Breast Augmentation – Implant Profiles, Incisions, Recovery
Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the U.S. and is also one of our most popular services. Breast augmentation (breast implant surgery) can provide women who have modest or unevenly sized breasts a fuller, firmer, more balanced look.
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 more shapely and full, often promoting a tremendous increase in self-confidence.
Customized Breast Enhancement
Each woman has unique physical attributes and unique goals and expectations regarding breast implant surgery. We recognize this and take time to ask questions and listen to what it is our patients hope to achieve. Dr. Kunkel was the first surgeon in Fort Worth and Tarrant County to use Vectra XT three-dimensional imaging. This system uses 6 cameras to take photographs of a woman’s torso. The computer software reconstructs those photographs into a three dimensional image. This image may be rotated in all directions, helping identify specific areas that may be addressed. The Vectra Breast Sculptor software 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 the woman may look like with a specific set of implants. Want something bigger or smaller? Just a few more mouse clicks. No longer is it necessary to put rice in baggies and wear that inside a bra to get an idea of what you might look like. A study published in 2014 showed the system is up to 90% accurate. The 3-d imaging system has transformed the consultation process in Dr. Kunkel’s office. He uses the Vectra system not to show a woman exactly what she will look like, but rather as a way to make sure that he and the patient are seeing and talking about the same things. It is a very interactive session. When a woman comes in to learn about breast augmentation or breast lift surgery, the visit typically lasts about 1.5 to 2 hours. The extended back-and-forth interaction between the woman and Dr. Kunkel, while viewing and altering the 3-d image according to what the patient wants to learn about and see, allows for a finely tailored approach in choosing which implants may provide her most ideal result. Dr. Kunkel does not decide for his patients, he decides with them.
Different Types of Breast Implants
Breast implants are silicone rubber shells filled with either saline (salt water) or silicone gel. Numerous clinical studies have demonstrated the safety of both types of implants. The implants may be round or they may have a shape (other terms used for shaped implants include “teardrop” and “gummy bear”). Round breast implants also come in different ‘profiles‘: moderate, moderate-plus (or midrange), and high. The profile refers to the combination of width and projection (front-to-back dimension) of the implant. Think of it as having three differently shaped glasses of water, each glass holding the exact same amount of water. Maybe one glass is short and wide, another is tall and thin, and the third is in between those two, but all three contain the same amount of water. A moderate profile 300 cc breast implant is wider and has less projection than a high profile implant, and a moderate-plus 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. It adds clarity to an otherwise confusing topic. The different implants have specific advantages and disadvantages, and these are addressed with our patients during the initial (and any subsequent) consultations. We offer all types of breast implants (saline and silicone, round and shaped, textured and smooth) to our patients and thoroughly explain the differences to help them decide which type may be best for their individual needs.
Breast Augmentation Surgery – Incision Techniques
The breast augmentation procedure typically lasts one to two hours and is performed under general anesthesia. Incisions are made in inconspicuous areas to help minimize scar visibility. These may be located:
- in the crease beneath the breast (inframammary)
- in the armpit (transaxillary)
- along the lower edge of the areola, the darker skin around the nipple (periareolar)
The breast is then elevated off of the underlying tissue, creating a pocket into which the implant is inserted.
Saline implants may also be placed endoscopically through an incision around the navel. This technique is known as a transumbilical breast augmentation or 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 approaches and does not allow the implants to be placed as accurately.
Breast Augmentation Surgery – Placement Options
After making the incision, a pocket is created into which the breast implant is inserted. The pocket is either immediately behind the breast tissue or under the pectoralis major muscle. The muscle adds a layer of tissue over the implant compared to when an implant is placed immediately behind the breast tissue. This extra layer is particularly beneficial in thinner patients who have minimal breast tissue. Other advantages of placing implants behind the muscle include a reduced risk of capsular contracture (hardening of the tissues around the implant) and less interference with mammograms. A possible disadvantage of placing implants behind the muscle is the potential for movement of the implant when the muscle is contracted. This probably is more important for women who participate in body-building competitions than most women in general.
Most patients feel a bit tight and sore after breast augmentation surgery, but much of this often passes in a day or two. Many women 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!).
Post-operative pain, swelling, and sensitivity diminish over the first few weeks.
Scars from breast augmentation incisions will begin to fade in a few months and will continue to fade for months or years.
Risks of Breast Augmentation
All surgical procedures include some degree of risk. Risks common to all operations are things like visible scars, infection, bleeding, and pain. Surgical procedures also have risks that may be unique to a specific procedure. With breast augmentation, these type of risks includes capsular contracture, infection around the implant, a change in nipple sensation, and breakage or leakage of the implant (implant rupture) as a result of injury or the normal compression and movement of your breast.
When a saline implant leaks, the body will absorb the salt water, dispose of it, and the breast will lose its volume. This may happen over a matter of hours but it may take several days or even weeks. The end result is that one breast is substantially smaller than the other and a woman in this situation will probably want to have that implant replaced.
With silicone implants, leakage is different. Chances are pretty good that a woman with a leaking silicone implant will not notice much of a change. Often leaking is suggested or noticed on a routine mammogram. Some women may notice a small lump that they had not noticed before and some women may develop firmness around the implant. 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.