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Breast Augmentation Before and After Photos
Saline or Silicone - A conversation with Dr. Mark Peters
Breast augmentation is one of the most common cosmetic surgical procedures performed with over 250,000 cases in 2003. The resurgence of the popularity of this procedure is attributed to the use of saline-filled implants instead of silicone gel filled, which has made women more comfortable with regards to the safety of the product. A majority of women considering breast augmentation have similar objectives in that they desire an enhanced self-image and more feminine appearance. Whether it is due to a loss of breast volume following the birth of a child or never having had a great deal of breast tissue, breast augmentation is an excellent method to achieve your aesthetic goal. The positive effect on her sexual life and interpersonal relationships has been noted.¹ One study has found that 96% of women felt that the operation met their expectations and 97% stated they would undergo the operation again.
The consultation often centers around the desired size of the breasts. Frequently the patient will state "I don't want to come out like Dolly Parton…but I want to get my money's worth." Several factors are used to determine the desired postoperative size of the breast. Clarifying the goals of the patient and the approximate desired cup size is central to the initial consultation. With that said, I cannot promise the final volume of the breast will end up at the desired cup size…no one can. My experience will allow me to determine the final volume based on a number of factors such as physical stature, skin condition, and specific chest measurements. I will be able to determine a suitable range of implant sizes for you and provide a breast volume proportional to your body.
Saline implants have become the device of choice for primary breast augmentation since the FDA placed a moratorium on silicone gel filled implants in 1992. Several other types of fillers such as soy bean oil, triglycerides, and saline hydrogel continue to be evaluated with clinical studies. In May 2000, the FDA approved two companies, Mentor and McGhan, to continue to manufacture and market their saline filled implants.
The silicone shell of the implant has either a smooth or rough surface. The initial intent of the rough surface was an attempt to decrease the incidence of capsular contracture (see section on potential complications). While this was effective in reducing the incidence in silicone gel filled implants, no significant difference occurs in saline filled implants. I prefer the smooth surface because it allows the implant greater mobility in the pocket and is less easily felt than a rough surface implant. With regards to the contoured, or teardrop shaped implants, I have not found a significant difference in the final breast shape. A recent study³ confirmed my own experience by demonstrating that the final breast shape is often more natural with a smooth, round saline implant.
The silicone gel filled implant cannot be used for primary augmentation of the breasts. There is, however, an ongoing clinical investigation conducted by the implant companies which allows patients with certain physical conditions to be included in the study. Dr. Mark Peters is one of the physicians who is participating in this study. When a patient meets the criteria, such as breast reconstruction, congenital deformities, and severe sagging of the breasts, they may be offered the use of silicone gel implants.
Location of the incisions is very important and there are multiple factors which influence the selection. Generally, there are three accepted approaches to placing the implant.
- The most common is the inframammary incision, which is located in the fold where the breasts and the chest meet. There are several advantages to this incision: provides easy access for the surgeon, better visualization, and allows for more precision when creating the "pocket" for the implant. The disadvantage of this incision is its location on the breast itself.
- This also applies to another approach, which is the periareolar incision. It is located at the edge of the colored area of the breasts in a half circle. This incision is considered the most versatile. While the areola does provide an excellent "camouflage" of the incision for some patients, it also has a higher incidence of affecting the nipple-areolar sensitivity, albeit very rare occurrence.
- The last incision is the transaxillary (armpit) incision. Its obvious appeal is that there is no scar on the breasts. The disadvantages of this approach are that if a revisional surgery is required, you will most likely require another incision (either inframammary or periareolar) to correct the problem; and it is an incision that can be seen while wearing a bathing suit for example.
All of the incisions that are utilized generally produce good quality scars. Each patient presents with certain anatomic variables that suggest one or more choices as superior options. I find that it is best not to rely rigidly on one incision type. We will discuss the options that are available to you and determine which incision would best suit your needs.
Over or under the muscle? A majority of implants are placed beneath the pectoralis major muscle, while the use of an implant above the muscle still may be the best option in some cases. When the implant is placed below the muscle, the additional "tissue buffer" usually provides the coverage needed to minimize the ability to see or feel the implant. There are, of course, other practical advantages to placing the implant beneath the muscle such as a lower incidence of capsular contracture and less bleeding. The main disadvantage of placing the implant below the muscle is occasional difficulty in achieving cleavage, which varies according to the anatomy of the individual.
The potential complications of having breast augmentation are mainly local in nature. Bleeding and infection occur in less than 3% of cases. Capsular contracture is the complication which is least understood and most controversial. Basically, the scar tissue that normally forms around the breast implant becomes "hard" and contracts. The exact cause of this complication is unknown but there is a great deal of evidence pointing to a low-grade infection around the implant. Over the past several years, I have developed a protocol to minimize the development of capsular contracture. While the literature reports a contracture rate of around 5-8%, I have experienced less than one percent capsular contracture rate using this protocol.
Deflation of the implant occurs in about 3-5% of patients. The deflation is usually the result of a valve malfunction. The Mentor Corporation has a lifetime guarantee on the implants and for a limited time, the company will also provide a monetary stipend toward the cost of the surgery. Other potential complications include asymmetry of the breasts, changes in the nipple-areolar sensation, and an effect on the ability to read and interpret mammograms. With regard to the mammograms, there is a special technique to visualize the breast tissue which must be utilized. This may result in a greater exposure to radiation over a lifetime.
There is often a question of whether the appearance of the implant will change significantly over time. These are, of course, difficult questions to answer and varies from patient to patient. A majority of patients who undergo secondary surgery are simply wanting to have larger implants. In general, the results are regarded as long-lasting, but are subject to normal effects of aging on the skin, pregnancy, and weight changes.
The operation is performed on an outpatient basis and under general anesthesia. Dr. Peters performs his surgeries in licensed facilities. You will be scheduled to meet with the nurse at least two weeks prior to the operation. A detailed packet outlining expectations and postoperative care, prescriptions, and any final questions about your procedure will be addressed.
Patients begin "massage" of the breast which mobilizes the implant to maintain the pocket created in surgery and soften the scar tissue after their initial visit postoperatively. This is to be performed by the patient four to five times each day for ten minutes during the first three weeks following the procedure. Sutures are removed between two and three weeks postoperatively.
When the implant is placed beneath the muscle, your recovery time is expected to be 7-10 days, while those placed above the muscle may be 3-5 days. A 6 week time period is needed for the formation and stabilization of the capsule around the implants. You should expect that you will not return to your regular exercise routine for 6 weeks. You will wear a sports bra for a majority of the first six weeks and underwire bras are not recommended until after the 6 week window.
Breast Augmentation Before and After Photos |
