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BREAST AUGMENTATION & BREAST IMPLANTS

 

BREAST AUGMENTATION / BREAST IMPLANTS

Breast augmentation utilizes FDA approved silicone or saline breast implants to enhance the shape and size of the breasts. Breast Augmentation is performed by placing breast implants under the muscle through a small incision made through the areola, through the armpit, under the fold of the breast or through the belly button. Utilizing the most advanced techniques, Dr. Smiley is an experts in the field, creating natural looking and feeling breasts. Breast augmentation (also known popularly as a "boob job") is sometimes performed alongside a breast lift to achieve the best results.

 

ABOUT BREAST AUGMENTATION

Breast augmentation is a surgical procedure performed to enhance the size and shape of a woman's breasts for a more aesthetically pleasing contour. Some of the most popular requests for breast augmentation include: increasing breast size for better proportion, correcting breast asymmetries and restoring volume and fullness to the breasts after weight loss, pregnancy or aging. Breast augmentation is also commonly known as a breast enhancement, breast enlargement, boob job or breast job.


PLANNING & PREPARING FOR BREAST AUGMENTATION

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  • WHAT TAKES PLACE DURING MY BREAST AUGMENTATION SURGERY?

Breast augmentation is performed by making a small incision in one of four locations: around the areola, under the fold of the breast, inside the armpit or inside the belly button. The most common incision site is around the areola because it provides direct access to the breast, provides a natural border to disguise scars and can be reused for any future breast surgeries (i.e. future breast augmentations or breast lifts).

A pocket is then made under the muscle and a sizer is used to ensure that the implant size selected is to the satisfaction of Dr. Smiley based upon the desires of the patient. Either a saline or silicone implant is carefully set into place and the layers of the breast tissue are closed. Saline implants are filled with sterile salt water while in the breast, while silicone implants come pre-filled.

In rare instances, breast implants are placed above the muscle; however breast augmentation under the muscle provides a more natural look and feel, a decreased risk of infection and a decreased risk of capsular contracture.

Breast augmentation is performed under general anesthesia and generally takes about 1-2 hours in the operating room.

  • BREAST IMPLANT OPTIONS: SILICONE VS. SALINE IMPLANTS

Both implants consist of a solid silicone shell. Saline implants are filled sterile salt water intraoperatively, while silicone implants come pre-filled with a cohesive silicone gel. Both silicone and saline breast implants are FDA approved and safe for use for both cosmetic and reconstructive purposes. They both have the same rupture rate and neither have been linked to any form of cancer or autoimmune disease. Although you will achieve a natural looking result from either implant, silicone implants more closely mimic natural breast tissue and therefore tend to feel more natural.

  • PREPARING FOR BREAST AUGMENTATION

Education is an important part of the surgical process. Before breast augmentation, it is important to discuss all of your questions with Dr. Smiley including: your goals, realistic expectations, downtime and recovery tips. You will be required to complete a pre-op appointment prior to surgery. At this appointment you will discuss any additional questions, go over paperwork and complete your lab work. You will receive specific pre- and post-op instructions for your breast augmentation. Be sure to follow these instructions carefully to ensure optimal results. It is also important to avoid any type of blood thinners for a minimum of 2 weeks before surgery (i.e. aspirin, vitamin E, ginko biloba, fish oils, etc) and avoid smoking for a minimum of 1 month before surgery.

  • BREAST AUGMENTATION RECOVERY

Immediate recovery from breast augmentation requires only a few days of downtime. You will need a responsible adult to pick you up from surgery and care for you for the first 24 hours. You will experience soreness, but this can be relieved with prescribed medication. Be sure to take it easy - no heavy lifting, cleaning, exercising, driving or lifting your hands over your head. Most patients are able to return to work within a week, although it is important to avoid strenuous activity for 4-6 weeks. It is important that you return for all of your post-op appointments and communicate with your surgeon with any questions or concerns.

Initially breast implants are high on the chest wall immediately following breast augmentation, but drop into place after the first month or two. You will be required to wear a sports bra that zips in the front for a minimum of 4 weeks after surgery. After a week, Dr. Smiley will demonstrate how to perform breast augmentation massage to break up fibrous tissue to prevent capsular contracture and to help drop the implants into place. Although breast augmentation scars are generally discrete, we recommend the use of scar cream beginning 2 weeks after surgery.


BEFORE / AFTER

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BREAST AUGMENTATION RISKS

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  • GENERAL RISKS ASSOCIATED WITH BREAST AUGMENTATION

As with any type of surgery, it is important to be aware of the risks associated with breast augmentation. Swelling, bruising, light bleeding and changes in sensation are all normal parts of the healing process. In rare cases, excessive bleeding or fluid collection may occur and additional surgery may be required.

