As plastic surgeons, breast augmentation is one of the most common procedures that we perform. Even though it can be a quick and “straight-forward” procedure, there are so many nuances that actually make it one of the most challenging procedures in plastic surgery. Breast Augmentation refers to adding volume to the breasts, by means of saline or silicone implant, or in some case using the patient’s own fat.
Breast Augmentation essentially “fills up” the empty container but does not change the shape of the container. This means that things like nipple position, breast width, and cleavage can not necessarily be changed through augmentation alone, and will typically require a breast lift or other reconstructive techniques.
Breast Augmentation can be used to treat a variety of conditions, both acquired and congenital. These are some of the reasons patients may seek breast augmentation.
Some patients may be develop a congenital breast deformity known as a tuberous breast. This typically entails an underdeveloped breast, a high fold, a constricted lower pole, and herniation of breast tissue into the areola. Breast Augmentation can be a useful treatment establishing symmetry in patients with this condition.
This is typically secondary to breast cancer in which a mastectomy is performed. Breast Reconstruction can be performed by adding breast implants to replace the lost tissue and give a woman her femininity back.
This is the most common indication for augmentation. This may be due to volume loss after pregnancy or massive weight loss. More often it may be because a women has always had smaller breasts and/or asymmetry and wants correction to improve the appearance.
The ideal candidate is one in good health without significant medical problems. They should be have reasonable expectations of outcome and understand the potential risks and complications that may occur. Women who have not had children, and those that are done having children are both excellent candidates if they understand that nuances of their individual situation.
During your consultation, you will meet with Dr. Arslanian and his staff and have the opportunity to discuss your individual situation as well as your concerns and aesthetic goals. Dr. Arslanian will take detailed measurements of your breast and body and perform a complete examination. Photos will be taken to help Dr. Arslanian point out certain things and explain his approach to breast augmentation. If you are deemed a good candidate, he will discuss the various options for breast augmentation and make sure you are happy with your decision. He will also show you photos of other patients before and afters to help determine what size and look you are trying to achieve. After answering all your questions, you will then sit down with the surgical coordinator to discuss timing, pricing, and any other questions you might have.
Before and After Photos
Silicone vs Saline
Dr. Arslanian will go over the different advantages and disadvantages of each during your consultation to help you determine the best choice for you. In general, silicone implants have a much more natural feel and give a more natural looking result. Saline implants are also an option but have fallen out of favor over the years due to the advances in silicone implant technology.
Implants come in either a round shape or an anatomic “tear drop” shape. Both have their pluses and minuses. Dr. Arslanian typically recommends round implants for cosmetic breast augmentation and shaped implants for reconstructive cases. However, each patient is different and this is something you can discuss with him during your consultation.
Breast implants can either come smooth or textured. The texturing provides a rough surface for your body to grow scar tissue on. This can help keep the implant in a fixed place in certain situations. Smooth implants have no texturing and can move freely in the pocket. Dr. Arslanian will help to guide you to the implant that is right for you.
The three main incisions that can be used for augmentation are: axillary (armpit), inframammary (breast fold), or periareolar (around the areola). They are all acceptable methods but Dr. Arslanian has reviewed the literature and his extensive amount of cases to help give you the best recommendation possible. He is one of the ONLY surgeons in Atlanta performing transaxillary endoscopic breast augmentation, and something he is very passionate about.
The implant can be placed either over the muscle or under the muscle. Dr. Arslanian prefers under the muscle, or submuscular, for many reasons including: better implant coverage, more natural look, less rippling, and decreased rates of capsular contracture. He can discuss this with you and make sure this is the right approach for you.
As volume is added to an implant it needs to either expand in width or height. The height is called “projection”. A higher profile implant has more projection which means that as it increases in volume it tries to stay narrower but expands in height. Factors such as your base width, chest dimensions, and personal preferences will help to decide what implant profile is right for you.
Prior to surgery you will be given instructions on the day, time and location of your procedure. You will be given your prescriptions that Dr. Arslanian prescribes, and all of your paperwork including consent forms will be signed. In some cases you may need to obtain medical clearance from your physician or specialist, and possibly meet with the anesthesiologist and undergo additional lab work depending on your medical issues and personal situation.
The procedure will be performed as an outpatient in an accredited surgery center with a board certified anesthesiologist in the safest conditions possible. The surgery will be performed under general anesthesia. Pre-operative markings will typically be made the morning of surgery.
After you are asleep, Dr. Arslanian will start by making his incision, either under the breast or in axilla (armpit) depending on the procedure you select. He will then create a pocket for the implant under the muscle. The appropriate size implant will then be placed using a “NO TOUCH” Technique and a Keller Funnel. This helps to prevent implant contamination and allows for the smallest scar possible. Once the implants are properly positioned, the incisions are closed with sutures, dressings are applied and you will be awakened from anesthesia. You may be placed into a surgical garment and instructions on use will be given.
You will go home the same day of surgery and rest. Over the course of the first week you will begin range of motion exercises to keep your arms and shoulders from tightening up. Dr. Arslanian will also go over breast implant massage to help prevent early capsular contracture. You will follow up within the first week at which point dressings will removed and any sutures that were placed on the skin. You will be given instructions on wearing your garment and increasing activity. Most people can be back to work within 3-7 days depending on if they work at a desk or have a more labor intensive occupation. By 2 weeks most patients are almost back to normal. You will then be able to start increasing activity, excising and start lifting heavier weight. We do not allow any heavy lifting, bench press or pushups until AT LEAST 6 WEEKS, to allow the muscle to fully heal. There will be some expected post-operative pain that typically resolves within a few days to a week, which you will be given pain medication for.
Patients can expect their implants to “settle” over the course of 3-6 weeks, and some may take 3 months. Final results are usually seen at the 3-6 month mark, but sometimes it may take an entire year for the breasts to settle to their new shape and position.
There are many decisions that go into tailoring an individual’s breast augmentation procedure and these will all be factors in determining the cost of the operation. If order to receive an accurate price estimate, please schedule a consultation.