When placing implants during breast augmentation surgery, there are several incision options that can be utilized: Underneath the breast Around… Read More
A woman usually considers having a breast augmentation for very personal reasons. I have done more breast augmentations than any other single operative procedure over the past twenty-five years and found that most women seek this procedure to help improve their body self image.
There are a number of decisions a woman must make when considering a breast augmentation:
- Choosing a qualified plastic surgeon
- Choosing the right breast implants for me
- What is the Kellner Funnel??
- Should the implant be placed over or under the muscle?
- Do I also need a breast lift and, if so, are the additional scars worth it?
- Is a textured or teardrop shaped implant better than a smooth or round one?
- What incision is best?
- What size implant is appropriate?
- How long will the implants last?
Choosing Your Breast Augmentation Surgeon
The most important decision, I believe, is choosing a qualified plastic surgeon. The recommendation of a person or number of people who have had a good experience and great results is often a good way to begin the selection process. I review in great detail the credentials to look for in my section entitled Finding a Certified Plastic Surgeon.
Breast Implant Options
During the consultation process, I work with the patient to establish what they hope to achieve through surgery. With this information I am able to guide the patient towards which implant type, size and shape can help them achieve their goals. Both saline and silicone implants are offered at my practice in a variety of shapes and sizes. While I may recommend certain options for a patient based upon their goals, the decision is ultimately up to them. My goal is to provide a better understanding of what the various options can offer their unique body structure, so they can choose implants they will be most pleased with. For more thorough information, please refer to my breast implant options page.
Keller Funnel for Breast Augmentation Surgery
The Keller funnel, in addition to speeding up the actual process of placing the implant and reducing surgery time, also allows the implants to be inserted with less overall trauma to the outer implant shell. This technique makes it possible for me to make a smaller incision and, most importantly, allows the implant to avoid all contact with the skin. Avoiding contact with the skin is important because residual bacteria on the skin or in the tissue of the breast may increase the risk of capsular contracture (scar tissue forming around the implant, giving it a hardened feel). With the Keller Funnel, the risk of developing capsular contracture may be somewhat reduced because it allows the implant to be totally placed inside the breast pocket without touching the skin during placement. Plus, the Keller Funnel allows me to put less stress on the implant during insertion, and minimize residual scarring because of the smaller incision required. Using the Keller Funnel is another way for me to employ state-of-the-art instruments and techniques in breast augmentation procedures, with the goal of giving you the best and most predictable results possible.
Implant Placement – Over or Under the Muscle?
Placement of the implant over or under the pectoral muscle depends on skin thickness and breast tissue development or shape. If the skin is very thin, then placement under the muscle is preferable. Implant shape and folds are less likely to show through the added thickness. Patients should recognize, however, that the bottom outer half of the implant will not be covered by muscle because of the anatomy of the muscle. This means that wrinkles and folds are more likely to be seen or felt in the bottom half of the breast mound. Implants placed under the muscle are more likely to migrate from ideal position and surgery is more painful because of trauma to the muscle. However, many patients and surgeons think sub-muscular implants look more natural. If skin and/or breast tissue needs to be stretched out, then placement over the muscle is preferable.
Will I Need a Breast Lift?
If too much skin is present and the breast is droopy, then a lift is necessary to achieve a good contour. Whether the improved contour is worth the additional scars is something only the patient can judge. (See my description of breast lifts).
There are a number of small incisions offered for placement of breast implants. These include under the breast, around the areola, in the armpit and at the belly button. The incision under the breast is, by far, the one I use most commonly. It is only an inch and a half long and heals well. It gives me direct access to the pocket and allows me to easily see everything I need to. It is also far enough from the nipple and breast tissue to decrease the chance that bacteria in the breast ducts might find their way on to the surface of the implant. The incision around the areola is also popular and my choice for women who are seen publicly without tops. There may be an increased chance that bacteria will contaminate the surface of the implant. The scar around the areola usually heals well but is sometimes visible as a white line adjacent to the pigmented areolar tissue. The incision in the armpit is well hidden but hurts more and has a higher chance of resulting in implants that are out of position. I do not offer the incision around the bellybutton because that approach can only be used with saline implants and the results that I have seen presented by surgeons at national meetings are aesthetically inferior to the results using other incisions.
Breast Augmentation Procedure and Recovery
The typical sequence of visits for a breast augmentation procedure at my office is as follows:
- A free pre-consult with one of my staff, if desired
- The initial consultation and evaluation ($40)
- A second, free consultation to answer any questions that may have come up, if desired
- A separate visit for sizing, or sizing can be combined with one of the initial visits
- A history and physical exam no more than one week prior to surgery
- Wound check the day after surgery
- Suture removal one week after surgery
- Post-operative checks 3 weeks, 6 weeks and 3 months after surgery
- Post-operative photographs (available to the patient) at 3 months
Patients usually require one to two weeks off of work. Active exercise may be carefully begun at about 3 weeks after surgery and all restriction are usually lifted 6 weeks after surgery. Each patient is considered individually according to needs and desires. The relevant risks and benefits are discussed at the time of the initial consultation and information packets listing these are given. The vast majority of patients are thrilled with their results.