Breast augmentation (enlargement) is performed to enhance or restore the size and shape of a woman's breasts. Breasts may be small because of lack of development or changes following pregnancy, weight loss or congenital abnormalities. Sometimes a woman's breasts are very asymmetric. This operation can improve a woman's self esteem and quality of life. Studies have shown over 90% of women are satisfied with their results.
The traditional way to enlarge the breast is the use of breast implants. Currently, saline implants are placed either behind the pectoral muscle and breast tissue or in front of the muscle.
Site of Incision. The options for site of incision are underneath your breasts (inframammary), around the nipple (periareolar), in the armpit (transaxillary) or through the belly button (TUBA or trans-umbilical breast augmentation). All these approaches have advantages and disadvantages.
The incision around the nipple can lead to numbness, and can be quite visible because it is the focal point of the breast, it may also result in difficulties with breastfeeding and has the highest rate of infections.
The incision under the breast is placed within or near the crease beneath the breast, the scar is usually hidden under the breast. This incision can sometimes become lumpy and could become very visible, especially in cases of a keloid scar formation.
When the incision is placed through the belly button (TUBA), the incision is hidden inside the belly button. It is an excellent scarless incision. Frequent problems with this approach however, are breast implant rupture during placement, undercorrection of certain breast asymmetries, incomplete control of shape, and bleeding.
The transaxillary (arm pit) approach is extremely popular with many patients because the incisions can be made smaller and they are almost invisible (they are hidden in the skin crease in the top of the armpit.) The addition of the endoscope has been a major breakthrough in the area of cosmetic surgery including breast augmentation. The standard placement of breast implants, regardless of the incision site, is essentially a blind operation that makes intraoperative visualization of the surgical area difficult for purposes of dissection of tissue planes, for the accurate division of muscle fibers, and the control of bleeding. The introduction of the endoscope has substantially improved the accuracy and predictability of breast enlargement with breast implant surgery allowing the cosmetic surgeon to create crease symmetry, muscle division, implant positioning and bleeding control under total endoscopic visualization with great control and ease.
Saline vs. Silicone Gel Implant: The FDA has recently approved silicone gel breast implants for use in primary breast augmentation for any woman over the age of 22. The main disadvantages include a possible higher rate of capsular contracture (scar around the implant), the incision to place the implant is larger than the one needed for placement of a saline implant, and the cost is substantially higher then saline breast implants.
It is important to remember that Breast augmentation with implants will not improve nipple asymmetry, move your breasts closer together, lift droopy breasts, or remove stretch marks.
Problems Related to Breast Implants:
Anesthesia reaction
Asymmetry
Bleeding
Breast droop
Capsular contracture (hardening of scar tissue around implant)
Deflation (approximately 7%)
Displacement
Hematoma (pooling of clotted blood, risk is 3-4%)
Implant leak
Infection (risk is less then 1% and always involves removal of the implant)
Interference with mammography
Visible scars or keloid (heavy scar)
Nerve damage, nipple numbness, pain, permanent numbness (risk is 15%)
Rippling
Rupture of the implant (often due to injury)
Seroma (pooling of watery blood)
Skin irregularities
Sloshing
Slow healing
Symmastia (the breasts are merging into one )
The Modern Alternative to Breast implants is the Breast Augmentation using your own Fat (micro-fat grafting technique)
Patients who desire breast augmentation but are wary of implants are candidates for breast enlargement using their own fat. Dr. Marcovici transfers the fat to the breast utilizing the micro-fat grafting technique. First, he removes the fat from selected areas of the body, purifies the fat, then re-injects the donor fat cells into the breasts. (Many patients that have body countering procedures like liposuction find it quit convenient to use their own fat for breast augmentation in the same session). The procedure is designed to fill the breasts so that they appear lifted and perky and the patient will achieve a uniform, smooth, normal appearance of the breasts.
Breast augmentation by fat transfer versus breast implants has many advantages:
Less expensive
Minimally invasive with less trauma
No visible scars
Can be done as an office procedure totally under local (tumescent) anesthesia
Avoids tissue or foreign material (implants) rejection because it is your own (fat) graft
Fewer post-operative complications
Touch up procedures are easily performed
Fat transfer does not make the performance on a future breast implant placement more difficult
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