prosthesis or silicone gel prosthesis?
The saline filled prosthesis hidden by chest muscles and the fascia that covers them will give a result similar to but not quite as good as silicone gel filled prosthesis. If you do not "hide" the saline prosthesis it gives a very poor cosmetic result. It essentially comes down to a patient's preference.
Is the gel prosthesis safe?
The new cross linked gel prostheses are much different from the old gels. The solid silicone envelope or bag has an inner lining to prevent sub-microscopic diffusion of gel through the bag. The gel is more viscous and this should decrease the fatigue stresses in the bag. Fatigue is one factor that weakens the bag with time. The gel is very cohesive. The gel wants to stay together even if the bag fails. The above factors and others make this a very strong and durable prosthesis. Of course nothing is as safe as sterile saline.
What size prosthesis is appropriate for me?
I will tell you what I think is appropriate but your wishes are what I try to fulfill. If you insist that you have a prosthesis size that I strongly think will cause you problems, I will ask you to find someone else to do your surgery.
Your present breast volume is measured with templates. You will tell me the cup size that you feel you would like reach with the augmentation. I know what the approximate volumes of different cup sizes with different chest circumferences are. By subtracting your present volume from the volume you want to obtain we obtain the volume of the implant.
Will I have a great deal of pain after surgery?
You will need to take the muscle relaxing medication and pain medication that is prescribed for you to make this tolerable the first night and day post-operatively. Most patients tell me that the intensity is down to a 1 or 2 (on a scale of 0 for no pain and 12 for maximal pain) by the 5th day after surgery.
When will I have my "final result"?
In most patients it takes from 6 to 12 weeks for the muscle to elongate and let the prosthesis settle into the most inferior aspect of the space surgically created for it. There will be some subtle additional settling for about 2 years after surgery.
Will I keep my sensation to my nipple?
Because of where and how I make the space for the prosthesis I have not had a patient with permanent loss of nipple sensation for at least 15 years.
What is fibrous contracture?
When any medical device is implanted in someone's body, the body will cover it with scar tissue to isolate it from the immune system. If the scar becomes reactive it will try to squeeze it into as small a volume that is possible. The geometric shape that will contain the most volume with the smallest surface area is a sphere - thus the term "spherical contracture". To my knowledge I have not had a patient have this problem since 2006.
Where do you make your incision?
I make my incision just above the fold created by the lowest part of your breast meeting the chest wall. I have operated many patients through an arm pit approach, across the nipple approach, and around the areola of the nipple approach. There were an unacceptable incidence of fibrous contracture, asymmetry, bleeding complications and loss of sensation when using these other surgical incisions or approaches. If your healing is normal and you keep the incision site covered with Micropore paper tape for 3 months after surgery, the scar becomes almost invisible.
If I become pregnant after augmentation will my breasts look OK?
This really is impossible to answer. Some women's breasts become very large with pregnancy and nursing their baby, while some hardly change at all. The same woman may have considerable increase in volume with one pregnancy and not with another. Of the women that do have considerable increase in volume and then return to their pre-pregnancy volume or smaller, some will maintain shape and others will lose their shape.