Breast Augmentation (Augmentation Mammaplasty)

Implants have been used for decades to enhance the bust for larger, shapelier, or more symmetric breasts. Breast augmentation is highly customizable and patient specific with the ability to choose incision placement, implant material, and a number of other features.

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Overview

According to the latest study by the American Society of Plastic Surgeons, breast augmentation surgery is the number one most popular cosmetic procedure in the country, with over 300,000 procedures performed in the United States in 2017 alone. Breast augmentations can be reconstructive or cosmetic, and the reasons that patients might choose to have the surgery are wide-ranging and variable.

For example, some of the reasons that patients might explore their options for breast enlargement include the need for breast reconstruction following a mastectomy for breast cancer, cosmetic improvement to achieve an asymmetrical breast size in otherwise healthy individuals, cosmetic breast repair after an injury, and for many other reasons. One of the most common reasons that patients choose to have a breast augmentation procedure is simply to increase the size of a naturally small bust, or to regain breast volume after losing breast tissue from weight loss, pregnancy, or to correct sagging breasts due to the natural aging process.

Breast augmentation procedures are not a one-size-fits-all operation, and much consideration must be given to customize the procedure to suit the individual needs and preferences of each patient. Patients that want to undergo a breast augmentation procedure must, therefore, meet with a plastic surgeon beforehand for an evaluation and a consultation. At this meeting, the doctor will determine what your options are for breast enlargement based on a variety of factors that include your body type, the natural shape of your breasts and skin type, your medical history, and your aesthetic goals. Your doctor will then give their own recommendations as to the type of procedure that will offer the best outcome, and the surgery procedure methods they are most comfortable using to achieve the best results for you.

While breast augmentation procedures are performed for a variety of reasons, and each one is tailored according to the unique and specific needs of each patient, the goal of most breast augmentation surgeries is the same. Breast augmentation is designed to enhance the fullness, volume, and proportional balance of the breasts, and to elevate the self-confidence of the patient with a more attractive appearance.

What Options Are There for Breast Augmentation?

There are two types of breast augmentations procedures: breast implant surgery, and fat transfers. Implant procedures utilize saline (sterile salt water), silicone, or gummy bear (silicone gel-filled) implants, which are slipped into a small incision to fill the breast with volume. More recently, a third type of implant has become available, known as the structured implant or more commonly, the “ideal implant”. The ideal implant features a silicone shell combined with an inner chamber filled with saline, and is thought to represent a blend of the best characteristics of silicone and saline implant materials. Incisions are most commonly made around the nipple, under the armpit, or on the inframammary fold (where the chest and the bottom of the breast meet). Navel insertion, while it might result in no visible scarring, is not usually recommended or practiced by surgeons as it can elevate the risk of complications.

Patients that choose implants will also decide on the characteristics of the implant: either round, textured, or smooth, and where they should be inserted—either above or beneath the pectoral muscle. This, along with the type of material chosen, the location of the incision, and other decisions, must be carefully considered, as each choice carries certain pros and cons. For example, silicone breast implants are thought to appear and feel the most natural, while saline implants are much easier to insert into a very small incision, which can mean a barely visible scar. Likewise, implants placed below the muscle are considered superior when it comes to looking and feeling more natural, while implants placed above the muscle are more noticeable, they are associated with a less painful and faster recovery.

Breast augmentation with autologous fat transplantation is another type of surgery option used to enlarge the breasts. This procedure uses fat grafted from other areas of the body (usually the stomach, hips, or thighs) through liposuction. The harvested fat is then prepared for injection into the breasts to add volume, enhance shape, and improve proportion.

While a fat transfer is generally safer and less complicated procedure for breast enhancement, the results are not as dramatic or striking as they are with implants. Instead, breast augmentation with fat transfer tends to offer more subtle and natural looking results, without the potential complications or the long-term maintenance requirements that can come with implants. In fact, many patients opt to have a fat transfer procedure done along with an implant procedure, to further define and enhance the results of their breast augmentation.

Who is the Ideal Candidate For Breast Augmentation Surgery?

First and foremost, a good candidate for breast augmentation should be in good health. Candidates should have recent check-ups and breast examinations done to eliminate the possibility of a breast or health condition that could interfere with your cosmetic surgery. Additionally, patients should be screened for possible allergies to the materials to be used in implant surgery, like silicone or saline, and any other allergies that might cause complications during or after your breast augmentation procedure.

Another important factor in determining the suitability of a patient for breast augmentation is age. Candidates who are younger than 18 years old should not have breast augmentation surgery and should wait until their breasts have fully developed and matured in order to avoid complications in the future.

Patients should also have realistic goals and expectations regarding surgery, and be capable of understanding the risks and potential complications that could occur with their choice of procedure. They should also be able to evaluate the options carefully and to consider the best course of action to take to achieve the most realistic outcome—based on their individual and unique circumstances.

Who is Not Recommended for Breast Augmentation Surgery?

Breast augmentation surgery is not recommended for patients that suffer from serious medical issues, like untreated breast cancer, certain heart conditions, and other illnesses. Patients who are pregnant or breastfeeding are not good candidates for breast augmentation, and those hoping to become pregnant should speak with their doctor to determine the best timing for their future augmentation surgery.

It is also important to note that patients with unrealistic expectations about breast enlargement are not recommended for surgery. Candidates interested in a breast enlargement procedure should consult with their doctor to learn about the potential risks and complications that could occur with each type of surgery. They should also understand what each procedure might entail as far as recovery and long-term maintenance, and how they can realistically expect their breasts to look and feel immediately after surgery, and in the long term. If a cosmetic surgeon suspects that a candidate’s expectations are not realistic in any way, or that the candidate is suffering from body dysmorphic disorder or another mental illness, the doctor could advise against surgery and even refuse to perform it.

