Breast Augmentation

Augmentation mammaplasty (breast enlargement) is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty can “lift “ the breast slightly, but it is not a substitute for mastopexy, which is a procedure to “lift” breasts that sag significantly.

OUR PROCEDURE PRICING

Breast Augmentation with Saline Implants (pricing includes implants) $4800
Breast Augmentation with Silicone Implants (pricing includes implants) $5200

AUGMENTATION MAMMAPLASTY WITH IMPLANTS

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IMPLANT TYPES – Silicone and saline are the two implant types used in augmentation mammaplasty. Both use a silicone-based outer shell. Silicone-filled implants feel slightly more like natural breasts than saline-filled ones. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant ruptures, the silicone filler is more difficult to assess and remove.

Other aspects of implants include “gummy bear” (cohesive) silicone implants, as well as round versus anatomic (tear-drop) and smooth versus textured implants. Cohesive (gummy-bear) implants come in at least three grades and make minor differences in the outcome. I do not use anatomic implants because they can move and look abnormal and studies have shown that they make no difference in appearance. I only use smooth implants because I feel I can predict their look better. In addition, there is the issue of BIA-ALCL noted below.

IMPLANT LOCATION – Implants are placed either behind the breast tissue or behind the main chest (pectoralis) muscle. Advantages of implant placement behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around the implant), and less interference during mammograms. Disadvantages include a longer recovery period and movement of the implant with pectoralis muscle activity. Advantages of implant placement beneath breast tissue are that the breasts move more naturally as with chest muscles use and that breast sagging is corrected more effectively.

istock 95188125621IMPLANT INCISIONS – Incisions can be hidden in the armpit, in the crease under the breast, around the areola, or in the belly button. In practice, the crease incision is used most often because it gives the best surgical view, it can be used to adjust or remove the implants later if needed, and it has the lowest infection rate.

The breast augmentation procedure lasts 1 to 2 hours and is typically performed with general anesthesia, although local anesthesia combined with a sedative may be used.

AUGMENTATION MAMMAPLASTY WITH FAT TRANSPLANTATION

Augmentation mammaplasty with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Augmentation mammaplasty is appropriate for women who are not looking for a dramatic increase in breast size (1/2 to 1 cup) and want breasts that look and feel as natural as possible.
Fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum. The harvested fat cells are then purified and the fat is injected into the breast through small incisions. The procedure takes approximately 2 hours.

RECOVERY FROM AUGMENTATION MAMMAPLASTY

After augmentation mammaplasty with implants, the incisions are stitched, taped and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days postsurgery, most patients feel tired and sore, but most return to work within a week. Stitches dissolve on their own; postoperative pain, swelling, and sensitivity diminish during the first few weeks. Scars begin to fade in a few months.
After augmentation mammaplasty with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction.

RISKS OF AUGMENTATION MAMMAPLASTy

In addition to the risks associated with surgery and anesthesia, those related to augmentation mammaplasty using implants include the following:

  • Capsular contracture – this is a serious and little discussed issue. Many patients, up to 10%, will develop a hardened scar around the implant. It can develop in as little as a few months after the procedure or sometimes many years later. Treatment can require removal of the implant and the scar with the placement of a new implant.
  • Implant leaks and ruptures – Implants are medical devices and will break over time. Most implants carry a partial warranty for 10 years, but they can rupture sooner or much later.
  • A temporary or permanent change in nipple/breast sensation
  • Irregularities in breast contour/shape which may require additional surgery.
  • Asymmetry of the breasts. This is usually from an original asymmetry with the breast anatomy prior to surgery which could not be completely corrected with implants.
  • One of the most important statistics of breast augmentation is this:

Patients with breast implants have a 20-40% re-operation rate within 10 years of their original breast augmentation. This is a national statistic looking at tens of thousands of patients. Revision procedures all cost additional money, so it is important to understand this information before surgery.

The risks related to augmentation mammaplasty using fat transplantation include those related to liposuction, as well as the following:

  • Calcifications – these can be seen on mammograms, but look benign.
  • Loss of volume – the most important issue since up to 50% of the fat placed will be absorbed. This is why some patents come back for 2-3 treatments to build up a significant size increase without implants.

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*All pricing includes pre-op/post-op appointments, surgeons fee, and facility/anesthesia fees.

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