Breast Augmentation San Antonio
Augmentation mammoplasty is the surgical procedure that involves the placement of implants to increase the size and improve the shape of the breasts. It is one of the most popular plastic surgery procedures. The purpose of this increase in size is to improve body proportion rather than to make your breasts the most noticeable part of your appearance. Some women seek breast augmentation because they never developed much breast shape or the breast is not the size they desire. Other women as a result of pregnancy, or breast-feeding, or weight loss have lost some volume from the breast. Their skin can appear loose and wrinkling and the nipples can fall.
Implant placement can increase the width of the breast as well as the projection. Some women who have a minor degree of looseness of breast skin can solve the problem of minor sagging of tissues with breast augmentation alone. It is the relationship of the skin envelope to the volume of both your own breast tissue and that of the implant that will determine how perky your breasts look. If your breast is significantly sagging placing an implant alone will not solve the problem. Some doctors place oversized implants so that the skin envelope in these saggy breasts can be stretched. This is not a good strategy. To solve the problem of significant drooping of the breasts, a breast lift may be one at the same time as the placement of implants. Implants can also be placed to fill out a particular part of the breast, such as the upper pole when performing a mastopexy.
The ideal patient for breast augmentation is physically healthy and dissatisfaction with the size of her breasts is based on proportion. Choosing implants that are too large for your frame is a mistake that does not beautify your appearance. Your breasts should blend with your appearance and not protrude too much. If you desire an elegant look on a Saturday night it should require a bra. If you are athletic and wear work-out clothing you should not be conspicuous. Other patients that benefit from breast augmentation have asymmetry of breast development. A third group of patients may have unusual shaping of the developed breasts and this can be improved with a combination of breast lift and implant placement.
Breast implants are manufactured based on a diameter and a projection so that implants have somewhat of a cone shape. All breast implants are made with an envelope or shell consisting of silicone rubber to surround the filling material. Saline breast implants are filled with saltwater using a valve at the time of surgery. Saline implants leak more often than gel implants, but when they leak the saltwater is absorbed by your tissues without consequence. Saline implants, therefore have the benefit of early detection of leakage. Saline is heavier than silicone gel so that saline implants may feel heavier. The saltwater acts like a hydraulic device so that it feels more firm than gel implants. Some patients complain of folds or scalloping of saline filled implants. Saline implants are most often placed under the pectoral muscle. The FDA directs that women under the age of 22 are limited in choice to saline.
Silicone gel filled breast implants have changed significantly in their construction over the last 40 years. I currently use gummy bear breast implants because the silicone gel inside the implant is more cohesive and thicker than older style silicone implants. I particularly like the feathered edge effect of these gummy bear implants. While saline implants can look like a round the ball these gel implants have a more gradual transition to your own body shape at their edge. The silicone rubber envelope of a breast implant can either be smooth or textured. Smooth breast implants are more often placed underneath the pectoral muscle to reduce the risk of capsular contracture. Implant massage is strategy that patients use to remove the implant within its pocket to reduce the risk of capsule contracture. Textured implants often are more limited in their movement and can be placed either above or below the pectoral muscle. After you begin to heal around the pocket surgically made for implant placement, your body will form a layer a scar tissue (called a capsule) around the implant. It is this capsule of tissue the can in some cases tighten and create a capsular constracture.
Your breast augmentation procedure begins with a consultation. At this time, I will ask you about your motivation for surgery and what you expect from the results of breast surgery. Your previous medical history and family history of breast cancer is important to assess. We will evaluate all of your current medications and supplements so that we can make the surgical procedure safe. Your breasts will be carefully examined and if appropriate, based on her age or family history of breast disease, a mammogram will be requested. At the time of the examination is important to assess your posture as many people stand with one shoulder higher than the other, which can be translated into a breast sitting lower on that side. The relationship of the nipple to the fold undr the breast is an important standard that tells us whether your breast is droopy or not. The balance of breast tissue from one side to the other is examined so that equal volume implants or volume adjusted for sized side difference can be chosen. The most important part of the examination is to determine that you’re breast is free of nodularity or active disease. Photographs will be taken for an additional assessment of your posture, breast size and breast position on your chest wall. The width of your breast on each side will be measured as will be the height of your breast from the fold below the breast to the appropriate position where the implant will reside. We call this the footprint of the breast and it determines the proper width of your implants. Each of the different implant manufacturers provided specifications to determine the volume that’s appropriate for an implant of a measured width. It is this footprint of the breast that’s more important in determining the appropriate implant size than any other measurement. When implants are chosen that or too wide for your chest wall there will be an increased risk of complications. Some of the support of the breast is lost by the extension of surgery for too large implants and the implant may fill out areas which are not aesthetically appropriate for breast augmentation. It is important to see that beauty in breast shape comes from gentle curves and appropriate size. When implants are used that are too large for patient’s chest they appear more rounded and lose some of that gentle teardrop curve and a natural appearance that we desire. We will discuss with you a recommendation of incisional placement, implant design and shape, and procedure and the likely outcome. The consultation is an important time to discuss potential risks and complications as well as to answer all of your questions. I see patients on 2 separate occasions at so that we can generate information and answer all your questions, so that you can gain confidence that you’re making appropriate decisions.
