Breast Enlargement Review

Breast Augmentation is the most frequently performed plastic surgery on women in the U.S. today. Over 300,000 women undergo breast augmentation every year, with the popularity of the procedure ever increasing, especially amongst female body-builders.

Breast implants are most commonly used as aesthetic enhancement on an individual who is lacking in natural breast tissue due to genetically predisposed or environmentally induced factors. Because breast tissue is primarily composed of fat cells, in the past, physicians attempted to inject fat (obtained through liposuction) into the breast. However, today, this is completely unacceptable due to calcification (complete hardening of the breast). Hormonal therapy may increase the natural breast size, slightly, but not enough for the majority of women.

Currently, the most common way to increase breast size is via breast implants. A breast implant is a sac of silicone elastomer that is either filled with saline or silicone, and is surgically implanted under the breast tissue. The proportion of the breast to body height and weight is taken into consideration, as is the chest width, location of nipple/areola complex, and cleavage. Because the concepts of aesthetics are constantly changing, there are many factors such as implant type, size, and site that should be tailored to the individuals' specificity.

Type of Implant:

Silicone vs. saline? This discussion is going to remain for many years. Until 12 Years ago silicone was the dominant implant in the U.S.A. However, due to possible autoimmune mediated health problems associated with leakage, saline is now used in 90% of surgeries. Legal, psychological, and technical factors will eventually determine which is preferable.

Silicone implants are now gaining momentum and the FDA is going to rule on weather or not to legalize them (which will probably happen). Although the silicone might have some side effects, it doesn't seem as awful as thought to be a decade ago. The advantage of silicone implants is that it is softer and appears more natural. However, leaks may be found in secondary tissue. Generally, saline is a bit firmer, but it is without the supposed health risks because a leak is simply absorbed by the body. The decision should be made after consultation with an experienced surgeon.

Location of Implant:

The breast implant can be placed either under the pectoralis major muscle (sub muscular) or on top of the muscle and under the breast glands (sub glandular). Sub muscular implants are more popular because they are less palpable, have lower risk of capsular contracture, and don't inhibit mammography. However, it requires more invasive surgery and longer healing time.

Bodybuilders prefer sub-glandular insertion because the heavily developed pectoralis muscle might flatten the implant and there will be less projection of the breast. Women with sagging or drooping breasts may opt for sub glandular placement for the better projection as well. Disadvantages of sub glandular implants include impairment of proper mammography and increased risk of capsular contraction.

Location of Incision:

There are four areas of incision:

Periareola (lower part of areola 1 - 1/2 inches)
Sub-mammary (on the lower breast crease)
Axillary (arm pits)
Trans umbilical (from the belly button)
Each has advantages and disadvantages but the preferred incision is periareola because it is less noticeable. Arguments

against periareola are that it is harder to perform, that there is interference with sensation of the areola and violation of the breast tissue. Physicians who are experienced in this method find it easy to do. Personally, I did not see a difference in nipple sensation compared to other methods. Instead of inserting the implant through breast tissue it can be turned under the skin to further preserve the tissue.

Shape of Implants:

Most surgeons have experience with teardrop (natural implants) and with the round implants. Preference is toward the round implant because it appears more natural. Previously, there were high profile implants (which projected more) and low profile implants (less projection). Recently, medium profile implants were introduced.

How Long Do Breast Implants Last:

There is no expiration date for implants. One should be checked by a physician if there are any symptoms or changes that are not expected including deflation, infection, change of location, etc. Mammography, ultrasound, or MRI should follow onset of any of these symptoms. Older patients have to be checked more regularly by themselves, a physician, or radiologist. Once someone has implants for over ten years they should consider replacing them.

What is breast augmentation?

Augmentation of the breast consists of insertion of a silicone bag (prosthesis) under the breast (submammary) or under the

breast and chest muscle (subpectoral) and then filling the bag with saline (salt water). This prosthesis expands the breast area to give a fuller breast (increased cup size), give a better contour, and give more cleavage.

How is the incision made?

The incision (cut) may be placed at various locations such as: under the breast at the breast fold; periareolar which is at the edge of the areola (brown area consisting of nipple and areola); within the areola; in the armpit (axillary); or in the umbilical area.

The thinnest scar is usually in the areola. The umbilical incision approach is used with an endoscope (tube with a light for

visualization and placement of the breast implant).

What are smooth and textured implants?

The smooth surface implant requires a large pocket and is associated with a 10% incidence of capsule contracture (tightening of the scar around the implant causing firmness or hardness). The smooth implant has only an occasional occurrence of rippling or wrinkling which gives the overlying skin a wavy appearance.

A textured (roughened surface) implant is associated with a 3% incidence of capsule contracture but has a 7-9% occurrence of rippling.

What are the choices of implant positions? The easiest surgical placement of the implant is under the breast tissue (submammary).

A slightly more difficult surgical placement is under the chest muscle (submuscular or subpectoral) but this position is associated with a lower incidence of capsule contracture and slightly less occurrence of rippling. There is more pain postoperatively than with a submammary placement.

