Breast implant surgeries are performed to enlarge small breasts, underdeveloped breasts, or breasts that have decreased in size after childbearing. Dr. Ewing will help you determine the most effective surgical approach following a thorough examination of your breasts. He will discuss with you the various alternatives of anesthesia available for your case, he will describe the surgical procedure, what results can be expected, and the possible risks and complications.
Screening for breast cancer using mammography and other tests such as ultrasound or MRI are required prior to surgery. Preoperative instructions include the discontinuation of certain drugs in order to decrease the possibilities of bleeding. Prophylactic antibiotics are routinely prescribed to prevent postoperative infection. Breast implant surgery does not generally interfere with the ability to breast feed.
Three general types of breast augmentation surgery are currently available: saline implants, silicone implants, or breast augmentation with fat injections (autologous fat transfer).
Breast augmentation with saline or silicone implants is performed through skin incisions placed either under the breast (inframammary), within the areola (transareolar or periareolar) or within the armpit (axillary). Saline breast implants may also be placed through an umbilical incision (transumbilical breast augmentation or TUBA). Endoscopic breast augmentation or endoscopy-assisted breast augmentation refers to techniques in which a surgical telescope is used to create the space for the implant. Transaxillary endoscopic breast augmentation is the most common type of endoscopy-assisted breast augmentation.
The space in which the breast implant is place is known as the surgical pocket. The implants may be placed in a surgical pocket either under the chest muscles (subpectoral or dual-plane) or over the chest muscles (subglandular). With the exception of transumbilical breast augmentation, a third surgical pocket is available over the chest muscles, but under the fascia which covers the muscles – the subfascial plane.
Both saline breast implants and silicone breast implants are available in two basic shapes: round and anatomic. Each shape is available in three different profiles or degrees of forward projection from the chest: low profile (moderate), medium profile (moderate plus), and high profile. The external surface of all breast implants is available in either smooth or textured varieties. Saline implants are designed to be inflated after they placed into the surgical pocket. Silicone implants come pre-filled and require larger skin incisions for insertion.
There is no single technique of breast augmentation which is best for all patients or for all surgeons. Each method of breast augmentation has advantages and disadvantages which must be considered. Excellent cosmetic results can be achieved with any technique when it is well performed in a properly selected patient with a properly fitted implant.
Breast augmentation using the patient’s own fat (autologous fat transfer or fat micrografting) is a procedure that involves removing fat from one or several areas of the body by liposuction and then injecting that fat into the breast tissue to achieve a cosmetic augmentation. Modest augmentations are possible with current fat grafting techniques. Be aware that unlike saline or silicone breast augmentation, some loss of the implanted volume is typical in the first three months after surgery. In order to compensate for this effect, many women are augmented to a larger initial volume, or elect to do two procedures so achieve a larger final outcome. Another factor to consider is that the mammographic changes created by implanted fat may make the future interpretation of such studies difficult. For this reason, it is recommended that patients considering this type of breast augmentation receive proper mammographic screening prior to surgery and not have an elevated risk for breast cancer.