Overview

Many women who would like to restore or enhance the size and shape of their breasts may benefit from breast augmentation, also known as mammoplasty. It is one of the most common procedures performed annually by members of the American Society for Aesthetic Plastic Surgery. Breast augmentation is performed to enhance the breast size and shape due to lack of development, congenital abnormalities, changes or asymmetries following aging, weight loss, and/or pregnancy. In addition, there may be personal reasons for augmentation mammoplasty. For example, some women may perceive their breasts to be underdeveloped and not proportional to their body size and image they wish to project. Women may also decide on breast augmentation, though they may be happy with their breasts, just because they would like them to be fuller. A positive impression of their body image is important to most women, and breast augmentation may aid in offering a more proportional breast size and shape as well as in improving self-confidence.

Would I be a good candidate for breast implants?

A variety of factors may indicate that you are a good candidate for breast augmentation. Some of these feelings and/or conditions include:

• You feel bothered and/or have low self-esteem that your breasts are too small.
• After giving birth, your breasts have become smaller and have lost their firmness.
• You notice that clothes that fit well around your hips are too big at the bust line.
• You feel self-conscious when wearing a bathing suit or other form-fitting apparel.
• A weight loss/fluctuation or pregnancy has changed the shape and size of your breasts.
• There is an asymmetry where one of your breasts is noticeable smaller than the other.

How does the procedure work?

Breast implant surgery is accomplished by surgically inserting either a silicone or saline implant (prostheses) behind each breast. The breast implants are placed either in front or behind the pectoralis major muscle and breast tissue. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift should have the implant placed above the muscle to prevent contour problems (double contour deformity). Those patients with minimal breast tissue usually have the implants placed beneath the pectoralis muscle for more soft tissue padding. In any case, your plastic surgeon will determine which placement is best for you and explain why. When you come in for a consultation, the different options will be explained in further detail as well as the three choices of implements currently available: silicone, standard saline, and IDEAL® double lumen saline implants (a new double lumen saline implant made to feel like silicone).

Is the procedure safe?

For the vast majority of patients undergoing breast augmentation, the procedure is extremely safe and involves minimal side effects. In my practice using board-certified anesthesiologists and FDA approved prostheses are always employed to ensure a successful surgery. A general anesthetic is used but a local anesthetic is also placed prior to awakening for postoperative pain relief. The implants, breast prostheses, are made of safe, non-reactive silicone material which have been studied by the FDA and worldwide, and used since the 1970’s. So much so, in fact, that they are the most studied medical device in the world. There is no link to date between silicone prostheses to other diseases like auto-immune disease, arthritis, cancer, or other connective tissue diseases. These problems occur to the same extent and at the same rate in women with breast augmentation as those who have not had the procedure. For instance, cancer occurs just as frequently in women with augmented breasts as it does in those with natural breasts.

What choices do I have with my breast augmentation?

Breast implants come in a variety of shapes, sizes, firmness and profiles in order to offer a custom-fit and natural-looking physique. It is also important to consider the substance and texture of an implant. The surface of round implants can be smooth or textured whereas shape implants are all textured to maintain their alignment. In particular, those implants approved by the U.S. Food and Drug Administration (FDA) are filled with silicone or saline. All implants at this time use cohesive silicone gel meaning that the gel maintains its shape like “gummy bear” candy or jello with more anti-leak properties unlike the gel prior to 2006 which was more like honey or molasses in consistency. These materials impact the feel and look of a breast implant, and thus are an important consideration in determining the desired appearance of your breasts.

For example, silicone is most popular world-wide as their feel and appearance most closely mimics the desired breast feel with less rippling. Standard saline implants have a higher rate of becoming hard (capsular contracture) and tend to exhibit more waviness or rippling if there is less breast or fat covering the implant. A newer breast FDA approved saline implant, IDEAL Implant^®^, is a double lumen “hybrid” implant that has the feel close to silicone, less risk of capsular contracture, and the peace of mind of saline; that is, if there is a leak, you can tell, just by looking in the mirror rather than requiring a MRI.

What results can I expect form breast augmentation?

According to studies, more than 90% of women are satisfied with the results of a breast augmentation. This is largely because the procedure often improves a woman’s self-esteem, not to mention quality of life. We aim to custom-tailor your breast augmentation based on your preferences for perkiness, firmness, shape, and size. Our goal is to match the appropriate implant type with the right procedure so that patients with realistic expectations are completely satisfied.

Breast augmentation will enhance the shape of your breasts as well as make them fuller. You may find yourself more comfortable wearing different types of clothing and may enjoy a boost in self-confidence, as is the case with most of my patients.

Usually, you can expect your breast augmentation surgery to have long-lasting effects, unless implant deflation requires surgical replacement with a new implant. Nonetheless, the effects of aging and gravity will eventually alter the shape and size of a woman’s breasts over time. As a result, you may later elect to undergo a breast “lifting” to restore the more youthful shape, size, and firmness. A breast lift of course can be performed at the same time as a breast augmentation or implant exchange.

Prospective patients should know that the final texture, shape, and appearance are not exactly the same as natural breasts. Many patients in fact prefer the firmness and slightly different contours than natural breasts. However, these differences may be more noticeable in some patients than others. The intended result of the procedure is to enhance the size and shape of the breasts to achieve the body image desired by the patient.

What are some considerations I should take into account when selecting a plastic surgeon?

The most popular way to improve breast size and shape is breast augmentation performed by experienced plastic surgeons. Generally speaking, seek out board-certified plastic surgeons by the American Board of Plastic Surgery with a great deal of experience and good reviews for best results. Those plastic surgeons that have specialized in breast and reconstructive surgery including breast revision surgery, such as the surgeons at Pacific Center for Plastic Surgery, are a great fit for your breast augmentation needs.

Larry S. Nichter, MD, MS, FACS