Breast augmentation, or enhancement of breast size using breast implants, is one of the most commonly performed procedures in plastic surgery. According to the American Society of Plastic Surgeons, over 230,000 breast augmentation procedures were performed in 2004 throughout the United States.
This number reflects the increasing desire of women for larger, fuller breasts but also speaks to the safety of the procedure and the high satisfaction rate following surgery. With continuing development of new implants and techniques for the insertion of implants women have many options available to them.
Breast augmentation is performed for women when breast size is inadequate due to under-development or when the breast size has decreased following weight loss or pregnancy-related changes. The enhanced breast should be natural looking and proportionate in size with the woman’s height, weight and overall body build. The implant should provide the breast with a gently sloping or tear-drop appearance and should be reasonably soft allowing the breast to move naturally with normal body movements. Incisional scars following placement of the implants should be small and well concealed after healing is complete.
The most popular implants in use are saline, or salt-water filled, round smooth moderate profile implants. Other options include textured round, textured anatomic, high or low profile implants and under select circumstances silicone implants may be appropriate. All implants in use are FDA approved. The position of the implants following insertion is typically sub-pectoral, or behind the major muscle of the chest. This provides a smoother, more natural slope to the breast and the implants are generally difficult to detect. Occasionally the implants may be positioned in front of the muscle if a small implant is being used.
Implants may be inserted through one of three different approaches. The peri-areolar incision is designed to extend along the border of the pigmented areolar skin and the clear skin beneath the nipple for a length less than an inch long. This incision heals rapidly with a nearly invisible line. The trans-axillary or underarm incision allows the plastic surgeon to place the implant without creating any scars on the breasts. An endoscope, which is a small fiberoptic video camera inserted under the pectoral muscle, allows the plastic surgeon to see inside the space that he is creating for the implant through a small incision away from the breast. This ensures proper placement of the implants for a natural appearing breast following augmentation. The infra-mammary incision is occasionally used for implant placement resulting in a small scar under the breast just above the crease with the chest. Primary breast augmentation may be combined with a mastopexy, or breast lift, if the breast is ptotic, or droopy as is often seen after breast feeding or significant weight loss. This may require additional incisions around the areola or beneath the breast but the benefit is a much improved shape of the breast with the nipple raised to be centered over the implant.
Breast augmentation is performed in a hospital out-patient center and takes just under two hours with about the same amount of time spent in the recovery room before being discharged home. Patients may shower the day after surgery and usually wear a surgical or sports bra for comfort for several weeks following surgery. Pain medication and antibiotics are generally prescribed for several days following surgery and if desired a automatic delivery “pain pump” may be used. Follow-up visits with the plastic surgeon usually begin about a week after surgery.