Breast surgery
Cosmetic breast surgeries typically fall under three procedure categories:
- Breast Augmentation (augmentation mammoplasty)
- Breast Lift (mastopexy)
- Breast Reduction (reduction mammmoplasty)
Breast augmentation
Breast Augmentation now offers patients and surgeons many choices in terms of implant type, location of incisions, and placement of implants above or below the muscle. A number of factors influence the utility of each method and not every option is available to every patient.
A surgeon should possess the appropriate judgment as to which combination of implant, incision, and pocket will have the greatest likelihood of producing a natural result, with the fewest possible risks or complications.
Types of Breast Implants:
- Saline vs. Silicone
- Smooth vs. Textured
- Round vs. Shaped
Saline implants vs. Silicone implants
Saline implants are packaged empty, then filled by the surgeon during the operation using sterile injectable IV saline solution, through a small valve located on the surface of the implant. Saline implants became most widely used between 1992 and 2006, during the FDA moratorium on gel implants.
After a 15 year hiatus, silicone gel breast implants were returned to full market availability in the U.S. in 2006. The silicone gel is a polymer with a density similar to fat, and can be chemically altered by the manufacturer in a variety of ways to create different degrees of viscosity, from a consistency somewhat like honey or molasses, to that of a “gummy-bear”.
All breast implants share the common characteristic of an outer silicone rubber shell, which can be either smooth or textured. The implants then vary depending on the characteristic of the filling material inside the shell.
Breast implant texture and shape
Implant shells can be created from molds in either a round, disk-like form, or in a shaped form (crescent, tear-drop, etc.) in both saline and silicone formats. The “anatomic” or “form-stable” implants are generally filled with a higher-viscosity (“cohesive”) silicone gel, and are intended to hold their form at all times, whereas round implants are intended to flow with the breast as the position of the patient changes, since the saline or silicone gel flows according to the laws of gravity in a round implant.
Generally speaking, saline implants can be placed through smaller incisions, and “form-stable” or large gel implants require larger incisions.
Incision Locations:
- Trans-Axillary - placing an incision near the apex of the armpit in the natural skin crease
- Peri-Areolar - placing the incision around the border of the areola where it meets the lighter skin of the breast, usually around the lower semi-circle of the areola.
- Inframammary - placement of the incision in the natural fold below the breast, or in the position where the fold is desired after placement of the implants
- Trans-Umbilical (TUBA) - placement of the implant through a remote incision at the upper border of the belly button.
Pocket Locations:
Through any of the potential incisions, a space for the implants, or pocket, can be created immediately behind the breast tissue and above the muscle (sub-glandular) or behind both the breast tissue and the pectoralis major muscle (sub-muscular).
In general terms, women with more breast tissue, or women who have some degree of sagginess of their existing breasts, are better candidates for sub-glandular implant placement. Women with smaller breasts, without droopiness, are generally better candidates for sub-muscular implant placement.
Your surgeon should carefully examine your breasts for masses, make note of your breast dimensions relative to the chest wall and your body build, and analyze the individual characteristics of your breasts.
After listening to your desires and goals for the surgery, your surgeon should be able to articulate to you a specific treatment plan that will meet your goals, including the best type of implant, incision, and pocket location for your specific case.
Breast lift
Many women, particularly those who have had children, will notice that their breast tissue will droop and “deflate” following breast-feeding. This phenomenon is not limited to mothers, however, as changes in weight and hormone fluctuations can cause these same issues, and some women are just born with breasts that may not be as “perky” as they would like.
Many patients who complain of this breast deflation, or “breast ptosis” in medical terms, benefit from an elevation of the breast tissue, known as a breast lift or mastopexy.
There are several ways to go about providing true or apparent lifting of the breast tissue.
Wise Pattern Breast Lift
Classically, breast lifts were done through a pattern similar to classical breast reductions, resulting in a scar around the nipple, down the center, and underneath of the breast, which you can think of as an anchor type of configuration.
While this operation works well for many patients, it provides a lot of scarring, and can, in certain patients, give rise to a breast that lacks proper projection.
Efforts were subsequently made to try and improve the deficiencies of this operation, and a plastic surgeon named Dr. Lejour developed a breast surgery that eliminated the scar under the breast and improved postoperative breast form. This is called the vertical mastopexy.
Vertical Breast Lift
The vertical mastopexy has become one of the mainstays of the breast lift. This operation works well for most women who do not have massive breasts, and allows some degree in reduction of the size of the breast if desired.
Alternatively, the vertical breast lift can be combined with a breast implant in order to increase the breast size. In either situation, the scars from this vertical breast lift look like a lollipop- around the nipple and down the center of the breast.
The concept behind the vertical mastopexy is the rearrangement of the breast tissue itself to a higher position, rather than creating a skin sling to suspend the breast tissue. This breast tissue rearrangement is felt to give a more pleasing shape and a longer lasting result.
Benelli Breast Lift
For those patients who require only minimal lifting and who may be adverse to the longitudinal scar of the vertical breast lift, an alternative may be what is called a purse-string, or Benelli mastopexy.
This operation is performed by resection of an eccentric area of skin around the nipple, which can be thought of as an oval shaped donut where more skin is resected above the nipple than below it. Following a small amount of dissection in the breast tissue to strengthen the breast lift, this incision is closed with a purse-string suture that “cinches” the breast envelope centrally and upward to provide a lift.
The scar resulting from this breast lift operation is only around the nipple along the transition between the pigmented areola and the skin of the breast. This operation does have the limitation of lifting the breast tissue only one to two centimeters, however, and so only patients with minimal ptosis may be candidates for this procedure. See Q&A: Pros and cons of Benelli Lift?
Breast reduction
If your breasts are larger than you prefer, or if you experience bothersome symptoms related to large breasts, breast reduction surgery may be an option.
Symptoms that prompt breast reduction commonly include upper back pain, neck pain, shoulder grooves from the bra straps, and occasionally irritation between the breasts and the upper abdominal skin.
The candidate should be in good physical and psychological health. Due to healing issues, it is imperative not to be a smoker or to be around second-hand smoke. It is also critical not to be obese. Patients who weigh over 200 pounds have a much higher complication risk and often don't get the results they desire. Finally, the patient must be able to accept the scars it takes to perform the procedure.
Non surgical breast enhancement
Options for non-surgical breast enhancement include the following:
- Hormone pills, supplements, creams
- Brava Breast Enhancement system
- Breast augmentation via fat injection
- Enhancing garments, such as bras or inserts
However, doctors typically don't stand behind the efficacy of non-surgical breast enlargement. Physicians on RealSelf maintain that surgical augmentation remains the mainstay of breast enlargement by providing reliable, predictable, relatively consistent and substantial breast enhancement.
Fat injection has recently been viewed as an option, yet concerns with interpreting mammograms, as well as the consistency of the results and problems with sufficient tissue in thin patients, limit the applicability of this procedure.
More about breast surgery on RealSelf:
- Are there non-surgical alternatives to breast augmentation?
- How do I choose the best breast implant for me?
- How much do breast implants cost?
- How to perk up sagging breasts
