Breast Augmentation: Breast Enhancements Through Implants & Augmentation

A woman has many choices to make her breasts appear larger, among them wearing a padded bra or silicone bra-enhancing inserts. But if you are looking for a more permanent way to bring balance to the curves of your body, finally fill out your female form or find the figure you lost after breastfeeding, the surgical placement of breast implants is the only proven solution to enhance breast size and shape. Most women who seek breast enhancement fall into two groups, according to New York City plastic surgeon Alan Gold, MD: "The younger woman who has always been dissatisfied with the size and proportion of her breasts, and the woman in her late twenties through forties who has lost volume due to pregnancy and whose breast shape may be drooping somewhat, but not enough to warrant a breast lift."

If you're considering breast augmentation, you have several choices. The first and most important is choosing a board-certified plastic surgeon who can explain and address all of your options and performs all of those options regularly. Other choices include:

> Incision location

> Implant location

> Type, size and shape of implant.

The decision about incision and implant placement is best done after a physical examination and a conversation with your plastic surgeon. Your body type will dictate the options appropriate for you.

Incision Location

The decision about incision placement is best done after a physical examination and a conversation with your plastic surgeon.

Around the nipple (Periareolar incision)

PROÊ Ê Usually a well-hidden scar.

CONÊ Nipple or partial-breast numbness is a potential side effect, but this can occur with any breast surgery, regardless of the incision placement. Although usually temporary, the loss of sensation could be permanent in some cases. Dr. Semlacher adds that contrary to previous concerns, Canadian studies demonstrate that this incision does not affect the ability to breastfeed.

In the armpit (Axillary incision)
This incision requires the help of an endoscope.

PROÊÊÊ A shorter, less visible incision.

CONÊÊ Can only be used with saline implants because implants must be filled after placement. Some surgeons find it more difficult to obtain reliable symmetrical implant placement using this method. If corrective surgery is ever needed, it will likely be necessary to make a new incision rather than go through the original one.

In the fold of the breast (Inframammary incision)
Most widely used.

PROÊ Ê Some surgeons feel that it allows more precision in implant positioning.

CONÊ A short, visible scar in the breast crease.

Once the incision is made, the breast implant is inserted into the body in one of two positions:

ABOVE THE MUSCLE (Subglandular)

ÊThe implant is placed over the pectoral muscle and under the breast tissue.

PRO | A somewhat shorter recovery. Better for patients with mild, preoperative sagging who do not plan to have a lift procedure performed.

CON | The implant is closer to the surface and could be more visible under the breast tissue. The appearance of the breasts can be unnaturally high and rounded. There is a greater chance of irregular and hardened scar tissue around the implant (capsular contracture) with this placement.

BELOW THE MUSCLE (Submuscular)

The implant is placed below both the pectoral muscle and overlying breast tissue.

PRO | Less risk of implant visibility and capsular contracture and less mammography interference. More appropriate when the patient has a small amount of breast tissue. Implants are less palpable and less noticeable in terms of wrinkling. "The breast profile is also much more natural," says Carmichael, California, plastic surgeon Roy Semlacher, MD. "And, if a woman has weight changes, even due to pregnancy, the muscle supports the implant and therefore the breast and implant are less likely to sag."

CON | Two to three more days of recovery and somewhat more discomfort. May not be recommended for highly muscular or athletic builds.

When it comes to implant size, Dr. Semlacher advises that patients choose the most conservative implant size to achieve the enhancement they desire. "This will minimize the effects of gravity and weight and decrease the degree and rate of future sagging," he adds.