Breast Augmentation is the most frequently performed plastic surgery on women in the U.S. today. Over 300,000 women undergo breast augmentation every year, with the popularity of the procedure ever increasing, especially amongst female body-builders.

Breast implants are most commonly used as aesthetic enhancement on an individual who is lacking in natural breast tissue due to genetically predisposed or environmentally induced factors. Because breast tissue is primarily composed of fat cells, in the past, physicians attempted to inject fat (obtained through liposuction) into the breast. However, today, this is completely unacceptable due to calcification (complete hardening of the breast). Hormonal therapy may increase the natural breast size, slightly, but not enough for the majority of women.

Currently, the most common way to increase breast size is via breast implants. A breast implant is a sac of silicone elastomer that is either filled with saline or silicone, and is surgically implanted under the breast tissue. The proportion of the breast to body height and weight is taken into consideration, as is the chest width, location of nipple/areola complex, and cleavage. Because the concepts of aesthetics are constantly changing, there are many factors such as implant type, size, and site that should be tailored to the individuals' specificity.

Type of Implant:

Silicone vs. saline? This discussion is going to remain for many years. Until 12 Years ago silicone was the dominant implant in the U.S.A. However, due to possible autoimmune mediated health problems associated with leakage, saline is now used in 90% of surgeries. Legal, psychological, and technical factors will eventually determine which is preferable.

Silicone implants are now gaining momentum and the FDA is going to rule on weather or not to legalize them (which will probably happen). Although the silicone might have some side effects, it doesn't seem as awful as thought to be a decade ago. The advantage of silicone implants is that it is softer and appears more natural. However, leaks may be found in secondary tissue. Generally, saline is a bit firmer, but it is without the supposed health risks because a leak is simply absorbed by the body. The decision should be made after consultation with an experienced surgeon.

Location of Implant:

The breast implant can be placed either under the pectoralis major muscle (sub muscular) or on top of the muscle and under the breast glands (sub glandular). Sub muscular implants are more popular because they are less palpable, have lower risk of capsular contracture, and don't inhibit mammography. However, it requires more invasive surgery and longer healing time.

Bodybuilders prefer sub-glandular insertion because the heavily developed pectoralis muscle might flatten the implant and there will be less projection of the breast. Women with sagging or drooping breasts may opt for sub glandular placement for the better projection as well. Disadvantages of sub glandular implants include impairment of proper mammography and increased risk of capsular contraction.

Location of Incision:

There are four areas of incision:

Periareola (lower part of areola 1 - 1/2 inches)
Sub-mammary (on the lower breast crease)
Axillary (arm pits)
Trans umbilical (from the belly button)
Each has advantages and disadvantages but the preferred incision is periareola because it is less noticeable. Arguments

against periareola are that it is harder to perform, that there is interference with sensation of the areola and violation of the breast tissue. Physicians who are experienced in this method find it easy to do. Personally, I did not see a difference in nipple sensation compared to other methods. Instead of inserting the implant through breast tissue it can be turned under the skin to further preserve the tissue.

Shape of Implants:

Most surgeons have experience with teardrop (natural implants) and with the round implants. Preference is toward the round implant because it appears more natural. Previously, there were high profile implants (which projected more) and low profile implants (less projection). Recently, medium profile implants were introduced.

How Long Do Breast Implants Last:

There is no expiration date for implants. One should be checked by a physician if there are any symptoms or changes that are not expected including deflation, infection, change of location, etc. Mammography, ultrasound, or MRI should follow onset of any of these symptoms. Older patients have to be checked more regularly by themselves, a physician, or radiologist. Once someone has implants for over ten years they should consider replacing them.

What is breast augmentation?

Augmentation of the breast consists of insertion of a silicone bag (prosthesis) under the breast (submammary) or under the

breast and chest muscle (subpectoral) and then filling the bag with saline (salt water). This prosthesis expands the breast area to give a fuller breast (increased cup size), give a better contour, and give more cleavage.

How is the incision made?

The incision (cut) may be placed at various locations such as: under the breast at the breast fold; periareolar which is at the edge of the areola (brown area consisting of nipple and areola); within the areola; in the armpit (axillary); or in the umbilical area.

The thinnest scar is usually in the areola. The umbilical incision approach is used with an endoscope (tube with a light for

visualization and placement of the breast implant).

What are smooth and textured implants?

The smooth surface implant requires a large pocket and is associated with a 10% incidence of capsule contracture (tightening of the scar around the implant causing firmness or hardness). The smooth implant has only an occasional occurrence of rippling or wrinkling which gives the overlying skin a wavy appearance.

A textured (roughened surface) implant is associated with a 3% incidence of capsule contracture but has a 7-9% occurrence of rippling.

What are the choices of implant positions? The easiest surgical placement of the implant is under the breast tissue (submammary).

A slightly more difficult surgical placement is under the chest muscle (submuscular or subpectoral) but this position is associated with a lower incidence of capsule contracture and slightly less occurrence of rippling. There is more pain postoperatively than with a submammary placement.