All precautions are taken to avoid infection including: upholding the highest standards for sterilization and providing antibiotics during and after the procedure; however, if infection occurs, patient may be placed on stronger antibiotics or may require removal of the implant(s) for a period of a few months. This is extremely rare. In order to prevent breast augmentation complications it is important to follow Dr. Smiley’s instructions. Do not "over do it" after surgery. No cleaning, exercise, dancing, etc. Do not take blood thinners, drink alcohol or smoke cigarettes. Smoking greatly impairs your ability to heal and can lead to more serious complications including poor wound healing, bleeding, infection and skin necrosis.


  • CAPSULAR CONTRACTURE – HARDENING OF BREASTS(S)

After breast augmentation, your body will form a fibrous tissue around the implant called a capsule. This is the body's natural response to a foreign object placed in the body. In some cases, excess tissue can form and tighten around the implant. This is a condition known as capsular contracture. There are different levels of capsular contracture and are rated on a scale from 1-4. Mild cases of capsular contracture after breast augmentation do not require any correction, while severe cases can cause discomfort and distortion of the implant. In this case additional surgery may be necessary to correct the condition. The risk of capsular contracture is decreased by placing the implant under the muscle and performing breast augmentation massage beginning one week after surgery.


  • BREAST IMPLANT RUPTURE – LEAKING IMPLANTS

Both saline and silicone implants are FDA approved and proven safe and effective for breast augmentation. Although breast implants are very durable, they are medical devices and can rupture. Studies have shown that no implant is more likely to rupture than the other. In the event of a rupture, saline implants will deflate and the sterile salt water will be safely absorbed by the body. This can happen over the course of a few days or a few months depending on the nature of the rupture. Silicone implants are more difficult to detect because they are made of a cohesive conform gel. In the event of a rupture the silicone will stay in place and may require an ultrasound to detect. Signs of a rupture include breast discomfort or distortion. Either way the implant, or shell of the implant, will need to be removed.



BREAST IMPLANTS FOR VERY SMALL BREASTS—COULD I STILL ACHIEVE GOOD RESULTS?

The actual breast implants sizes may have little to do with the post-op appearance since other variables such as the existing tissue or amount of “coverage,” the chest and breast measurement, the innate shape of the breast, the areola position, and even the torso all have their impact.

Breast augmentation surgery for very small breasts has its challenges, although acknowledging the anatomical limits is one way to achieve impressive results.

First and foremost, small breasts have insufficient coverage that makes them prone to visible rippling and more palpability, as suggested by celebrity Los Angeles plastic surgery expert Dr. Tarick Smiley. To minimize such risks, he says that smaller implants are highly ideal for small-breasted women.

Smaller or conservative-sized implants are less likely to cause scalloping, rippling, and other telltale signs of surgery because the overlying skin and breast tissue is not overstretched, Dr. Smiley adds.

Aside from the actual size of implants, which is determined by cubic centimeter (cc), the leading plastic surgeon says their profile or forward projection, width, and base should also match the preoperative measurement of the breast and chest.

By acknowledging the anatomies and their limitations, Dr. Smiley says it would be easier to achieve natural results from breast augmentation or any type of body contouring surgery.

To further minimize the risk of unfavorable waviness and palpability, he highlights the importance of using submuscular, which is also referred to as subpectoral implant placement. The idea is to increase soft tissue coverage by positioning the upper half of the prosthesis beneath the pec muscle.

The opposite of submuscular is the subglandular in which the implants are placed above the muscle, only covered by the tissue and skin. For patients with sufficient coverage this could provide good results, but for small-breasted women and female body-builders this could spell trouble.

Aside from increasing soft tissue coverage, Dr. Smiley says the submuscular also provides more natural results by making the breasts appear more like a teardrop rather than too round (especially in the upper cleavage), which is a dead giveaway that an implant is underneath the skin.

Women with very small breasts are also generally advised to choose silicone implants whose cohesive filler material can make up for their lack of coverage. Saline implants, meanwhile, could make them susceptible to less natural results, too rounded appearance, more palpability, and rippling, Dr. Smiley warns.

But one downside of using silicone implants is the longer incision than saline implants (2 cm vs. 3.2-4 cm) because they are implanted “intact.” On the other hand, saline implants are only inflated with salt water solution once in position, so the resulting scars are shorter.

Nevertheless, the use of Keller Funnel technique in which a funnel-like device is used to propel silicone implants to their pocket is an effective way to reduce the length of incision by almost half, so the resulting scar is almost like that of a saline implant’s.


 
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