Breast Augmentation Explained

During the summer, people generally start to think about outdoor sports and other fun in the sun activities. For some women, this is followed by the thought, “How will I look in my bikini or my jog bra?” which is often tied into breast size and shape. Breast augmentation is a fairly easy, 45-minute procedure that has come a long way since its inception in the 1960s.

There are basically two types of implants: saline-filled and silicone-filled, both of which consist of the same silicone shells. Saline implants are balloon-type devices filled with sterile saline to reach a specific size. The pros for this type of implant include ease of placement as well as ease of adjustment of size during the operation. One of the cons of this implant is that the material inside is very liquid, which can lead to wrinkling of the shell that is easily visible under the skin. The new, more popular silicone-gel implants, also known as “gummy bear” implants, are a major improvement compared to older silicone implants. The older silicone-gel implants are very liquid in consistency and, when ruptured, can spread to surrounding tissues causing an increase in scar production. Remember the silicone scare in the 1990s? Well, it was just that, a scare! There have been 26 major research studies from world-class institutions that concluded silicone does not cause disease or immune disorders. People can actually absorb more silicone from their drinking water than from the silicone inside these implants.

The new and improved cohesive gel implants look and feel more natural with little to no wrinkling of the skin over the implant. Why is that? Imagine a gummy bear. When cut in half, nothing inside spills out, and that is exactly how these new, cohesive-gel implants work.

Implants are produced in a variety of shapes and surface textures. They come in smooth, textured, or polyurethane covered surfaces, along with round and teardrop shapes. My bias is the round, smooth gel implant. When a woman stands up straight, the round implant settles into a teardrop shape. When she reclines or lies down, it becomes more round in shape, which is what happens with a normal breast. Textured surfaces were theoretically developed to decrease the risk of capsular contracture, which is the body’s natural defense response that causes scar tissue around the implant. However, this has not been my experience. I feel that a round, smooth implant has fewer capsular contractures than the textured implants. Nationally, 85% of implants placed are smooth and round, and women are experiencing exceptional results.

Placement of the implant can be subglandular (under the breast tissue), submascular (under the muscle), or dual plane (partially under the muscle). Most implants are placed in a dual plane position with the subglandular being the second most common. Patients who are very thin or have very little breast tissue tend to have better contour and results if the implant is placed behind the muscle.

How does a woman choose the right size for her frame? There are many options available to help with this decision. Bras, which can be filled with an implant to simulate appearance after the procedure, are available as well as computer software where surgeons can upload a picture of the patient and digitally manipulate the size and shape of the breast. I feel that this particular method is one of the most accurate ways to choose an implant size. I also ask all of my patients to bring in a picture of what they would like to look like post augmentation so that we are on the same page, and I bring these pictures into the operating room where my team and I do our best to give the desired results.

Most women’s clothing is made for a C-cup breast; therefore, I feel there are fewer complications if the patient stays in the “C” to “small D” size range. With larger implants come larger complications. However, I try my best to accommodate each patient’s goals as breast augmentation can be a very empowering surgery for a woman with little to no breast tissue, tremendously boosting self-esteem and confidence. Often, a woman’s breast tissue decreases in size after childbirth and breast-feeding, so this procedure can be a great way to help Mommy get back to feeling like herself again. And everyone deserves to feel great about herself!

All cosmetic procedures come with risk of complications, such as bleeding and infection, though these are quite rare. With breast augmentation surgery, capsular contracture is the most common problem surgeons have to combat. During the procedure, the surgeon creates a pocket either under the muscle or breast tissue in which the implant is placed. In rare cases, the pocket can close in and become smaller, causing the implant to feel hard and look distorted. I discuss using vigorous breast exercises, massage, and anti-inflammatory medications to prevent scarring from happening with my patients both before and after surgery.

In general, breast augmentation is a very safe and quick procedure with very little downtime. Most patients can resume work and simple day-to-day tasks with 2-3 days of recovery, allowing many women to have the procedure on a Thursday or Friday and return to work on Monday. However, there are some post-surgery physical activity and exercise restrictions that are important to consider. If a woman’s implant is placed subglandularly, she can resume aerobic activities two weeks post-surgery. If the implant is placed submuscularly, she may resume aerobic exercise three weeks post-surgery. I promote walking right away to promote circulation of blood flow. For patients with submuscular placements, I highly suggest avoiding heavy pectoral exercises (such as bench press, for example) all together because it could lead to herniation of the pocket, thus requiring additional surgery down the road. Another popular sport in our area is tennis, which requires vigorous back and forth strokes. For sports like this, I suggest waiting 4-6 weeks post operatively and that the patient ease back into exercise slowly. I encourage patients to “listen to your body,” as they know best what they can handle!