BREAST AUGMENTATION

You’ve decided you want to do a breast augmentation. You’re going to see a doctor for a consultation. You want to ask him or her three important questions.

The first question you want to ask is, “Are you going to put the implant over or under the muscle?” That’s an important one. Most doctors put the implant under the muscle. By putting the implant under the pectoralis major muscle, you’re able to camouflage a bit of the implant so it doesn’t look as round or as unnatural. It also has a protective effect to prevent scarring over the implant which is an important consideration later on.

The second question you want to ask your doctor is “What kind of incision are you going to use?” Generally, there are three widely used incisions. One goes under the arm, that’s called a trans axillary approach and the benefits of that are that it’s not on the breast, so you don’t have a scar on the breast. However, if you’re going out to the beach a lot and playing volleyball or doing something like that where you raise your arm up, you might see the scar. The second place the scar can be placed is around the nipple areolar complex which is just on the bottom edge of the pigmented part of the nipple that really heals very nicely. Most times you can’t even see a scar, but every once in a while, that scar will be like a line that’s visible so that’s something to consider. The other thing is when you’re going through the nipple portion of the ducts that go to the nipple which might affect breastfeeding later on. The third approach is under the breasts itself. It’s called an infra memory fold incision. It’s kind of in that fold area so the only way you could really see it as if you kind of look up from underneath. That generally heals real well. The advantage of using that incision is it’s hidden, number one, second, it allows the surgeon to really shape the pocket for the breast implant in the best way possible to give the best results possible.

The third question you want to ask you surgeon, and it’s something you’ve already probably don some research on, is “What kind of implant are you going to use?”

There are basically two types of implants. There’s saline and silicone. What we’re referring to specifically is what makes up the implant and what’s on the inside of the shell. Saline is saltwater. It’s a very safe natural material, if it leaks, it gets absorbed by the body so a lot of people like that as part of the safety factor of having an augmentation. With saline implants, it doesn’t quite feel as natural as silicone implants do because it is saltwater which has a different texture of density compared to breast tissue, but it is a very popular implant.

Silicone implants have silicone gel. Silicone gel has a much more natural feel to it. It feels like breast tissue so when the implant is inside and you feel the breast, it actually feels real. It’s hard to tell that the implants are even in there. This is really good for patients that don’t have a lot of breast tissue covering the implant. If they just have a little bit of skin, just a little bit of breast tissue, silicones definitely are the preferred implants because it feels more natural.

Okay – You’ve decided you’re going to have breast augmentation and you’re all excited. You’re breasts are going to bigger, they’re going to look better, and you go to your doctor and he says “You know, you might need a lift.” And you think, “Why would I need a lift?”

I’m going to demonstrate. This is a breast, the breast has the bottom part called the inframammary fold. This is where your tummy ends and your breast skin begins. If your breast is at, and your nipple is above that inframammary fold, then you don’t need a lift. You can just get an augmentation. It’ll look great.

If your breast droops below that and your nipple is starting to fall below that fold as well – maybe it’s even pointing down or not looking like where it should – then that nipple position needs to be raised and the skin needs to be tightened so that breast can be put back into a perkier position, so to speak. That requires a breast lift. 

For breast augmentation, you have two main choices of implants: saline and silicone. Both implants have a silicone shell, but one is filled with salt water, known as saline implants, and the other is filled with silicone gel, known as silicone implants.

Saline implants are safe because if they leak, the salt water is absorbed by the body. They feel soft and are less expensive. Silicone gel implants are also safe and are more popular because they are slightly lighter and have a more natural feel and look in patients with little breast volume. Implants  come in many shapes and sizes. Some are designed to wider to properly fit a wide chest, while others are designed with more projection and a higher consistency to give a fuller appearance, especially in the cleavage area. 

Part of your consultation includes Vectra 3D imaging. This technology is an excellent tool that allows us to virtually test the shape and size implants that will best fit your body. Patients love to have a virtual simulation of what their breast augmentation will look like. Selection of breast implants depend on the body and chest wall proportions, breast anatomy, and patient preference. Together we will choose the implants that best achieve your desired results. 

According to the American Society of Plastic Surgeons, more than 300,000 North American women seek out breast augmentation and related cosmetic procedures every year. The best candidates for breast augmentation in Naples, FL tend to be women who maintain a healthy lifestyle and are within close range of their ideal weights.

Candidates need to maintain their good health both before and after implant procedures, and need to closely follow the pre- and post-operative guidance provided by their surgeon. Maintaining one’s weight is a key component of this guidance, as changes in weight can affect the size, shape, and proportion of the breasts. Smoking is also strongly discouraged, and those who smoke will be urged to quit.

