Breast Augmentation

Over 300,000 breast augmentation procedures are performed by plastic surgeons each year and that number continues to grow. With so many breast implant options and variations available the decision process can be a bit overwhelming for patients. Dr. Raj leads his patients every step of the way, from the initial consultation through the procedure and into recovery. Breast augmentation surgery, as with any kind of surgery, has risks and complications, so it’s a good idea to ask questions. With modern surgical and recovery techniques patients can be on their feet in as little as 24-hours with some minor restrictions.

What is Breast Augmentation?

Surgical breast augmentation, also frequently referred to as breast implant surgery, is the most common type of cosmetic surgery. This procedure utilizes either artificial breast implants or fat grafts to alter the shape, size and/or texture of a patient’s breasts.

Who is a good candidate for breast implants?

Ideally patients are in good mental and physical health and have a realistic expectation for plastic surgical outcomes. Patients breasts should be fully developed. Generally breast implants are recommended in cases where patients are dissatisfied with the size, shape, or texture of the breasts and other procedures such as breastlift alone aren’t adequate to give a desired result.

Options and Variations

Every patient is unique, from the texture and quality of their skin to their muscle tone and build. The popularity of breast implants has led to a wide variety of options and techniques. Some of these options are chosen by default based on the unique qualities of the patient – from skin texture and quality to muscle tone and build. Others require the patient, with guidance from Dr. Raj, to make choices in pursuit of the best result. The six major options for breast implants are:

Breast Implant Size

Most of the time patients consider their breast size in terms of cup sizes, but breast implant sizes are measured in discrete volumes (cubic centimeters or cc’s) and they do not necessarily correspond to bra sizes. This can be a common source of confusion for patients, as the same size implant in different patients may result in incredibly different outcomes.

How Big is Too Big?

There are two major factors that can limit the maximum size of breast implants. The maximum size of the surgical pocket is based on the body dimensions and tissues. Too large implants risk bottoming out or other abnormal movement, which can require revision surgery. Secondly, skin elasticity is important in determining the maximum size as skin will only stretch so much before tearing.

Implant Surface

Breast implants can be textured or smooth. While textured implants were designed around maintaining their position and reducing rippling in the skin, in practice they have been shown to be more likely to ripple than smooth implants due to their lack of mobility. Some patients have reported that textured implants tend to be stiffer, more uncomfortable and in some cases have been associated with a rare form of lymphoma called BIA-ALCL (breast implant associated anaplastic large cell lymphoma).

Smooth breast implants on the other hand move more freely beneath the skin. This leads to fewer intrinsic risks and potential negative outcomes, and to many patients can feel much more like what they expect natural breasts to feel like than textured implants. Smooth implants are also less likely to cause rippling under the skin.

Breast Implant Shape

Breast implants come in different shapes as well as sizes. The two most common shapes are round and teardrop shaped.

Round implants come in many sizes and options and are generally expected to lead to a fuller result and a rounder upper breast. These implants are divided by profiles, which determines how far forward the implants will project from the chest while standing. Generally, patients choose between low, medium, and high-profile round implants to achieve the desired result.

Teardrop shaped implants are designed to look and feel more natural overall, with a flatter upper breast and fuller, rounder bottom half. These implants are usually textured, firmer and are constructed with semi-solid gel, such as Gummy Bear Implants, to make them stable and maintain their shape. Their asymmetry can be problematic if the implant shifts – which means that frequently these types of implants are also textured.

Various studies have shown that the shape of the implant alone is not a good indicator for the final result. The eventual shape is mostly determined by the plane (subpectoral or subglandular) and position of the implant placement.

Breast Implant Position

Breast implants are either placed under the breast tissue (subglandular pocket) or beneath the pectoralis major muscle (subpectoral pocket).
Subglandular placement is technically less demanding and results in less post-operative pain but there is a greater risk of skin rippling or the development of scar tissue around the implant which can lead to the breast and implant feeling hard to the touch, as well as changing the shape or appearance in undesirable ways.

Placement in a subpectoral or submuscular pocket has more potential for pain and discomfort in the early stages, but as a tradeoff provides a natural, longer-lasting shape with a significantly lower risk of rippling or stiffening. As with any cosmetic surgery, there are risks – the one most frequently associated with submuscular implantation is displacement of the implant via a muscular contraction, which is why this method may not be recommended for athletes and those who weight train.

Location of Incision

There are multiple options when choosing where to place the incision for breast augmentation:

UNDERNEATH THE FOLD OF THE BREAST – INFRAMAMMARY

This is the most common incision used and it gives the best visualization of the pocket for ease of placement. It is a very safe and predictable approach that allows any type of implant to be placed in either pocket. Dr. Raj places the incision in a well-hidden spot and utilizes a technique designed towards minimizing the length of the incision without risking damaging the implant on insertion and placement.

