Breast Implants Augmentation

Breast augmentation provides an opportunity for some women to change their breast size to obtain a more satisfying physical appearance, allowing them to improve body image and enhance confidence in the way they present themselves.

Breast implants augmentation is a common procedure performed to enlarge small breasts. Dr.Shu will help you determine the most effective surgical approach following a thorough examination of your breasts, and he will explain the surgical procedure in a personalized fashion.

The type of implants used for breast augmentation varies depending on the patient. Silicone and saline implants are available for this procedure. Round implants ranging from low profile to high profile are commonly used. However, a consultation with your doctor is the best way to consider various factors to determine the best style of implants for your body.

Screening for Breast cancer using mammography and other imagine tests are required prior to surgery. Preoperative instructions include the discontinuation of certain drugs in order to decrease the possibilities of bleeding. Prophylactic antibiotics are routinely prescribed to prevent postoperative infection. Breast implants surgery does not generally interfere with the ability to breast feed.

Surgery Procedure

The goal of breast augmentation is to obtain a more natural-looking breast that transitions to the upper chest of the breast mound in a more appealing way. Dr. Shu prefers to use the inframammary (under the breast, in the crease) incision and transaxillary incision for placement of the implants in breast augmentation surgery. These incisions allow for convenient access to the sub-muscular level and will not damage the breast. Placing the implants underneath the the muscle typically produces a more natural look and also significantly decreases the amount of scarring around the implants. Furthermore, because the patient's own tissue covers the implants, there is lower chance of rippling or folding in the implants envelope.

The surgery includes the pre-operative period, surgical procedure, and post-operative period. During the pre-operative period, the patient consults with his/her doctor to make final decisions about the surgery, such as the size or type of implants used. For the surgery, local anesthesia is used. After the surgery, the patient spends a short amount of time for recovery.

Recovery

Following the surgery, the patient must be taken home by a family member or friend who can care for them the first 24 hours. Soreness is expected, and discomfort can usually be controlled with medication. Any bruising or nipple burning sensations will fade after about two weeks, and stitches can be removed after 7 days. Swelling in the breasts may take 3 to 5 weeks to go away. Patients typically return to work within a few days after the procedure.

Site of Incision

There are four common sites of incision in the breast augmentation surgery: underneath your breasts (inframammary), around the nipple (periareolar), in the armpit (transaxillary) or through the belly button (TUBA or trans-umbilical breast augmentation). All these approaches have advantages and disadvantages.

The disadvantages of the incision around the nipple include numbness, visible scar and difficulties with breastfeeding.

The TUBA technique can result in breast implants rupture during placement, undercorrection of certain breast asymmetries, incomplete control of shape, and bleeding. When properly performed in the experienced surgeon, it is an excellent scarless alternative to the other type of incisions.

The inframammary incision under the breast is the most common site of incision for the breast augmentation, the scar is usually hidden under the breast.

The transaxillary approach is getting more popular because the incisions can be made smaller and they are almost invisible (they are hidden in the skin crease in the top of the armpit.)

The Endoscopic Transaxillary Approach

Traditional breast implants surgery is a blind operation that has the difficulty in  intraoperative visualization of the surgical area. The use of illuminated surgical retractors and focused headlight has offered only a partial visualization solution. The addition of the endoscope has been is a major breakthrough in the area of cosmetic surgery. The application of the endoscope has substantially improved the accuracy and predictability of breast augmentation surgery.  It allows the cosmetic surgeon to create crease symmetry, muscle division, implants positioning and bleeding control under total endoscopic visualization with great control and ease.

Implant size and volume

The common sizes of breast implants ranges from 300 - 450 ml. Choosing your desired size can be highly personal. You may use breast implants sizers to determine the size you want. Take the time to decide what you will be happy with so you don’t feel the need to undergo a second surgery.

Saline vs. Silicone Gel Implant

The FDA has approved silicone gel breast implants for use in primary breast augmentation for any woman over the age of 22. Silicone implants has the disadvantages of a possible higher rate of capsular contracture, larger incisions, and the substantially higher cost. On the other hand, they provide the most natural look and feel ideally suited for women with a modest amount of breast volume.

What are the limitations of breast augmentation with implants?

Breast augmentation with implants will not improve nipple asymmetry, move your breasts closer together, lift droopy breasts, or remove stretch marks. Also, breast implants are not completely free of problems.

What are the possible risks and complications of breast augmentation with implants?

Anesthesia reaction, asymmetry, bleeding, breast droop, capsular contracture (hardening of scar tissue around implants), deflation (approximately 7%), displacement, hematoma, implants leak, infection, interference with mammography, keloid (thick scar), nerve damage, nipple numbness, pain, permanent numbness (risk is 15%), reactions to medications, rippling, rupture of the implants (often due to injury), seroma (pooling of watery blood), skin irregularities, sloshing, slow healing, swelling, symmastia (breasts merge into one mass), and visible scars. 

What are the patient recovery times after breast implants surgery?

After surgery your breasts will be very firm, high, and swollen. After about a month, the swelling will be gone and they will be lower, smaller, and softer. It may take several months for the implants to settle into a permanent position.

	Above the muscle	Below the Muscle
Pain Level	Mild to moderate discomfort; 1-2 weeks of pain medication	Moderate discomfort; 1-2 weeks of pain medication
Swelling	4 days to 2 weeks	2 to 12 weeks
Bruising	Up to 2 weeks	Up to 2 weeks
Numbness	1 to 2 weeks	Up to 2 weeks
Work	Return to work in 1 week	Return to work in 1 to 2 weeks. If job is strenuous or requires lifting, wait 1 month
Exercise	Wait 2 to 4 weeks	Wait 2 to 4 weeks
Final Result	1 month	4 months

 

What kind of anesthesia is used by Dr. Shu?

Dr.Shu performs the majority of the breast implants procedures, including the endoscopic transaxillary approach, under local anesthesia using a modified tumescent technique and intravenous sedation (twilight sedation).

What are the advantages of breast augmentation by fat transfer versus breast implants?

• Minimally invasive with less trauma to the breast
• No visible scars
• Can be done as an office procedure totally under local anesthesia
• Avoids tissue or foreign material (implants) rejection because the fat is an autologous graft
• Fewer postoperative complications
• Touch up procedures are easily performed
• Fat transfer does not make the performance on a future breast implants placement more difficult
• Body contouring with liposuction in the donor site