Article: Cosmetic
Breast SurgeryRamsey J. Choucair, M.D.
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COSMETIC BREAST SURGERY
Many women are in search of an improved breast appearance. It may be
unhappiness due to an inadequate breast size, atrophy or sagging due to
pregnancy, or simply age-related loss of skin tone. Today some women
choose to do something about their undesirable breast appearance.
Breast augmentation and/or breast lifts are increasingly popular
procedures that reliably and safely change breast shape and size.
BREAST AUGMENTATION
Successful breast augmentation begins with clear communication between
the patient and surgeon. There are multiple options available.
Experienced, board certified plastic surgeons will review these choices
with you and then, based on your goals and expectations, determine the
best approach to reshape your breast.
THE INCISION
There are three common incision sites. These include an incision on the
lower portion of the breast, just about the crease where the breast
touches the chest (inframammary). A second option places the incision
along the edge of the areola (junction of the darker pink skin and the
lighter skin of the breast). Finally, an incision along the axilla
(armpit) can be used for breast augmentation. Experienced surgeons are
able to successfully perform breast augmentation through any of these
approaches and will help guide you to the incision best suited for you.
IMPLANT LOCATION
Should the breast implant be placed on top of or beneath the chest
(pectoralis) muscle? Advantages of subpectoral (beneath the muscle)
implant placement include:
1.diminished risk of implant visibility (rippling or wrinkling)
2.mammograms more easily interpreted
3.diminished capsular contracture rate
(scar tissue that makes the breasts feel hard
Breast implants placed above the muscle may be recommended if existing
breast tissue is of adequate thickness to camouflage the implant edges
so that rippling or wrinkling is not visible. A slightly abbreviated
convalescence is noted when implants are placed above the muscle since
the pectoralis muscle (chest muscle) is not released.
THE IMPLANT
Deciding upon the implant type can be confusing and controversial.
First of all, most breast implants used today are saline-filled
implants (silicone rubber envelope filled with saline). Only patients
who fit specific FDA criteria may elect (after a lengthy informed
consent) to have silicone gel implants placed by surgeons who are
enrolled in the FDA study protocol. Therefore our discussion is
essentially focused on saline breast implants.
SMOOTH IMPLANTS
These saline implants have a slick or smooth surface that allows the
implant to glide within the tissue. These implants tend to be more
mobile—leading some patients and physicians to believe they are “more
natural.”
TEXTURED IMPLANTS
Textured implants have a fuzzy or “rough” surface character. The
implant does not move freely. The texturing process requires a thicker
implant shell and therefore a firmer feel to the breast.
The choice between smooth or textured (rough surface) implants is often
confusing. Although textured implants may diminish the risk of capsular
contracture (firmness or hardess of the breast, the medical literature
is unclear. Therefore implant choice is determined by the patient’s
desired appearance and the surgeon’s ability to reach this goal.
IMPLANT SHAPE
Smooth implants only come in round shapes. Because the implant moves in
the pocket, maintaining a specified geometric shape is not possible.
However, textured implants are available in round or teardrop
(contoured) configurations. Patients must first decide whether they
desire the characteristics associated with textured surface implants.
Then a patient may choose between round or teardrop-shaped implants.
The tear drop implant may diminish the bulging in the upper portion of
the breast, but in reality the breast implant itself has less to do
with the ultimate shape and appearance of the breast than other
variables already mentioned.
SIZE
The final size and shape of an augmented breast depends upon the
original breast size plus the selected implant volume. The selected
implant volume (size) requires careful assessment of several factors,
including chest wall dimension, skin elasticity, existing breast ptosis
(drooping) and of course, the patient’s desired size. The implant
selection process is facilitated with review of appropriate
before-and-after photographs in addition to the use of implant samples
placed inside a bra to provide an estimate of future breast size.
SPECIFICS OF SURGERY
Breast augmentation is done as an outpatient procedure in a certified
surgical facility under general anesthesia. Most patients are away from
normal work activities for three to five days and begin low-impact
aerobics in two to three weeks. Upper-body weight lifting or other
high-impact activities require six weeks for complete recovery.
Bruising is often minimal and swimwear can often be worn within seven
to ten days following surgery.
WHAT ABOUT BREAST LIFTS
A breast lift is performed when skin and breast tissue droops. In very
mild ptosis (drooping), breast augmentation may be adequate to fill out
the loose skin and eliminate the need for lifting incisions. However,
if more severe drooping (ptosis) is present, removal of skin may be
necessary in the lower portion of the breast. A combined beast lift
with augmentation may be done to provide the most cosmetically
appealing breast rejuvenation.
YOUR SURGEON
The single most important factor in successful cosmetic breast surgery
is the surgeon you choose. An experienced surgeon, specializing in
cosmetic surgery and certified by the American Board of Plastic
Surgery, is a legitimate start in your search for an improved breast
appearance.
Breast augmentation is an increasingly popular procedure that reliably
and safely changes breast shape and size. Additionally, many women
experience an improved body image with better proportions, allowing
clothes to fit better. For those whose soul-searching leads them to
cosmetic surgery, call 214-754-9001 for your complimentary consultation
or informational brochure.
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