BREAST AUGMENTATION
For Size Enhancement and Minimal Lift

 Background
 Patient Groups
 Patient Concerns and Planning
 Preparing for Surgery
 The Operation
 Recovery
 At Home
 Office Visits and Follow-up
 Outcome and Complications
 Case Histories (Before and After)

PATIENT CONCERNS AND PLANNING
As a surgeon gains greater experience with breast enlargement surgery it clear that the operation is not routine, and the patient population is as varied as with any area of Plastic Surgery. The prospective woman seeking this surgery is in search of a long-lasting, natural, soft result, and in many cases would like to exceed a size commensurate with her frame. Women in this category have a particular focus on their physical appearance and may feel less feminine with smaller breasts. The best candidates are those who want the operation as something they are doing for themselves and have considered it quite a long time. They will have the highest satisfaction rate compared to someone who is trying to please significant others, or somehow feel the operation will improve lead to more attention and a life change. The average age of patients undergoing the operation is 25 to 45 years.


A patient will ordinarily be concerned about breast shape and breast size. The surgeon must listen carefully in order to best meet expectations after surgery. A hesitation by the patient pausing to remind the surgeon not to go too large may be a reflection of modesty. This must this must be explored to help the patient overcome any embarrassment over the subject, since misconceptions about why the patient is there, to have large breasts, can result in disappointment in the postoperative period. The patient is placed in two bras, one of a moderately large cup, and a bra with a smaller cup is placed over that. Our preference is to insert implants to a volume and size that is preferred by the patient while wearing the double bras. The smaller bra on top simulates the compression by the pectoral muscles, and seems to correlate beautifully with the postoperative look in a bra following surgery. This Practice places all implants behind the muscles due to the distinct advantages of this method following many years of experience. A natural and soft result similar to full natural breasts can be achieved with new methods of breast pocket development and internal tailoring performed at the time of implant insertion. Saline implants in the moderate projecting round smooth-shell design, have been compared with anatomic and tear-drop styles. The results i9n patients and on x-ray examination finds that the round implants look tear-shaped over time, but give better upper breast enhancement. The texture-surface implant shells while initially produced as a hedge against implant firmness have not proven to work in this way, but instead the texture might lead to a shortened life of the implant shell. Final data on these issues is being studied.


Augmented breasts that look and feel natural and leave no telltale scars are the next most important issues for patients. It is important to discuss advantages and disadvantages of implant shapes and styles, saline versus silicone, and how each may look on a particular frame. The use of photographs of case histories is important to properly inform the patient how their breasts may look once augmented and how they may compare to some ideal shape provided by a picture of a model or celebrity. Patients who display mild forms of breast sag and slope to their small breasts (described as minimal ptosis, moderate ptosis, pseudoptosis, and glandular ptosis) (See Classification of Ptosis under Breast Lift (Mastopexy)) may expect to have a result with a bit more slope of the breasts rather than the highest firmest look expected when the breasts are small but firm before surgery.


Sensation ordinarily is unimpaired by breast augmentation. With large implants, following difficult secondary breast procedures, or use of sharp methods of pocket creation, the incidence of diminished sensation may be a bit higher. Rarely there can be a temporary neuralgia of one of several tiny nerve branches that innervate the skin of the breast, areola, and nipple, but usually resolves in a few weeks. At first the breasts may appear to have diminished sensation but this rapidly improves 2 weeks following surgery. Sometimes the skin just below the areolae can be less sensitive for a while. For patients who develop the rare painful breast there are agents based on the medication Neurontin and others which can be quite helpful over a period of a few weeks to a few months. These agents are used in patients with pain disorders, and for the short-lived and rare episodes of nerve discomfort from breast operations, they can be highly affective.


It is best to remind a woman seeking breast augmentation that breast surveillance is important since breast cancer can occur in as many as 1 in 9 women. Patients with high risk of breast cancer by family history, or who may have had breast lumps from time to time, must be screened by physical examination, ultrasound, and even mammography, prior to consideration for surgery. Special breast compression mammograms have been available for many years to best image breasts containing prosthetic devices. Implants have no association with an increased risk of developing breast cancer, nor is the stage at diagnosis delayed due to late recognition of a breast lump. Several long terms studies following patients with breast implants revealed their incidence of breast cancer was the same as the general population, although the Los Angeles study of over 33000 women with breast implants demonstrated a slight decrease in the normal onset of breast cancer by a few percentage points.


Breast feeding following breast implantation should not be impaired, although there may be a slight decrease by 15% when periareolar incisions for placement are used, or when the implants are placed behind the breasts and above the muscles. Following pregnancy, breast augmentation should be deferred until milk has production has dried up, and some gynecologists feel that this may be 6 weeks to 2 months, although some authorities recommend waiting up to 6 months.