Breast augmentation or breast enlargement is performed to enhance body proportions. The success of the augmentation procedure relies upon a variety of decisions related to incision options, implant styles, sizes and positions. Incisions include peri-areolar (at the edge of the areola), transaxillary (within the armpit) and inframammary (in or near the breast fold). Each has associated advantages and disadvantages which must be weighed by each patient.
The peri-areolar incision has the advantage of being placed near a natural anatomical line (the junction of light breast skin with the darker areolar skin). It allows for more accurate positioning, a very important aesthetic consideration. Its disadvantage is that while most patients maintain normal nipple sensation, there may be a greater chance of lose of sensation.
The inframammary incision goes in or near the natural fold under the breast. It works well when the woman has enough tissue to have a distinct fold, but it typically is not a very good option when a defined fold is not present. This technique tends to preserve sensation well. It is the best option when old scar tissue (capsular tissue) requires removal in secondary surgery. Some women prefer not to have a scar on the white skin of the breast, even in the fold.
The transaxillary incision is placed within the axilla (armpit). It has the advantage of avoiding a scar on the breast. It has the disadvantage that if the scar does not heal well, it is visible when the arm is raised. It also has the disadvantage of making optimal positioning more difficult. Larger silicone gel implants may not be able to be placed via this approach. Secondary procedures are very difficult from the axilla.
The umbilical incision has been used by some because of the appeal of a distant incision. However, accurate positioning and pocket modifications are most difficult from the umbilicus. Silicone gels cannot be placed. Positioning issues have been described and most surgeons do not utilize this approach.
Each individual has unique concerns and priorities. The incision selection is just one part of the equation to a successful, pleasing result. This along with implant style, size and position and whether or not a lift is required are all issues which should be thoroughly discussed with your surgeon, to help arrive at an optimally aesthetic outcome.
Today, a variety of implant designs exist. It is now accepted that current implants require maintenance and will likely require replacement possibly multiple times in the course of a young woman’s life. These should not be thought of us permanent devices. More common reasons for replacement include deflation or rupture, hardening of scar tissue (capsular contracture) around the augmentation material and desire for change in size. Secondary procedures are often more involved than the initial one. The maintenance issue must be considered in making the decision to undergo implant placement.
All current implants have a silicone rubber shell. The shell can be filled with salt water (saline) or silicone gel. Because the body is largely composed of salt water, saline implants are the safest available. Saline-filled implants can be placed through smaller incisions because they are inflated after they are placed. However, because of their watery consistency, they are less natural than silicone gel implants that more closely resemble a breast in feel and appearance. One of the common complaints regarding saline is that particularly in thinner individuals, implant visibility such as rippling is greater. Usually over the course of years, the silicone rubber shell can crack, this results in deflation which requires replacement. The leaked saline is usually considered harmless and is absorbed and excreted by the body.
More recently, silicone gel implants have again become available for use in woman 22 years of age and older, who desire their placement. Patients and surgeons tend to agree that these look and feel more natural. As with saline devices, the silicone rubber shell may crack over time and rupture can develop. Fortunately, most ruptures are contained within the fibrous capsule that surrounds the implant. However, removal of the capsule and implant material is a more involved procedure than the initial augmentation procedure. Most ruptures beyond the capsules appear to have occurred in the past due to trauma related to the squeezing of the capsules (and implants) in an effort to soften firm scar tissue. This closed capsulotomy procedure is no longer a recommended procedure and it should not be done. Studies continue following FDA approval. It is hoped that the newer designs will have a lower rate of encapsulation (hardening), as well as a decreased rate of rupture. However, the studies are ongoing.
Newer materials include more “cohesive” silicone fillers. These materials could be less of an issue in the event of rupture. Silicone gel implants are often selected by very thin woman and those undergoing reconstruction of the breast following mastectomy.
For women in Beverly Hills, can achieve a more pleasing size and shape. Dr. Jay Orringer has two decades of experience creating .
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