BENEATH OR AROUND THE NIPPLE – PERIAREOLAR

This incision allows a surgeon to place in any type of implant directly through the nipple. While this incision location is intended to reduce visible scarring by blending the scar with the areola, sometimes the scar can be conspicuous, and its placement makes it difficult to hide. There is a greater risk of infection due to exposure of the implant to breast tissue, as well as a higher incidence of capsular contracture with this approach. There is also a risk of damage to the implant since this incision is much smaller.

AXILLARY (ARMPIT) INCISION

An axillary incision is designed to leave no visible scarring on the breast, but it limits the size and type of implants which can be used. The small incision increases the risk of damaging the implant or placing the implant incorrectly with this approach which for many patients outweighs the benefit.

What are the different types of breast implants?

Most breast implants fall into one of two general categories, saline or silicone, with some variations on the theme.

  • Saline Implants are filled with sterile salt water. They are inserted into the breast cavity while empty,
    properly positioned, and then filled with the correct volume of saline solution. Due to smaller incisions
    required to insert them, the scars from saline breast implants are decidedly smaller than scars from silicone
    implants.

    • Pros
      • Lower Cost
        • Saline implants can cost half as much or more less than Silicone
      • Smaller Incision
        • Saline implants require only a small incision, therefore result in less scarring
      • In Case of Rupture
        • Saline implants are absorbed by the body if they break.
    • Cons
      • Saline Implants can rupture and leak
        • This will generally cause a noticeable change in the shape and size of the
          breast.
        • Saline implants tend to drain and be absorbed by the body quickly and safely,
          however the silicone shell may need to be surgically removed.
      • May cause rippling in cases with thin skin
  • Standard Silicone Implants are filled with a silicone gel which can result in a more natural feel and a longer
    time between maintenance visits.

    • Pros
      • Reputation for more natural look and feel
        • Silicone mimics the properties and cohesion of body fat, creating a realistic feeling.
      • Less Rippling
        • This can be especially beneficial in patients with little breast tissue with which to
          cover the implant
      • More Options
        • Highly Cohesive Silicone implants, or Gummy bear implants are a fuller implant which
          maintains shape and density.
      • Longer Average Life Span
        • Standard Silicone Implants are designed to last about 15 years.
    • Cons
      • Bigger incisions, bigger scars
        • Silicone implants are pre-filled with silicone gel, requiring longer incisions
          for insertion. This increases the potential for scarring.
      • Difficult to detect breakage
        • Silicone breast implants leak more slowly, and the silicone can become trapped
          within the scar tissue surrounding the implant.
      • Higher Price
        • Silicone implants frequently cost around $1000 more than saline implants.
  • Highly Cohesive Silicone (Gummy Bear Implants) are a popular choice when there is little available tissue
    surrounding the implant, as is the case with mastectomy patients. The implants help to define and maintain the
    shape of the upper and lower spheres of the breast and prevent rippling of the skin.

    • Pros
      • More with Less
        • Patients with less breast tissue can achieve excellent results without the usual risks
          of caving or rippling associated with reconstructive augmentation
      • Durability
        • Aside from cases with rarer complications, gummy bear implants can last up to 20 years.
    • Cons
      • Scarring
        • These more solid silicone implants require a much larger incision for safe
          insertion, leading to potential for larger scars
      • More expensive
        • Gummy Bear implants can cost double or more that of saline implants

The Initial Consultation

During the initial consultation patients will meet with Dr. Raj and his staff, and a thorough medical history and physical will be conducted to ensure that the patient might safely undergo plastic surgery. Dr. Raj and the patient will then discuss desired outcomes and look at any reference materials which the patient has brought to gain a thorough understanding of what the patient is trying to achieve with cosmetic surgery. Dr. Raj will then utilize imaging technology and examine the patient to determine which options are available and if the patient is a candidate for breast implants.

The findings of these measurements and examinations can help Dr. Raj to determine a range of implant sizes and types which might work. The patient is then given an opportunity to evaluate those sizes in a breast sizing kit to determine which of the options is closest to their desired result. By the end of the initial consultation the patient should have their questions about the procedure answered and Dr. Raj will design an individualized surgical plan.

Before the procedure

Instructions for pre-surgical care will be provided by Dr. Raj prior to surgery based on the patient’s individualized surgical plan. Instructions are provided on preparing for the surgery and patients are made aware of any possible complications, as well as information to help them prepare logistically for the recovery process.