RISKS AND COMPLICATIONS
It’s important to understand the risks and potential complications of breast augmentation. Surgical decisions are made based on comparing a benefit to you of enhancement of self-esteem and more improved proportion against the risks and potential complications of surgery. Complications can be divided into early surgical complications and problems that occur based on the placement of an implant implantable device. The initial risks relate to anesthesia, postoperative bleeding, infection, alteration in nipple or breast sensation. Scarring of the initial incision is something that is evaluated over time and sometimes requires scar cream or steroids to improve. The implant can migrate and this is especially common when a smooth surface saline implant was placed behind the pectoral muscle. Implant leakage or rupture is easily detected with saline implants, but more difficult with gel-filled implants and may require MRI studies to evaluate. Each of the implant manufacturers provides an appropriate warranty for complications relating to their device. Dr. Levine and will go over the warranty in detail for the implant that you choose.
Capsule contracture is a problem relating to the scar tissue that patients form around any implant, which can form tightness and thickness which would make the implant move position and feel firm. The reason for capsule contracture is incompletely understood. Seroma or fluid accumulation around any implantable devices is common in small volume but large amounts of fluid is something to be evaluated. It’s important to know that breast implants may not last year lifetime and that future surgery may become necessary, regular examinations of your breasts surgery will help determine the success of your result. Dr. Levine will see you at least twice for examination and consultation prior to your procedure. He will evaluate your request for implant size based on the footprint of the breast and discuss the choice of incisions for insertion of the implant. Prior to surgery, you will be asked to get a blood test and appropriate evaluation of your current medications. I may asked to call your family physician for information about your medical history. Patient’s will be asked to stop smoking and avoid taking aspirin and anti-inflammatory drugs as they may increased bleeding.
All breast augmentation surgery is a hospital out-patient procedure. A board certified anesthesiologist will provide general anesthesia so that you are safe and unaware of the operation. The key to the reduction of risk is to have a carefully controlled environment for surgery. That is the reason that Doctor Levine performs breast surgery at the Methodist Hospital rather than an out-patient facility of medical office. When you are asleep on the operating table the skin of her breast will be prepared and scrubbed with 3 different antibacterial solutions. At the beginning of the procedure the nipples are covered with a sterile plastic. After the incision is made, which is either at the inframammary fold or around the areola, careful dissection to minimize blood loss is performed to your breast tissue to the underlying pectoral muscle. Most primary breast augmentations are performed in the dual-plane position. This means that the implant is placed partially under the pectoral muscle and partially under the breast. The part under the breast is in the lower pole of the breast footprint so that we gain more projection in this area. The muscle above prevents a shelf from forming in the upper pole of the breast, which would make your implants obvious. Prior to the placement of the implant the space which is developed for breast augmentation is irrigated with a triple antibiotic solution and a no touch technique is utilized. The use of a Keller funnel assists in placing an implant after being washed in antibiotic solution and position. All of these procedures help us reduce the risk of infection. Incisions are then closed in layers after we are sure that implants are in balance position from side to side. There may be some postoperative swelling after discharge from the hospital. Dr. Levine will see you the following day. Subsequently there will be a schedule for return follow-up visits so that we can ensure and optimal breast augmentation result. The best strategy is an annual examination by to evaluate your breast health and implant integrity. Over time, and possibly the consequences of additional pregnancy, hormonal factors and gravity your breasts can change and in addition breast implants may need to be replaced.
Additional information about augmentation mammoplasty is provided on the website for the AmericanSociety of Plastic Surgeons in the American Society for Aesthetic Plastic Surgery both of which Dr. Levine is a member. In addition, on this website are 3-D animations, which show a schematic of the procedures as performed. Having breast implants has given so many women fine new confidence. We welcome your consultation visit you may determine if breast augmentation is appropriate for you.