Breast Augmentation
Breast augmentation, also called “augmentation mammaplasty,” is a procedure designed to increase the size and enhance the shape of a woman’s breasts. This is accomplished with silicone or saline implants and may be combined with one’s own fat tissue (fat grafting).
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How do I know if a breast augmentation is right for me?
Women have many different reasons for pursuing a breast augmentation, but most of them fall into one of the following categories:
Naturally Small Breasts
Women who have small or asymmetrical breasts due to genetics can achieve enhanced volume and natural-looking results with breast augmentation.
Change in Breast Size After Pregnancy And / Or Weight Loss
Conditions that cause large fluctuations in breast size such as pregnancy (and / or breastfeeding) or weight loss often lead to a deflated breast appearance with loss of volume and dropping of the nipple / areola (ptosis). Breast augmentation restores or increases one’s original breast volume. In this setting a breast lift may be recommended in addition to your breast augmentation (augmentation mastopexy). This determination will be made at the time of consultation.
Breast Revision
If a previous breast augmentation was unsatisfactory or resulted in complications, a secondary breast augmentation or breast revision can be performed to address one’s concerns.
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Types of Implants
There are hundreds of FDA-approved breast implants available in the United States made by various manufacturers. These implants differ in their composition, volume, projection, texture and shape.
Composition (Silicone vs. Saline)
Silicone Implants
- Pre-filled with a fixed volume of cohesive silicone gel
- Many patients attest to a more natural feel than saline implants
- If rupture occurs, gel is most-often contained within implant shell or scar tissue surrounding the implant
- Depending on manufacturer, may come in different “cohesiveness” or thickness of the silicone gel which impacts how the implants feel
- FDA-approved for women 22 years of age or older
Saline Implants
- FIlled with a sterile salt water solution (saline) in the operating room after insertion
- Size can be adjusted during surgery
- If rupture occurs, your body rapidly absorbs the sterile saline causing implant deflation (think flat tire)
- FDA-approved for women 18 years of age or older
Volume
Implant volumes range from roughly 100-800cc (ml). In general, the bigger the implant volume the bigger the augmentation. That being said, every person’s body frame is different and a given implant volume on one person may look dramatically smaller or larger on someone else. It is for this reason that implant sizing must be tailored to each individual. At the time of your consultation Dr. Gougoutas will review your anatomy with you to determine the best range of volumes for your frame.
Projection
In general, every implant comes in a range of so-called “projections”. Imagine taking any implant (say 300cc), setting it on a flat surface and then viewing it from the side. The higher the projection of the implant the taller the implant is (the more the implant sticks up from the table). As a generalization, the higher the implant projection the more “artificial” the augmentation appears.
Texture
Implants come in two different textures: “smooth” or “textured”, each of which refers to the feel of the implant surface. A smooth implant surface is just that, smooth. Like glass. A textured implant on the other hand has a rougher surface, like a very fine sandpaper. There has been much recent debate about the long-term safety of textured implants, and their popularity in the United States has dropped off significantly because of this.
Shape
Depending on the manufacturer, implants are available in two fundamental shapes: round and tear-dropped. While not all round implants are textured, all tear-dropped implants are textured. It is because of this that the popularity of tear-dropped implants has diminished significantly in the United States. At the time of your consultation Dr. Gougoutas will review the different shape options with you to determine which will give you the results you seek.
The Breast Augmentation Process
Consultation
At the time of your consultation, Dr. Gougoutas will review the various types of breast implants with you and make size recommendations based on your anatomy. While you make the ultimate decision regarding your implants, it is important to understand that only a relatively small range of implant sizes is appropriate for a given person. Dr. Gougoutas will walk you through the sizing process and facilitate the selection of implants that will give you the results you seek.
During the Procedure
Breast augmentation is typically performed as an outpatient procedure with deep sedation or general anesthesia. The procedure typically takes roughly an hour-and-a-half to complete, depending on your specific procedure.
Recovery
After surgery, you will likely be advised to wear a snug-fitting bra for several weeks to aid with swelling and discomfort. Most swelling will subside by 3 weeks, but may not completely go away until after a few months. There will be some simple activity restrictions after surgery which will be reviewed with you prior to your procedure.
Q. What is a composite breast augmentation?
A. A composite breast augmentation combines augmentation with an implant and one’s own fat (fat grafting). This type of augmentation is often performed for those patients who wish to have their implants placed above the push-up muscle of the chest wall (pectoralis major). Dr. Gougoutas will discuss the benefits of this type of augmentation with you at the time of your consultation and determine if you are a candidate.
Q. Will my implants be placed above or below the muscle?
A. Breast implants may be placed either above or below the pushup muscle of the chest wall (pectoralis muscle). This decision is based on the amount of existing tissue thickness one has to conceal, or hide the upper part of the implant. For thinner patients with little tissue to conceal the implant, either placing the implant under the muscle or performing a composite augmentation will be recommended. Those patients with adequate tissue to conceal the upper part of the implant can either have the implants placed above or below the muscle. Dr. Gougoutas will review these options with you at the time of your consultation and determine which option is best suited to your anatomy.
Q. Will I need a lift at the time of my augmentation?
A. A breast augmentation must be individualized to each patient. If you have significant droopiness (ptosis) of the breasts and / or nipple/ areola then a breast lift may be recommended at the time of your augmentation, or in extreme cases, as a separate procedure prior to your augmentation. Dr. Gougoutas will make this determination at the time of your consultation.
Q. Where are the incisions made?
A. The vast majority of breast augmentations are performed through a 4-5 cm incision that is well concealed under your breast (inframammary). In certain cases, an augmentation can be performed through a small incision around the areola (periareolar).
Q. How long will my breast implants last?
A. A breast implant is a “device”, albeit not a very sophisticated one. Like most devices, breast implants will likely need to be replaced at some point. While many women have their implants replaced between 10 and 15 years after their insertion, most surgeons agree that it is not necessary to replace your implants until a problem occurs.
Q. Is there any required maintenance with breast implants?
A. When a saline implant leaks, the sterile salt water is absorbed by your body very quickly and the loss of volume is usually immediately apparent. Because the silicone in modern implants is a cohesive gel (think pulling a gummy bear in half), the silicone does not “spill out”. Because of this, a leak in a silicone implant may not be noticeable.The FDA recommends periodic imaging of your silicone implants (with either ultrasound or MRI) to evaluate any leak. This is usually done three years after the insertion of your implants, and every two years thereafter.