Breast augmentation is one of the most common cosmetic procedures performed today. There are many reasons why women seek breast enlargement. Some women seek breast augmentation because they have small breasts and wish to balance their figures. Others have lost breast tissue simply through aging or childbirth, and some want to correct breast asymmetry that may be congenital. In some cases, if a woman has lost a lot of breast tissue and does not like the appearance of her breasts, she may need a lift in addition to breast implants.
Implants can be placed either above or below the muscle. I believe this is the most important decision. The best location for implant placement will be decided by you and your doctor, depending on several factors: the appearance of your breasts, the size of the implant used during the consultation time, and the expected/anticipated outcome. Generally speaking, when implants are placed above the muscle, the recovery time will be slightly less than when placed below the muscle.
There are four possible incisions that can be used to place the implant in the selected pocket:
Near the areola: Through an incision near the areola (the outer edge of the nipple).
Under the armpit: Through an incision under the armpit.
Across the navel: Through the navel.
When I place implants through the navel or armpit, I use an endoscope, which allows me precise positioning and lets me watch on a video screen. This makes the actual procedure faster, and the patient has little or no bruising after surgery. When using an endoscope, there is no tearing and ripping of muscles and tissues, thus reducing recovery time.
Method near the areola:
The incision is usually made from the lower part of the skin near the areola, joining it with the skin of the breast. Implants can be placed in a pocket either above or below the muscle. When this incision heals well, there will be a fine white line, which is barely noticeable upon examination. There is no loss of sensation in the nipple when using this method. Unless you show someone, this incision is always hidden.
Incision placed under the breast or just above the fold:
Implants can be placed in a pocket either above or below the muscle. This incision provides the best access to breast tissue and is used in cases of congenital or developmental deformities. When healed, this incision will be barely noticeable after a breast examination, leaving a fine line. Unless you show someone, this incision is always hidden.
Method across the armpit:
This method uses the existing pre-fold in the armpit. Implants are placed in a muscle pocket most often using this method. This method has been around for a long time, but the use of an endoscope has completely transformed it. The endoscope provides visualization allowing for the proper placement of the pocket in 90% of cases, with little or no bruising of the muscle. When the incision heals, it is almost invisible. There is no increased risk of infection with this method.
Method across the navel:
This is also known as the TUBA procedure. This technique has slowly gained traction, but works well on the right patients. Implants can be placed below the muscle or above the muscle. The rate of normal placement in a sub-muscular pocket is close to 15%. I prefer to use this technique when placing above the muscle. Recovery is fast, and in most cases, there is very little bruising.
Breast augmentation is ideally performed under general anesthesia. It can be done under local anesthesia, but the process takes longer and increases the risk of bleeding complications. The procedure takes from 30 minutes to an hour to perform. Implants placed in a sub-muscle pocket will sit high for two to four weeks. Most patients who undergo the procedure on Thursday can return to work the following Monday or Tuesday. They will most likely be sore and tired but still able to perform normal duties. The implants will feel firm for a couple of months, and you should see your final results around three months.
Determining size can be tricky for patients to understand and find out. Instead of cup sizes, we measure in different volumes or cc's. If two friends receive the same size implant but start with different amounts of breast tissue, they will end up being different sizes. We address this issue by measuring the width of the breast and selecting an implant with a similar diameter. Then, we have the patient try on implant sizes to get an idea of size and volume. This is just a rough estimate, but it helps patients translate into volume size. We also offer photographic services during consultations so that patients can take home photos of what they might "look like" afterward to see what size they prefer.
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