The day of the procedure

In order to maintain the highest standards of safety and patient care, all surgical appointments take place at an accredited surgery center, where patients will be greeted by staff to help them prepare for their procedure. Prior to the procedure Dr. Raj will perform a marking and discuss the details of surgery in the pre-operative holding area. This provides a final opportunity for Dr. Raj to answer any questions before the patient is placed under anesthesia and the surgery commences in an operating room.

The Procedure

Breast augmentation is one of the most common procedures performed by a plastic surgeon. Breast implant surgery is performed in an operating room under general anesthesia as an outpatient procedure for patient comfort and safety. During the procedure:
An incision is made, and the breast pocket is carefully developed to fit the appropriately sized implant. The dissection is done in a manner to minimize post-operative pain, bleeding, and swelling.
Local anesthetic and antibiotic solution is instilled in the pocket to assist with pain control and reduce the risk of infection.
The implant is then carefully placed to prevent any contamination or disruption of the implant.
The positioning and sizing are confirmed before the incisions are meticulously closed.

In most cases the procedure takes about one hour, and you can generally resume normal activities within 24 hours.
Breast Fat Mammography, or Fat Transfer Breast Augmentation is a different procedure that some patients choose in order to achieve their desired results. Fat can be harvested or obtained from patients using liposuction and then specially prepared before undergoing reinjection into the breast. This procedure is also done in some cases as a supplement to breast implant surgery.

After the procedure

The patient will be taken to a post-anesthesia care unit for recovery before being discharged to home to follow their post-operative recovery plan. Dr. Raj has trained extensively in advanced breast augmentation techniques which allow for a speedier recovery and minimizes pain, swelling and discomfort after the surgery. There are no drains used for the procedure and the sutures will dissolve. It’s recommended that patients wear a support bra initially after surgery to allow the tissues to heal. Patients will be provided with an individualized post-treatment protocol consisting of recuperative massage and exercise techniques which can be performed after a few weeks from surgery.

How long does it take to recover from breast augmentation surgery?

Depending on the procedure and the individual recovery plan, patients may be able to resume normal activities in as little as 24 hours. After this initial stage it’s important to continue to take it easy and follow the recommended recovery protocol, which generally restricts strenuous activity and heavy lifting for up to 4 weeks.
Each patient is different, and some procedures may require additional time to heal. In most cases patients can return to work within 1-2 weeks at the latest.

Limitations, Risks, and Possible Complications of Breast Augmentation

All surgeries carry some risk including breast augmentation. The most common risks are bleeding, infection, and reactions to anesthesia. Although rare, some other risks include loss of sensation in the nipple or breast, capsular contracture (hard capsule or scar tissue around implant), implant rupture or leakage, and implant malposition. Some complications may lead to requiring revision surgery.

FAQ

Q: Which shape or type of breast implant looks more natural?
A: Every patient has their own personal definition when it comes to what looks and feels natural. These definitions can be heavily influenced by cultural and interpersonal factors. This is because there is a range of sizes, shapes, and textures that can be defined as normal when it comes to human bodies, and everyone’s “normal” falls somewhere along a spectrum. This also means that there is no one-size fits all solution. This is one reason why breast augmentation has so many different options and varieties and why the pre-surgical consultation can be the most important part of the process.
Q: What is Capsular Contracture?
A: Capsular contracture is the most common risk of breast implant surgery. This occurs when the body builds painful and very hard scar tissue around the implant. This condition can create an abnormal appearance. If any implant-related complications occur, another surgery may be required to fix the appearance of the breasts and the implants.
Q: How long do breast implants last?
A: It is a commonly held belief that implants need to be changed every so often. The honest answer is it really depends. Some patients can live with the same set of implants for 20 or 30 years. Other women may need to change the implants sooner than that. The important thing to remember is that implants aren’t permanent. As the implants get older, they may weaken or rupture but there is no way to predict if or when this will happen.

Real Facts: In a patient that has had breast augmentation, it is normal for them to undergo another surgery to remove or replace the implants in their lifetime.

Why choose Dr. Raja Mohan?

Patients choose Dr. Raj for a variety of reasons. He trains and studies with the best in the industry as a peer and leader, and this commitment means that his patients are always able to benefit from advancements at the cutting edge of science and surgery.
He is knowledgeable and personable and is known for both candor and compassion. He really cares about his patients and it shows, both in how he interacts with them as well as in the quality of patient care he provides.
Ultimately, all roads end with the outcomes, and the reason most people choose Dr. Raj is because he delivers results that speak for themselves.

Schedule a Consultation

If you want to learn more about breast augmentation surgery please call (469) 301-1725 to schedule a consultation with Dr. Raj Mohan, board certified plastic surgeon serving the Dallas-Fort Worth Metroplex. He operates in Arlington, Grapevine, Southlake, Dallas, Plano, Frisco, Irving, and Coppell.