Saline and silicone breast implants can reduce the appearance of minor sagging of the breasts, but those experiencing significant sagging often require mastopexy, which is more commonly called a breast lift. During your initial consultation, Dr. Gardner or Dr. Baccaro will evaluate your breasts to determine which procedure(s) will most likely provide you with the aesthetic results sought. In many cases, your surgeon may recommend that breast lift surgery be performed in conjunction with breast augmentation, as the best means for enhancing the size, position, and proportions of the breasts.

Silicone- and saline-filled implants can often appear to be too highly positioned on the chest for a time after surgery. This apparent high positioning is typically caused by breast tissue swelling and skin tightening due to the breasts’ increased volume. This should not be cause for alarm, though, as many women’s implants begin to “drop,” or settle into lower, more natural-looking positions after about 3 weeks. Note, though, that the settling process can take as long as six months.

Breast massage may work to a degree in speeding the settling process, but massage is not recommended for those who have opted for textured implants. Dr. Gardner or Dr. Baccaro will provide a full preoperative briefing on potential postoperative issues and concerns such as breast dropping for patients seeking breast implants in Naples, FL.

Naples Plastic Surgery utilizes a Vectra 3D breast augmentation simulator to demonstrate the potential outcomes of breast augmentation and breast implants. Vectra 3D images allow the patient to visualize from all angles how the breasts might look depending upon the procedure(s), and assists the surgeon and patient in fine tuning the desired aesthetic outcome.

Many women considering breast implants in Naples, FL struggle with deciding what type of implant is right for them. The choice between silicone implants, saline implants, or structured implants is not easy, and ultimately the woman seeking augmentation needs to make the choice. Saline implants are perceived as having the best safety profile, while silicone implants are popular due to their natural feel that closely approximates breast tissue. Structured implants, which use internal structuring with saline to approximate the look and feel of breast tissue serve as a recent compromise between the other two.

Along with saline and silicone implants, Naples Plastic Surgery offers the Ideal Implant® as its structured option. No matter which breast implant type chosen, Dr. Gardner and Dr. Baccaro have the requisite training, experience, skill, and cosmetic surgical artistry needed to provide you with the fuller, more youthful-looking breasts.

Breast augmentation scars are typically short in length and usually well-disguised within the creases beneath the breasts and can be further hidden by a bra or bathing suit top. Longer incisions going up to the nipple may be apparent in those who opt for a combination of breast enhancement procedures, such as a breast lift with implants.

Implants come in round or teardrop shapes, with the teardrop-shaped implants designed to display a more natural appearance. Round implants placed in the submuscular position can provide a similar natural-looking shape as well. The optimal implant shape varies on a person-to-person basis, so Dr. Gardner or Dr. Baccaro will thoroughly review breast implant shape options with you to determine which style will help you best achieve your aesthetic goals.

In most cases, breast augmentation does not impact the ability to breastfeed and there is no danger that breast implant materials, such as saline or silicone, will be passed onto the baby in the breast milk.

Typically, most patients are mobile within a day or two after surgery, and any resultant discomfort is kept under control with prescription pain medicine. You will be able to shower and tend to other personal hygiene regimens almost immediately and will return to our office for follow up examination and stitch removal (unless dissolvable suture was used) within a week. Sexual relations can be resumed as soon as the desire strikes, though the breasts need to be treated gently during recovery.

Patients are usually able to return to work within a week; however, any work activities requiring lifting, pushing or stretching of the arms should be conducted with care and modified or avoided to limit pain and discomfort. Submuscular positioned implants (which comprise the majority) generally take longer recovery times before becoming pain free. A return to exercise routines should also be done with care and attention to any discomfort. After two weeks of recovery only a few exercises are likely to impact the incision or breast implant placement, but strenuous exercises focused on the pectoralis muscles—such as bench presses or push-ups—should be avoided. Most patients can resume their full, vigorous workout routines after a month or so of recovery.

Following surgery, steri-strips are typically applied over small incisions and a surgical-recovery bra with minimal dressings is worn. This surgical bra will usually be used for a week or more. Depending upon your implants and surgery, your surgical bra may put pressure on the upper edge of the breast or implant to hold it in a lower position to account for implants that initially tend to sit high on the chest. This high position (see question regarding “implant drop”) is caused by the need for the fold under the breast to stretch into a new relaxed shape to account for the larger implant.

Once the breast implants have dropped into the desired position, you can opt for the bra of your choice. Those who have undergone a large breast augmentation should always wear a bra during exercise and even normal daily activities. Underwire bras can also be worn after the implants have settled into their desired positions. Dr. Gardner or Dr. Baccaro will provide you with further details regarding implant dropping and appropriate bra usage.