Patients with a history of breast cancer may not be recommended for this procedure. If breast cancer and other breast conditions run in your family, talk with your plastic surgeon about whether breast augmentation options are right for you.

Are There any Side Effects, Risks, or Potential Complications?

Patients should be aware of the risks of any and all possible complications during breast surgery, or following surgery. The risks and complications will vary according to the type of procedure performed. Some of the most common risks of having breast augmentation surgery with implants include changes in the way the nipples and breasts feel and even a loss of sensation in the breast. There is also a possibility of developing a capsular contracture, which is the most common complication experienced in breast augmentation patients, and quite often the reason for re-operation. Breast pain, including the risk of a rupture or leaking of both saline and silicone gel-filled implants, are also possibilities, although great lengths are taken to reduce the risk of implant rupture or leakage after surgery.

Other complications from implant surgery range from mild to life-threatening. These include ptosis, the possibility of future implant removal, deformation of the chest wall or breast shape, wrinkling of the breast or breasts, infection, inflammation, and the possible inability to breastfeed in the future. If you are considering breast augmentation surgery, ask your doctor about the possible side effects that can happen from your surgery and what you can do to lower or prevent your risk of complications.

Surgical fat transfer procedures are generally much safer than implant surgeries. However, these also carry their own set of potential risks and complications. These include temporary swelling and bruising, fat necrosis (or skin tissue death), hematoma, and scarring.

As with any type of surgical procedures, all kinds of breast augmentation operations carry small but serious risks of blood clotting, infection, allergic reactions, and other side effects. The anesthesia used during your procedure, whether general, local, or with IV sedation, is also associated with various risks and complications that you should know about before deciding on whether to have the surgery. It is important to talk to your doctor seriously before surgery to understand these risks, and how they might affect you.

How to Choose a Surgeon and Questions to Ask During a Consultation

Choosing the right surgeon is the most important part of having any kind of surgery. If you are interested in breast augmentation, make sure to take the time you need to investigate cosmetic plastic surgeons in your area to find the best one.

The doctor you choose should be recognized by an official organization like the American Society of Plastic Surgeons or the American Board of Plastic Surgery, and should also be very experienced in performing breast augmentations. If possible, read online reviews from former patients, and meet them in person for a consultation to learn more about the breast augmentation procedure you want to have done.

When meeting your doctor for a consultation, it is a good idea to prepare a list of questions to ask to learn all that you can about that particular doctor’s approach to breast augmentation surgery. You will also want to know as much as possible about the cost, recovery, and pain involved with your procedure, as well as the doctor’s training, experience, and qualifications, and their expectations about your surgery.

You should also ask your board-certified plastic surgeon to see before and after pictures from their previous patients. Also, inquire about the number of procedures they perform on a daily basis, in a month, and over the course of a year. While you do want to see a doctor that is well-versed and practiced in the art of breast augmentation, you also want to avoid doctors that perform dozens of daily operations. Cosmetic surgeons, after all, should possess a considerable degree of artistry into their work, in order to sculpt the breast to meet a certain aesthetic balance. Doctors that have a full, back-to-back schedule of operations might not be willing or able to give each patient the proper care and attention they need to achieve the best results.

Some other questions to ask your doctor include:

  • How do you decide what type of breast augmentation procedure is right for each patient?
  • Which type of procedure do you feel is right for me, and why?
  • Will my surgery be done in a hospital, an outpatient center, or somewhere else?
  • What are the risks for the type of surgery I want? Do I personally have a higher risk of complications or side-effects with this surgery?
  • What will this procedure cost, and does your clinic offer financing?
  • What will I need to do to prepare for surgery? Is there anything I can do now that will help to enhance my results?
  • What are my options for anesthesia?
  • When will I be scheduled with my first follow-up appointment?
  • What kind of pain medication will I be given after my surgery?

Making a Decision: Weighing the Pros and Cons of Breast Augmentation

For many patients, the pros of breast augmentation—that is, the physical benefits of a larger, fuller, symmetrical, and more attractive bust—far outweigh the cons. Even if you are convinced that larger breast size is worth the surgery required to get it, knowing all of the details before making a decision is an important part of the process of deciding on whether or not to have plastic surgery. In many cases, patients seeking breast augmentation decide on a breast lift surgery instead, which can provide many of the same benefits of breast augmentation at a lesser risk for complications and other issues.

Although breast augmentation can certainly help to improve your self-confidence, enhance your appearance, and help you to live a happier life, there are many cons to consider as well. Breast augmentation surgery is a costly procedure, and as with any surgery, comes with risks and complications and the possibility of general dissatisfaction with your results.

While an excellent doctor can dramatically improve your chances for a successful outcome, it is still worth it to weigh the potential pros and cons of surgery before making a decision. This includes a careful consideration of the pros and cons of each type of surgery. For example, your doctor should discuss with you the pros and cons of gummy bear, saline, and silicone implant materials, round, textured, or smooth implants, implant surgery vs. fat transfer procedures, implant placement below vs. above the muscle, the benefits of various incision locations, like under the armpit vs. periareolar incision, general anesthesia vs. monitored anesthesia care, and many other details. Once you have decided on a particular procedure and method for your surgery, find out the particular pros and cons of that surgery—and how it might affect your life now, at the moment of your surgery, during the recovery process, and for years to come.

List of Sources

Different Types of Breast Augmentation (Augmentation Mammaplasty)

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