What is breast augmentation?

A breast augmentation is an enhancement in size and shape of a woman's breasts with a breast implant.

Above or below the muscle

My preference is to place the implants in the partially sub-muscular position because I feel it lends to a more natural overall breast look post-operatively. I also feel that in most patients, by leaving the suspending ligaments in place that connect the muscle to the skin of the breast (Cooper's Ligaments) more support of the overall breast is maintained. However, the placement of a breast implant above or below the muscle is determined individually for each patient after a careful discussion of your goals followed by a comprehensive examination. There is a different appearance to the breast after each procedure and patients will have their input in this decision as well.

Types of Implants

Two manufacturers currently make FDA approved implants in the US. The manufacturers are Allergan (formerly McGhan & Inamed) and Mentor. These companies manufacture a variety of products, which include both saline and silicone filled implants. These are both made in a variety of sizes, and shapes. The exact implant size, shape and texture should be discussed with your plastic surgeon. High profile, anatomic, expandable implants are available and the use is dependent on what your desires are, and the pre-operative breast appearance. This decision is only made after discussion with you and after allowing you to see and feel the options available to you. The vast majority of my patients have smooth round implants used because my experience has been that a softer result is achieved this way with proper post-operative massage. Many techniques have been developed over the years to decrease the scar tissue (capsular contracture) around breast implants. Originally, it was thought that a textured shell may decrease the rate of capsular contracture, but this in fact is probably not true. The rate of rippling is probably less with a smooth implant and the deflation rate is also presumed to possibly be lower than with a textured implant. Round implants are used much more commonly than anatomic or "breast shaped " implants. Shaped implants can also shift or rotate causing an unnatural appearance, and possibly needing a re-operation.

Incisions and Scars

The vast majority of my implants are placed through the inframammary crease where I feel I can create a more precise pocket which I feel yields a better long term position and result. There are however, a few options for implant placement in the primary breast augmentation. Possible incision locations include periareolar (around the nipple), inframammary (in the fold beneath the breast), transaxillary (in the hollow of the armpit), and transumbilical (through the belly button). NOTE - The transumbilical approach may void the replacement policy of some implant manufacturers. The most commonly used incision is inframammary, but this depends on your plastic surgeon. Many plastic surgeons use this incision because it arguably gives good control in placement of the implants and the incision is usually not visible although with any incision, there will be a scar. Some plastic surgeons feel that there may be more of a chance in alteration of sensation utilizing this incision, as well as a questionable decrease in the ability to breast feed in the future. Some plastic surgeons feel that there may be a higher rate of capsular contracture due to an increased exposure to bacteria found in the patient's milk ducts. The transaxillary incision is a procedure in which an incision is made in the armpit. Some plastic surgeons feel that this incision gives less implant placement control. The Transumbilical (TUBA) procedure uses an incision inside the umbilicus (belly button). Many plastic surgeons feel that the disadvantages outweigh the advantages.

Michael C. Edwards, MD, FACS 653 N. Town Center Drive, Suite 214 Las Vegas, Nevada 89144 (702) 248-8989 For more information visit http://www.medwardsmd.com/plasticsurgery_questions1.html