Breast Augmentation – Implant Profiles, Incisions, Recovery, and Risks
Women choose to undergo breast augmentation for many reasons. Some lose volume and fullness after pregnancy, breast feeding, and weight loss. Others have breasts that did not develop proportionally with their hips, shoulders, and frame. Some women have congenital breast issues including significant asymmetries. Breast augmentation creates breasts that are shapely and full, often promoting a tremendous increase in self-confidence.
3-d imaging and breast augmentation
Dr. Kunkel uses Vectra XT 3-dimensional imaging to help create a customized treatment plan. Six cameras take photographs of a woman’s torso. The system software reconstructs those photographs into a 3-d image. The Vectra Breast Sculptor program contains information about almost every breast implant available in the U.S. With a few clicks of the mouse, the software alters the 3-d image to show what a woman may look like with specific implants. Want something bigger or smaller? Just a few more mouse clicks. The Vectra system does not show a woman exactly what she will look like. It is a terrific way to make sure the patient and Dr. Kunkel are seeing and talking about the same things. Dr. Kunkel does not decide for his patients, he decides with them.
Types of Breast Implants
Round breast implants come in different ‘profiles‘: moderate, moderate-plus, and high. The image on the left demonstrates different profiles of breast implants, with all three implants having the same volume. The profile refers to the combination of width and projection (front-to-back dimension) of the implant. A moderate profile 300 cc breast implant is wider and has less projection (like the implant on top in the image on the left) than a high profile implant (the implant on the bottom). A moderate-plus profile implant is in between those two. All three may contain 300 cc’s of saline or silicone, but the shapes are different. It’s pretty hard to look at pictures on websites, trying to determine what volume and profile implant might work best for you. That’s where the Vectra 3-d system adds real value to the consultation, helping see potential outcomes with specific implants.
The shell of the implants may either be smooth or textured. Smooth surface implants are used in about 90% of breast augmentation procedures in the United States today. The implants shown above have smooth surfaces. Textured surface implants have a surface that’s a little rough, kind of like the surface of a peach.
When a textured surface implant is used, the tissues around the implant become adherent to the rough surface. Tissues do not attach to the surface of smooth implants. Textured surface breast implants are more commonly used outside the United States, particularly in Europe, Israel, and South America. Dr. Kunkel and his staff will go over these issues very thoroughly with you when you visit the office.
Breast Augmentation Surgery – Incision site options
Incisions are made in inconspicuous areas to help minimize scar visibility. The incisions may be located:
- in the crease beneath the breast
- in the armpit
- along the lower edge of the areola
Each incision has advantages and disadvantages. No matter where the incision is made, however, the resulting scar is generally very subtle. In Dr. Kunkel’s experience it is uncommon to hear a woman even mention her scars after surgery.
When the incision is made below the breast the final scar is either in or very near the breast crease. This scar is concealed in most bathing suits and bras. It may be visible in an intimate setting. Published studies have shown this incision to be the most commonly used. These studies also indicate that women who have implants placed through this incision have fewer problems with the implants being placed in an odd position (‘malposition’), have less risk of infection, and less risk of developing capsular contracture than when other incisions are used.
Placing breast implants through an armpit incision is a very good option. It leaves scars that may be quite hard to see. A potential drawback of these scars is perhaps being more likely to see them in a bathing suit if a woman’s arms are over her head, but this is not a common concern.
Breast augmentation may also be performed through an incision along the inferior borders of the areolas. These scars may be the most difficult to see of all the approaches. However, studies have also shown this approach has the highest rate of infection, implant malposition, and capsular contracture.
Saline breast implants may also be placed through an incision around the navel. This technique is known as a transumbilical breast augmentation (TUBA) approach. Dr. Kunkel does not use this approach for breast augmentation. He believes that the TUBA approach is more traumatic to the tissues than the other options and does not allow the implants to be placed as accurately.
Breast Augmentation Surgery – above or below the muscle?
After making the incision a pocket is created for the breast implant. The pocket is either immediately behind the breast tissue on top of the pectoralis major muscle, or beneath the pectoral muscle.
In the United States it is more common to place the implants beneath the muscle. The muscle adds a layer of tissue over the top of the implant in the upper part of the breast. This extra tissue is beneficial in thin patients who have minimal breast tissue. It helps makes wrinkles in the implant more difficult to see. Several studies also indicate that implants placed behind the muscle are less likely to develop capsular contracture (thick scar around the implant).
