Breast augmentation, technically known as augmentation mammaplasty, is a surgical procedure to enhance the size and shape of a woman's breasts. It one of the most common cosmetic procedures performed by plastic surgeons in the United States.
First, let's review breast implants. Breast implants are medical devices with a solid silicone elastomer shell. Saline implants arrive sterile and empty. The elastomer shell is filled during surgery, which allows a plastic surgeon to make minor volume adjustments during surgery. The saline solution is sterile salt water that is easily absorbed by the body should the implant ever rupture. Saline implants are optimal for women who have a moderate amount of breast tissue. The incisions are small, approximately 3 cm long. Saline implants have a slightly higher rupture rate than silicone implants and are generally less expensive. Most manufactures offer a replacement warranty on the implant and provide money to cover the cost of surgery.
Silicone implants come pre-filled with sterile silicone. These newer silicone gels are cohesive, meaning that they tend to hold their shape and are not fluid. You can think of the gel as being similar to a soft gummy bear: if the implant shell is breached, the gel tends to stay in its original shape and location. The liquid gel from many years ago had a tendency to move within the pocket and in adjacent tissue planes. Because the silicone implant comes pre-filled, it is inserted at full volume and, therefore, requires a slightly longer incision (3 to 3.5 cm). The most common access location is the inframammary fold. Dr. Barlow utilizes a new implant delivery device (the Keller funnel) that permits this smaller incision. Silicone implants are usually more expensive but have a lower rupture rate. Silicone implants are optimal for those who have little or no breast tissue, especially those who have had a mastectomy, and for those patients who desire the most natural feel. A silicone implant feels and looks like natural breast tissue when covered by skin and muscle. Most patients prefer silicone for this reason; plastic surgeons prefer silicone because it has a lower rupture rate. All manufactures provide a replacement warranty for silicone implants, which also helps to defray surgical fees.
Now, let's cover implant insertion and pocket location. There are many places to insert the implant. Some physicians offer the transaxillary method (under the arm) or the transumbilical method (through the belly button). The transaxillary method utilizes an endoscope (small camera) to develop the pocket where the implant will lie. Dr. Barlow no longer offers the transaxillary approach, as the underarm scar is frequently more hypertrophic (raised, ugly, and potentially painful). The transumbilical method places a scar in the belly button and a long tunnel is created up to the breasts. A pocket is then created blindly around the muscle. Dr. Barlow does not offer this approach, either, due to the lack of precision inherent to the procedure. Dr. Barlow prefers to create an incision below the breast where he creates a pocket behind the pectoral muscle to support the implant. If a breast lift is performed at the same time, the incision used for the lift can provide access for the implant. Dr. Barlow prefers implant placement under the muscle because the implant is better camouflaged and it creates a more natural look. Rupture and contracture rates are also lower for implants placed beneath the muscle.
The choice of implant (saline vs. silicone) filler, implant size, implant shape (profile) and other features will be determined based on your breast anatomy, body type and your desired increase in size. Together, you and Dr. Barlow will make implant decisions based on your lifestyle, goals and personal preferences, as well as Dr. Barlow's surgical judgment for your wellbeing.
Dr. Barlow's surgical time for breast augmentation is approximately one hour. Dr. Barlow performs all breast augmentations in two hospitals in the Clear Lake/Houston area (Houston Methodist St. John Hospital where he is co-director of the Plastic Surgery Program or Clear Lake Regional Hospital where he serves as the Plastic Surgery Section Head on the Surgical Executive Committee) as an outpatient procedure. This is an important distinction. In Texas, a fully trained plastic and reconstructive surgeon is granted hospital privileges to perform breast augmentation. Physicians who call themselves cosmetic surgeons may not have completed a plastic surgery residency. In fact, some cosmetic surgeons have not completed a single day of any surgical residency, let alone plastic surgical residency. These physicians generally perform procedures in their own facilities because they cannot obtain hospital credentials. There is only one certifying board for plastic surgeons that is recognized by the American Board of Medical Specialties and that is the American Board of Plastic Surgery. The American Board of Medical Specialties governs and regulates each residency program, insuring that every graduate has met a rigorous training standard.
Post-operatively, you will be seen within a day or two to evaluate you for fluid collection. Since your implants will be placed under your chest muscle, most of your discomfort will be muscle spasm-related. A muscle relaxer will be prescribed in addition to a narcotic pain medication. Another consequence of the muscle spasm is that your implants will initially sit high on your chest. To encourage your implants to settle into position, you will be placed into a post-operative bra. The bra has an elastic strap to provide a gently but continuous downward push. Most implants will settle into place in two to three weeks. Implant massage will be taught to you once your tenderness has subsided. You will be seen weekly for the first month, every other week for the second month and then every other month out to six months. You will be followed annually from then on. Patients who are over 40 or who have an increased family risk of breast cancer will be required to have a current mammogram prior to proceeding with surgery.
Full activities are resumed gradually but rigorous exercise is prohibited for the first post-operative month. This will allow your body time to recover from the surgery and avoid any unnecessarily prolonged swelling. During the early recovery period, increased activity will often lead to increased swelling. Most of Dr. Barlow's patients tell him that their implants feel like a fully integrated and completely natural part of their bodies by the time the come for their two month follow-up visit.
Breast augmentation is one of the most gratifying procedures for both Dr. Barlow and his patients. Dr. Barlow looks forward to meeting with you and discussing your options. Call or e-mail today to schedule your appointment!