Breast Augmentation
with Dr. ThomassenWhat is A Breast Augmentation?
What implants are used in a breast augmentation?
Breasts implants are made of a durable silicone shell called an elastomer, filled with either a silicone gel or saline. The shell can be either smooth or textured; however, textured implants have fallen out of favor due to their association with breast implant associated Anaplastic Large Cell Lymphoma (Bi-ALCL). The gel inside silicone gel implants is made of a highly cohesive form of silicone that avoids leaking if the shell were to break.
What Size Implants Are Used in Breast Augmentation?
Implant sizes vary from around 100 ml or cc (cubic centimeters) to over 800 cc. Silicone implants come in fixed sizes that vary by as little as 15 cc in certain ranges. Saline implants are filled with sterile saline at the time of implantation and therefore can have more size variation than silicone. This is useful in women that have breast asymmetry and may need a slightly bigger implant on one side than the other. Some women may desire to have significantly larger implants and in these cases, several thousand cc's of saline can be placed in saline implant shells sized for 800 cc.
What are the different shapes of breast implants?
Breast implants come in different shapes as well as sizes. They vary in their amount of projection and width. The more projecting and narrow implants are called High or Ultra High Profile Implants. The flatter, wider implants are called Low or Moderate Profile Implants. In general, women that desire a more voluptuous breast choose High Profile Devices. Women that desire a more natural look choose Low or Moderate Profile Devices. Another consideration is the width of the chest wall. If a woman has a narrow width, a higher profile device is needed to match the narrow chest wall.
through what approaches are breast implants placed
The most common approaches for augmentation mammaplasty are using the periareolar incision and the inframammary fold incision. There are also the transaxillary and transumbilical approaches that may require special endoscopic equipment. The selection of the approach is dependent on the your anatomy after careful examination by Dr. Thomassen
Where are implant placed on the chest wall?
Once the approach is decided, the next decision is where to place the implant. The two most common locations are the submuscular, or subpectoral plane. In this plane the implant is placed under the pectoralis major muscle. The other option is the subglandular or prepectoral, located directly underneath the breast tissue. There is also a subfascial location in which an implant is place under a thin layer of fascia or dense connective tissue that covers the muscle. However this option is still considered somewhat controversial regarding its benefits. Most surgeons opt for the subpectoral option because it has less risk of capsular contracture, a condition where the breast implants become hard.
Who is a Good Candidate for a breast augmentation?
Preparing for your breast augmentation procedure
Medications
Smoking
Mammogram and Ultrasound
Physical Exam
Dr. Thomassen will examine you to determine how best to undergo the surgery. Key information gathered in exam is your current breast cup, asymmetry, any axillary or breast masses, and the presence of breast ptosis or excess breast droop.
Breast ptosis is evaluated based on the relationship of the nipple-areola complex (NAC) to the inframammary fold. For patients with a NAC located at or just slightly below the inframammary fold, a breast implant will provide a slight lift that will correct a mild sag. For patients with more severe ptosis or significant asymmetry, a lift or mastopexy may be required for optimal results.
Choosing the Breast Implants
Dr. Thomassen will take measurements of your chest width, breast skin pinch thickness, and breast skin stretch. These measurements help narrow the options of implant sizes and shapes suitable for your body frame.
Dr. Thomassen will then use implants placed inside a thin bra to simulate your augmentation in the office so you can visualize your result. When sizing for an implant, you should pay attention to the weight of the implant as well as the appearance over a fitted blouse to get an idea of which implant will give you the look you want.
Preoperative Clearance
Days before Surgery
- Avoid strenuous exercise in the days leading up to your surgery. You should be well rested leading up to your surgery date. Also avoid excessive sun exposure.
- Refrain from alcohol the week before surgery.
- Pick up your prescriptions with plenty of time before your procedure. Set up a comfortable recovery area at home and plan your meals including a light clear liquid meal for the first night.
- Plan for someone to be with you for 24 hours after surgery.
- You will receive a call from our Operating Room Nurse a few days before your procedure to go over the consent and any preoperative details and instructions to make sure you are ready for surgery.
- You will recieve a call from our Anesthesia Provider the day before surgery to go over your medications and discuss details about your anesthesia.
- Use antibacterial soap when showering the day before surgery.
- Remove any piercings or jewelry you may have before coming in for the procedure.
What to expect the day of surgery
The day of surgery you will arrive at our office at the appointed time. Wear something loose and comfortable that you can easily remove and put back on after the procedure. A button down shirt and loose pajama bottoms are ideal.
You will meet the surgical team, including a preop nurse and anesthesia provider. Dr. Thomassen will answer any final questions you may have regarding the procedure and do some markings.
What Anesthesia is Used for a Breast Augmentation Procedure?
How long does the breast augmenation procedure take?
What is the Recovery like for a breast augmenation
Your first follow up with Dr. Thomassen will be in 1-2 days after surgery. You will have small steri strips or tapes along your incisions. Dr. Thomassen will remove these on your second visit. Your breast size will be larger in the first few weeks due to swelling.
You should not undertake strenuous exercise for at least 4 weeks after surgery. Light walking is fine the first week and you can gradually increase excercise as you feel better.
You will be started on implant mobility excercises at 2-3 weeks after surgery. Implant mobility exercises are important for two reasons. First, they appear to be helpful in preventing capsular contracture. Second, as patients are able to stretch their tissues with the exercises, they are able to become comfortable more quickly.