Internationally it is more common to place implants on top of the muscle. Women in places like Brazil, France, and Italy typically choose smaller implants than are popular in the U.S. Smaller implants may be less prone to showing wrinkling toward the tops of the breasts. An advantage of placing implants on top of the muscle relates to distortion. When an implant is placed beneath the muscle, the breast shape may become distorted when a woman contracts her pectoralis. This does not happen when implants are placed in front of the muscle.
It is becoming more common in the U.S. to place implants in front of the muscle, particularly silicone gel implants. Newer formulations of the silicone gel are thicker than implants used in the early 2000’s. Thicker silicone gel implants don’t wrinkle as much as thinner gel implants. This is quite a bit to think about but Dr. Kunkel and his staff will go over this with you at length during your visit.
Recovery after breast augmentation
Most women feel tight after breast augmentation surgery but don’t actually have much pain. It is common to return to work within a few days. Fridays are often Dr. Kunkel’s busiest days for breast augmentation because many women are actually able to return to work on Monday (3 days later!).
The breasts look full at the top and feel firm for about 4 weeks. In the fifth week the tissues stretch and settle a bit and the breasts feel more normal. Over the following two or three months the swelling goes down and the breasts achieve their final appearance.
Scars are pink for 4 to 6 months and then fade over the next 6 months. It is uncommon for women to have complaints about their scars after breast augmentation.
Risks of Breast Augmentation
All surgical procedures include some risks. Common to all operations are risks like visible scars, infection, bleeding, and pain. Breast augmentation surgery has its own risks. The FDA has a website that lists risks of breast implants. Additional details about each type of implant by each implant company can be found here .
To summarize the information in these sites, breast augmentation includes risks of capsular contracture (hardening of tissues around the implants), infection, change in nipple and breast skin sensation, leakage (rupture), visible wrinkling from the implants, an implant may not end up in the desired position, a woman may end up being larger or smaller than she hoped, and there may be a need for additional surgery at some time during her lifetime. Dr. Kunkel and his staff go over this and more in detail during your visit to the office.
Two additional issues have been in the news recently. One of these includes what is referred to as breast implant illness, and the second is breast implant-associated anaplastic large cell lymphoma.
Breast Implant Illness (BII) is a somewhat vague collection of symptoms described by some women who have breast implants. They describe having issues like fatigue, headaches, anxiety, rashes, sleep disturbance, “brain fog”, hair loss, chills, sensitivity to light, body odor, depression, and neurological issues that they believe are directly connected to their breast implants. An extensive review of studies by the Institute of Medicine demonstrated no clear link between silicone implants and any systemic illness. Numerous studies have looked at specific autoimmune disorders and diseases. These studies show few to no links between breast implants and any disease. To date, there has been little research into this breast implant illness. A few studies show some degree of improvement in patient symptoms after removal of their breast implants, some of which are temporary. There is no current definitive evidence to support a direct link between breast implants and any specific disease process. Further study is being done regarding these concerns.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of lymphoma that can develop in the scar tissue capsule around saline or silicone breast implants. ALCL is a cancer of the immune system that can occur anywhere in the body. The United States Food and Drug Administration (FDA) estimates the total number of US cases of BIA-ALCL to be around 300. It has been noted that the majority of BIA-ALCL patients have a history of having had a textured-surface breast implant. The lifetime risk of developing BIA-ALCL has been estimated at 1:1,000 to 1: 30,000 for women with textured breast implants. The way BIA-ALCL usually shows up is swelling of a breast an average of 3 to 14 years after the initial breast implant operation. Most cases are cured by removal of the implant and the scar tissue capsule surrounding the implant; however, rare cases have required chemotherapy and/or radiation therapy for treatment.
what happens when a breast implant leaks?
When a saline implant leaks the body absorbs the salt water and the breast loses volume. This may happen over a matter of hours but could also take several days or weeks. Loss of saline from a breast implant results in one breast becoming substantially smaller than the other. It is noticeable but not dangerous. It’s actually more of a social emergency than a medical emergency. The implant will need to be removed and potentially replaced.
With silicone implants leakage is different. A woman with a leaking silicone implant may not notice a change at all. Often a leaking silicone implant is noticed on a routine mammogram. Some women may notice a small lump that they had not noticed before, or maybe firmness develops. Ruptured silicone implants should be removed, and most women choose to replace them.
Regular monitoring of breast implants is recommended after breast augmentation to ensure breast health.