About Breast Surgery

Breast Augmentation using implants is the second most popular cosmetic surgery procedure in the U.S. following liposuction. The amount of women undergoing breast augmentation has tripled in the last six years from 101,176 in 1997 to 280,401 in 2003. Innovations in breast implant surgery has led to improved results with shorter recovery time and decreased scarring.

Size and Placement of Breast Implants

Dr. Senderoff performs the majority of his breast implant procedures under general anesthesia as an outpatient in his fully accredited surgical facility located on Park Avenue South in Manhattan. The most popular breast size requested is a C cup. Keep in mind that the same size saline breast implant in one patient will look different in another patient depending on how much breast tissue each patient has to start with. The goal is to create a natural looking breast that is in proportion to the patient’s frame. Factors that must be considered prior to choosing a breast implant size include, the height and weight of the patient, amount of existing breast tissue, any asymmetry, and patient lifestyle including occupation, exercise habits and clothing choices. The most common breast implant used is a smooth, round, saline implant between 300cc and 420cc. This implant is less palpable than a textured implant and usually provides a 1-2 cup size increase. The anatomical or tear drop implant is not usually used since it has not been shown to improve the results of the surgery. There are three incision sites that are commonly used depending on the needs of the patient. The inframammary approach involves placing the incision in the breast fold at the bottom of the breast. This site is used very commonly in women with a well defined breast fold and is the simplest and easiest method to insert the breast implant. The periareolar approach involves an incision on the inferior or bottom part of the areola. This approach can result in an inconspicuous scar but can distort the areola if healing is not perfect. In addition with the periareolar approach, the breast tissue is disturbed by dissecting through the middle of the breast. The transaxillary approach involves placing the implant through an incision in the armpit or axilla. With this approach there is no scarring of the skin of the breast. Dr Senderoff uses an endoscope which is a tiny camera attached to a monitor so he can create a precise pocket to fit the implant. This approach is appropriate for patients with fairly symmetrical breasts who do not desire an incision on the breast itself.

Positioning of Breast Implants

The breast implants are usually positioned behind the chest wall muscle known as the Pectoralis Major muscle. Breast implants placed behind the Pectoralis muscle have been found to develop less capsular contracture. In addition, these submusular implants are less palpable and exhibit less rippling than implants placed above the muscle known as the subglandular position. Sometimes breast implants that were originally placed in the subglandular position are converted to the submuscular position to alleviate rippling and palpability. While the submuscular position does produce more discomfort immediately after surgery the results are well worth it. Studies have shown a complete return in chest muscle strength with no loss of function in patients with submuscular implants. In addition, mammography is more effective in imaging the breast if the implant is positioned below the muscle as compared to a breast with an implant placed in the subglandular position.

Augmentation Mastopexy (Breast Implants and Breast Lift)

Sagging of the breast called ptosis occurs when the breast has lost its firmness due to weight loss, pregnancy, or age. When the sagging is minimal it can be corrected by the insertion of an implant. When the sagging is moderate to severe the nipple will point to the bottom of the breast. In this case a breast lift or mastopexy will be required to create a more youthful breast shape. The mastopexy can be combined with the insertion of a breast implant to create a fuller and more lifted breast. The mastopexy procedure does require an external incision on the breast. A periareolar mastopexy involves an incision around the areola which can reduce the diameter of the areola and tighten the breast skin. A vertical mastopexy involves an incision around the areola and down the center of the breast which produces a scar in the shape of a lollipop. This procedure is used to raise the height of the nipple and create a round and lifted breast. A mastopexy can be performed without implants for patients who are satisfied with their present breast size and only desire a lift.

Saline Breast Implants vs. Silicone Breast Implants

In 1992 the FDA placed a moratorium on the use of silicone breast implants for breast augmentation. Since that time numerous studies have been performed on the health risks of silicone implants. The conclusion was that there are no health risks associated with silicone breast implants. Silicone breast implants are available to women who choose to participate in one of the FDA trials through investigator surgeons. Dr. Senderoff is a clinical investigator in the Inamed Silicone Implant Study and does use silicone implants in select patients who meet the criteria for participation in the study. The advantages of silicone implants over saline implants include a softer, more natural feel to the breast with less rippling. Silicone implants are used widely throughout the world with great results. It may be a few more years before silicone implants are available to all women here in the United States.

After Breast Surgery

As with all procedures there is a recovery period. Immediately after surgery patients usually complain of a pressure sensation on the chest which persists for several days. If the implant was inserted through the axilla there may be some restriction in arm raising until the soreness subsides. Patients are prescribed an oral pain reliver until the discomfort subsides which is usually 3-5 days. The breasts may appear swollen and tight for several weeks until the skin and muscle relax. After the swelling resolves the breast may appear smaller than they were immediately after surgery. It may take 6 months or longer for the final shape to be evident and for the scars to fade.

Complications To Consider Before Your Breast Implants Surgery

All surgery carries some risk. While the risk of serious complications such as bleeding and infection are rare there are several more common complications that should be mentioned. Breast asymmetry can occur as a result of one breast being larger or a different shape than the other breast. This complication is rare in patients who have symmetrical breasts to begin with. Changes in nipple sensitivity are usually temporary and return to normal in 3-4 weeks in most patients. The most common complication with breast implant surgery is capsular contracture with occurs as a result of scar tissue building up around the implant. This scar tissue creates a tight pocket which can produce a firm breast and deform the shape of the implant. In some cases capsular contracture can be treated effectively with medications. Some patients will require another operation to either open or remove the implant capsule. As mentioned earlier submuscular implant placement minimizes the risk of capsular contracture. Breast implant deflation can occur at any time after breast implant surgery. In the case of saline breast implants the patient will notice an immediate decrease in breast size as the saline is absorbed by the body. The breast implant can be replaced and is usually covered by the manufacturer’s warranty. A silicone implant deflation is harder to detect since the silicone is not absorbed by the body. Sometimes an MRI is needed to detect a rupture in patients with silicone gel implants.

Patient Satisfaction With Their Breast Implants

Overall, the vast majority of women experience great satisfaction from breast implant surgery. Many women report an increase in self-esteem and confidence within days of the surgery. Some women experience a heightened awareness of their sexuality and feel sexier in intimate situations. In addition, many women are delighted that they are finally able to wear the type of clothing they could not feel comfortable in before their surgery. Breast implants surgery can be a rewarding and life enhancing experience when performed thoughtfully and carefully in patients who are well informed and willing to undergo elective surgery in order to achieve their goal of a better breast.

If you have any questions about the breast implants (saline breast implants or silicone breast implants) or a breast lift procedure please feel free to contact Board Certified Plastic Surgeon, Dr. Senderoff, at our Manhattan or Westchester, New York offices.