UNDER LOCAL ANESTHESIA, IT IS SAFER & MORE AFFORDABLE

Breast augmentation, technically known as augmentation mammaplasty, is a surgical procedure to enhance the size and shape of a woman's breasts.  

Why Do Women Get Breast Implants?

� To enhance the body contour of a woman who, for personal reasons, feels her breasts are not of ideal size, shape and/or symmetry.
� To correct a reduction in breast volume after pregnancy.
� To balance a difference in breast size.
� As a reconstructive technique following breast surgery.  

Breast implant surgery is one of the most common cosmetic surgeries.  Currently, over 100,000 such surgeries per year are performed in America and over the past 35 years approximately three million women have had cosmetic breast enlargement.
By inserting an implant behind each breast, your doctor is able to increase a woman's bustline by one or more bra cup sizes.  

THE SURGERY:

BREAST IMPLANTATION UNDER LOCAL ANESTHESIA  

Our Doctors have incorporated into the breast implant procedure some of the advancements that have been made in other areas of minimally invasive cosmetic surgery, such as liposuction and SSL mini-facelifts. We perform the surgery using local anesthesia, wherein you will be fully anesthetized using a local anesthetic and mildly sedated using oral pain medications, yet still awake.  This choice of anesthesia is safer than general anesthesia and many of the severe risks associated with general anesthesia are removed including allergic reactions to potent general anesthetics, adverse cardiovascular and respiratory effects and the nausea that is common after general anesthesia. Fifteen minutes after the procedure you will be able to walk out of the office. Because an aesthesiologist is not required, local anesthesia is also much more affordable.This is the same effective anesthetic technique we use to perform breast augmentation, LipoSelection by VASER, Smart Lipo, facelifts and all of our surgeries.  

TRANSAXILLARY, SUBFASCIAL IMPLANT PLACEMENT  

Our Doctors prefer to use the transaxillary (through the armpit) implant placement technique because this technique leaves no scars on your breasts and keeps scars as inconspicuous as possible. Working through the armpit incisions, the doctor will place your implants in a pocket created in each breast, centered beneath your nipples. We prefer to place the implants in the subfascial position, over the pectoralis chest muscle yet under the muscle�s tough, fibrous envelope. This positioning provides the same benefit as placing the implants under the chest muscle (decreased appearance of implant rippling) without the many disadvantages of placing them behind the muscle, such as the need to cut a portion of the chest muscle off the chest wall to make a pocket for the implant, etc.  

You may read more about Subfascial Implant Placement at the web site of the American Society of Cosmetic Breast Surgery, of which our doctors are members. That web site address is www.ascbs.org. Once you are there, click on the link labeled "Above, Below Muscle or Subfascial," then click on "The Subfascial Approach in Augmentation."    

SUMMARY OF ADVANTAGES OF SUBFASCIAL IMPLANT PLACEMENT

� Permanently cutting a part of the chest muscle away from the chest wall to make room for the implant is NOT required as it is in under-the-muscle implant placement.� Discomfort, operative injury and recovery time are significantly less than if the implant is placed behind the muscle.� Flattening & distortion of the implant by chest muscle flexion during activity are less than if the implant is placed behind the muscle.� The implant "rides" in a lower, more natural looking position.� Surgery control is better and bleeding is reduced.� The breasts feel softer, more natural and are more comfortable during physical activities.� Rippling of the implant under the skin is decreased.� Better results for mild to moderately sagging breasts.  

 Implant position (Above or Below the Muscle)

Above the Muscle (Subglandular Implant)
The breast implant is placed over the pectoralis muscle and below the breast tissue. Advantages:

• Less postoperative discomfort and swelling
• Lower chance that the breast will appear to move when the patient exercises the upper body

Disadvantages:

• Greater risk of visible rippling appearance in women with smaller breasts
• Marginal cosmetic results are seen in women with small breasts

Beneath the Muscle (Subpectoral Implant)
The breast implant is placed under the pectoralis muscle. Advantages:

• Less interference with a mammogram
• Less rippling appearance in the upper half of the breasts
• More cushion between the implant and the skin
• Ideal for thin and small-breasted women

Disadvantages:

• Not well suitable for large breasted women
• Worse cosmetic result are seen in athletic women

     Implant Shape: Round or Teardrop
Round implants are shaped like jelly donuts. They are not affected by rotation and cost less than teardrop implants. There are no disadvantages to round implants. It is favored by most cosmetic breast surgeons. Teardrop implants are shaped more like the breast. The teardrop implant may rotate, creating a distorted breast shape. It also requires a textured surface to prevent rotation.
Implant Surface: Smooth or Textured
Textured implants are rough, similar to sandpaper. They were developed to decrease the risk of capsular contracture. However, studies have not shown a consistent advantage over smooth implants regarding capsular contracture. They have an increased risk of rippling, have a higher deflation rate and are firmer than smooth implants. They are also more expensive. Most breast cosmetic surgeons favor smooth implants.
Implant size and volume
Breast implants are available in various sizes ranging from 200 - 600 ml. The range 300 - 450 ml is the most common. Choosing your desired size can be a difficult decision - it is highly personal. You can determine the size you want by placing breast implant sizers in your bra and then putting on a sweater, blouse or a t-shirt. You�ll want to decide your cup size and that will determine how large your implant will be. A 400 ml implant placed in a woman with an A cup will produce a C cup. The same implant placed in a woman with a B cup will produce a D cup. Bring the pictures of your desired size (take a look at a lingerie catalog or swimsuit pictures) to your consultation. Take the time to decide what you will be happy with so you don�t feel the need to undergo a second surgery. Each saline implant must be overfilled by an additional 25-30 ml. This technique decreases the risk of deflation, rippling, and sloshing. There are no disadvantages to overfilling. Implants are meant to be overfilled, and the implant manufacturers recommend surgeons to overfill them.
Saline vs. Silicone Gel Implant
The FDA has recently approved silicone gel breast implants for use in primary breast augmentation for any woman over the age of 22. The main disadvantages include a possible higher rate of capsular contracture, the incision to place the implant is larger than the one needed for placement of a saline implant, and the cost is substantially higher then saline breast implants. On the other hand, they provide the most natural look and feel ideally suited for women with a modest amount of breast volume.    
Breast implant projection (Standard vs High Profile)
With a high profile implant, the liquid volume is the same as a standard implant but its diameter (footprint) is narrower and the projection (the amount it protrudes out and away from your body) is greater. Most women are better candidates for standard implants. If the diameter of the implant size (standard implant) you selected is about the same as, or smaller than, your measured breast diameter, then a standard implant is your best choice. If the diameter of the desired breast implant size is larger than your breast diameter, then a high profile breast implant is best.