During breast augmentation surgery, we make a small incision either around
the areola or in the crease underneath the breast, go down through the
breast tissue and elevate the chest muscle and place an implant underneath
the chest muscle. This both reshapes and increases the volume of the
There are a whole host of breast implants available today. The choices come
down to the material used to make the implant, the texture of the implant
shell itself, and the shape of the implant. Implants are either silicone or
saline. Silicone implants are now FDA-approved again. They are back on the
market, and I personally feel they're very safe, so I do recommend them to
most of my patients. They have significantly better feel, and significantly
more natural look than saline implants.
The second choice between implants is the texture, either smooth or
textured. Textured implants have a Velcro-like surface which prevents the
implant from moving around. Some people feel like the textured implant can
provide a slightly reduced risk of capsular contracture, one of the
problems associated with implants, although it really hasn't been borne out
in studies. I personally think that smooth implants, which can move and
shift a little, provide an overall more natural look in the patients. I
generally use smooth implants.
Breast implant can be placed either underneath the breast tissue or
underneath the breast muscle. Underneath the breast tissue, or sub-mammary
pocket, is a quicker operation, with a much faster recovery time. Having
said that, the implant is completely supported by the breast tissue, and
long-term tends to lead to issues of support, where the implant drops and
the breast tissue is stretched out. Personally, although it's a more
difficult operation to perform with a longer recovery time, I do place all
my breast implants underneath the muscle. Long-term, it provides a much
better result in the patients.
The best technique is spending time with the patient, talking to her, and
trying to understand exactly what her goal is, what size she would like to
be. Once you understand what it is the patient wants, you select a range of
implants which you both think would be most appropriate. Then, during the
operation, we create the space for the implant, and the final implant
selection is made by me during the operation, by using different sizers.
Sizers are sterilized, disposable implants. They can be placed one after
the other, until the perfect implant is selected. Having an operating room,
we have the luxury of having a consignment, which means that we have every
implant made available on the shelf at all times.