Patient Choices in Breast Augmentation

Posted Tuesday, January 8, 2008 to PATIENT STORIES > Breast

Posted by Kathy@mk2lv.com

Breast augmentation surgery is one of the most common procedures performed by our practice.  Hundreds of women come into the office each year with the same request, “I’d like to be bigger.”  There are many reasons for this including poor self image, inability to find appropriately fitting clothing, and simply seeking “ideal” female proportions.  Contrary to the feelings of ultra-conservatives and purists who oppose cosmetic procedures, the majority of these women are not vain beauty queens seeking future employment as topless dancers.  They are often professional ladies simply seeking a more feminine look.  Since breast augmentation appeals to thousands of ladies each year, it seems a good idea for us to educate you as to the options you have.

The first choice women must make concerns the implant itself.  Currently, implants are either saline filled or silicone filled.  As you would expect, there are advantages and disadvantages to both.  Saline implants are less expensive and the exact filling volumes can be adjusted to compensate for different sized breasts.  In the event that they are traumatized in any way, they will simply leak saline  (water balanced with a little salt).  This is rapidly absorbed into the body without any harmful effects, except for the fact that the implant is now deflated.  The disadvantages to saline include rippling of the implant which may be visible through the skin, sloshing noises, and an “unnatural” feel if placed above the muscle (more on that later).  Since most implants are placed under the muscle and slightly overfilled, these disadvantages are rarely noted by the majority of patients.  While saline is probably the most popular choice among our patients, silicone is an option that should not be overlooked.  Since the FDA has re-approved their usage in women who are more than 21 years old, silicone is making a comeback.  Contrary to previous concerns, silicone has now been shown to be safe and without total-body side effects if leakage occurs.  All reports of joint issues, chronic fatigue, and generalized body pain previously associated with silicone implants have been disproven by scientific studies.  Also, silicone implants are now cohesive gels.  This means that if the implant covering is ruptured, the silicone stays together as one unit (like Jell-O) and does not ooze into other parts of the breast or body.  The advantages of silicone implants are that they have a more “natural” feeling and possibly a less chance of rippling when placed.  Their disadvantages include higher costs and a small increase in the frequency of capsular contracture (scar tissue which makes the breast firm and may distort the breast shape).   As you can tell, there are advantages and disadvantages to both and the choice of implant material is entirely up to you.

The second choice women must make is what incision will be used to place the implant.  Implants can be placed through incisions in the areola (the dark circular skin around the nipple), under the breast in the inframammary fold, through the axilla (armpit), and through the umbilicus (belly-button).  In our practice, we offer all incisions except for the umbilical incision.  Because we feel that the umbilical approach provides inferior control of the inframammary fold (if this is gone, then the implant can “fall” into the abdomen and the breast will drop) and makes the control of bleeding almost impossible, we believe this incision leads to more complications and therefore we simply do not offer it.  All other incisional choices are up to the patient.  Many patients feel that incisions under the breast in the fold are optimal because they are hardly ever seen.  Others prefer incisions through the areola because they feel that the scar will “blend in” with the skin better.  This incision seems to look better on patients with darker skin.  The axillary incision is nice in that it keeps all scars completely off the breast and tends to blend nicely with skin creases in the area.  All three choices that we offer result in excellent cosmetic results.  In the end, the patient can decide which incision they desire 5 minutes prior to their operation and we will happily comply. 

The third choice women must make with their surgeon is where the implant will be placed.  The choices include above the pectoralis muscle (and directly under the breast tissue itself) or below the pectoralis muscle.  If saline is the type of implant chosen, we generally feel that the implant should be placed under the muscle.  This results in more of your body covering the implant which decreases wrinkling and feels more natural.  Placement under the muscle however does not “lift” the breast if that is desired.  For women who desire mild lifting of the breast without a formal lift procedure, implants may be placed above the muscle and under the breast tissue.  In this situation, we feel that because less of one’s body is covering the implant, silicone is likely the better choice since it will wrinkle less and feels more like normal breast tissue.  One thing that all women must seriously consider is the fact that breast augmentation is simply that. It is not a procedure meant to replace a breast lift.  Many women (particularly after having children) desire both augmentation and a lift.  Simply placing the implants over the muscle is unlikely to fix the drooping associated with pregnancy, breast-feeding, and weight gain.

The fourth, last, and most difficult choice women must make when seeking breast augmentation is the size of the implant. The most common nationwide complaint women have after augmentation is that they wish they had chosen a larger size. At our office, we carefully measure the breast and based on these measurements we explain the implant size choices that will look the best on the patient.  We then allow the patient to try on a special bra with those implants in order to find the perfect look.  This can be done with your significant other, with a friend/family member you trust, or simply with our staff as many times as you need until you find the perfect look.  We find that allowing you to pick your implant size results in a happy postoperative outcome.   At our practice, you will never be encouraged to choose a larger size in order to avoid a formal breast lift.  And, we certainly would never place a larger size without your total agreement and consent.

As you can now tell, women have many choices to make when seeking breast augmentation.  Breast augmentation is not as simple as, “I want larger breasts.”  This procedure is always “life-enhancing” and in many women may be truly “life-changing.”  We want you to understand what choices are available to you and make those that will result in your optimal happiness with the procedure.  When choosing a surgeon, look for a surgeon who offers you these choices and ultimately allows you to choose the type of implant, incision, placement location, and size that will make you the women you desire to be.   By doing this, you can be sure that you have made the best choices for your needs and therefore will reap all of the wonderful benefits of breast augmentation.

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