Breast Augmentation by Tenley Lawton, M.D.

Breast Augmentation - Overview, Saline vs Silicone

Breast size and shape is important to many women. Some women are genetically predisposed to have small breasts and others have large breasts. Breasts also come in many different shapes independent of their size. There are many women who have breasts which are different from one side to the next in respect to size and/or shape.

The breast is a gland which is made up of milk ducts and glandular tissue which is surrounded by fatty tissue. This is what gives the breasts their shape and feel. Factors such as weight loss, pregnancy and the effects of aging (gravity) can cause the skin to stretch which may cause the breasts to become ptotic which is a fancy name for sagging. As we age the amount of glandular tissue is often replaced by fatty tissue which also contributes to the decrease in fullness of the breasts as we age.

The two most common reasons women seek breast augmentation are complaints of small breasts and complaints of deflated appearing breasts after pregnancy or weight loss. Women often feel that small breasts limit their clothing choices as well as cause some dissatisfaction with body image. Breast augmentation surgery is designed to increase fullness and projection of the breasts but may not adequately lift the breast or correct the skin stretching which may have occurred with pregnancy or aging. It may be recommended to have a procedure such as a mastopexy in order to correct the skin laxity (excess skin) at the time of breast augmentation surgery.

Breast augmentation increases the size of a woman’s breast through the placement of an implant. This is considered to be a cosmetic surgery meaning that it is performed strictly for the benefit of personal desires for larger breasts and is not covered by insurance. It is designed to provide fullness or to restore volume which may have been lost due to pregnancy or weight loss. Implants can also be used to improve symmetry of the breasts.

Breast augmentation can be performed at any age after the breasts are fully developed, but there are regulatory restrictions on the use of breast implants in women younger than 18. There is no scientific evidence that breast augmentation increases the risk of breast cancer, autoimmune disease or any systemic illness. Breast augmentation does not generally affect pregnancy or the ability to breast feed. In addition to the positive aesthetic outcomes of breast augmentation, there is data that shows that many patients enjoy substantial psychological benefits, including enhanced self-esteem. A woman who is motivated by her own personal desires is most likely to be satisfied with the results of augmentation mammoplasty (breast augmentation).

Incision Placement

During breast augmentation, implants are inserted through an incision made in the skin which is appropriate for the implant. The three most common incisions are the inframammary - made just above the breast crease, periareolar -around the pigmented skin surrounding the nipple, or transaxillary- in the armpit. The implant is then placed into a "pocket" created by the surgeon behind the breast tissue (sublgandular) or behind the chest muscle (submuscular). Implant type, size, pocket placement as well as incision site will be determined based on your breast anatomy, desired increase in breast size as well as the surgeon’s judgement and expertise.

Saline vs Silicone

The outer shell of both silicone and saline implants is made of a solid silicone material. Solid silicone is widely used in implantable medical devices. In contrast, silicone gel implants are filled with silicone gel, which is a semi-solid and has a soft consistency. Saline-filled implants are filled with the same kind of salt water that is used in I.V. fluids.

Saline implants have a silicone rubber shell that is inflated to the desired size with sterile saline. Most implants have a valve that is sealable by the surgeon and the volume which is added can either be increased or decreased as needed to achieve the desired result. The size of saline implants can be altered, depending on the aesthetic or physical needs of an implant recipient. The size of silicone implants cannot be changed without actually changing the implant.

Silicone implants have a silicone rubber shell that is filled with a fixed amount of silicone gel. Silicone implants come in smooth or textured shell surface and vary in shape, profile, volume, and shell thickness. Most silicone gel-filled implants are not adjustable which is one disadvantage compared to saline implants.

All implants carry a risk of rupture. If a saline implant leaks or breaks inside a woman’s body, the salt water is simply absorbed into her tissue. If a silicone gel-filled implant ruptures you may require a radiographic procedure in order to determine the integrity of the implant outer shell.

Some patients may find that saline implants do not offer a natural look and feel and that silicone mimics this more effectively.

Saline implants carry many of the same risks as silicone gel-filled implants, including capsular contracture, infection, pain, and nerve damage. Implants, whether filled with saline or silicone, are not a lifetime device and may need to be replaced in your lifetime.

Mammogram

A mammogram is often recommended prior to having breast augmentation surgery. This may serve as a baseline examination which can both ensure current breast health as well as to be used for future comparison. Breast augmentation does require maintenance including yearly breast examinations for breast health as well as to evaluate the condition of the implants. It's important to know that breast implants are man made devices which are not designed to last a lifetime. You should plan for an annual examination by your plastic surgeon to see if the implants need to be replaced.

Where to Begin?

A consultation with a board certified plastic surgeon is the first step to learn if breast augmentation is the right procedure for you. A consultation will help to educate you about the procedure and to answer all questions that you may have regarding the entire process.