Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the US and one of Dr. Hutchinson’s most popular services. Breast enlargement or augmentation is designed to enhance a woman’s appearance by using breast implants to increase volume and improve the contour of the breasts. This aesthetic plastic surgery procedure allows women with small or unevenly sized breasts to achieve a fuller, firmer, better-proportioned look through the placement of saline or silicone implants under the breasts. In women who desire a small increase in breast volume, autologous fat injections to the breasts may also be considered as an alternative to breast implants.
Patients elect to undergo breast augmentation for many different cosmetic or aesthetic reasons, including:
- balancing breast size when there is a discrepancy in size between the breasts;
- compensating for reduced breast volume after pregnancy or surgery to remove breast mass; or
- correcting a congenital breast defect or malformation such as tuberous breast deformity or breast hypoplasia.
Dr. Hutchinson strives to provide all her breast augmentation patients with the individualized results that they are seeking, with great-looking, natural-feeling breasts that complement their individual body and physique.
Breast augmentation can achieve beautiful results as a stand alone procedure by itself, or may be performed in conjunction with other cosmetic plastic surgery, minimally invasive or non-invasive aesthetic surgery procedures. Depending on the shape of your breasts and the look you are trying to achieve, Dr. Hutchinson may also recommend combining breast augmentation with other procedures such as a breast lift (mastopexy) or liposuction of the chest area for more satisfying results.
Fully Customized Breast Enhancement
Dr. Hutchinson knows that every woman is unique in both her desires and her body shape. With that in mind, she takes the time during pre-operative consultations with her patients to learn what each hopes to gain from breast augmentation surgery and to decide which implant type and implant placement is best. In this way, every one of our patients enjoys completely customized treatment designed with her specific goals in mind.
Breast Augmentation Implant Options
Breast implants are sterile prostheses that are either round or shaped to match natural breast shape. They are composed of an outer shell made of solid silicone, and are filled with either saline (salt water) or silicone gel. The outer silicone shell is available either as a smooth or textured surface. Both saline and silicone implant types, whether smooth or textured, are very safe, come in a variety of sizes, and each confers its particular advantages. During your breast augmentation surgery, implants are inserted behind each breast, either directly underneath breast tissue (subglandular or submammary) or under the pectoralis major muscle (subpectoral or submuscular) on the chest. During your pre-operative visits, Dr. Hutchinson will help you decide which specific breast implant and which placement location is right for you.
After many years of evaluation, research, and data collection, the U.S. Food and Drug Administration (FDA) approved silicone breast implants for cosmetic breast augmentation surgery. Dr. Hutchinson is proud to offer patients the option of silicone gel-filled breast implants, which have a softer texture and more natural feel than saline-filled breast implants.
Breast Augmentation Procedure – Incisions and Technique
The breast augmentation procedure lasts approximately one hour and is usually performed under general anaesthesia. In some patients who undergo subglandular breast augmentation, the procedure may also be performed safely using local anaesthesia with sedation. Incisions are made in inconspicuous places on the breast to minimize scar visibility. These may be located:
- In the armpit (transaxillary),
- In the crease on the underside of the breast (inframammary), or
- Around the areola, the dark skin around the nipple (periareolar).
The incision allow for access to the breast tissues and for creation of the site where the implant will be positioned. Using meticulous technique, Dr. Hutchinson dissects a pocket under the breast or below the pectoralis muscle into which the implant is inserted.
Breast Augmentation Procedure – Implant Placement Location
Breast implants may be placed either under the breast itself or below the pectoralis major muscle. Implant placement beneath the muscle of the chest offers some advantages over placement beneath the breast tissue only. These include reduced risk of capsular contracture (post-operative tightening around the implant) and the least interference with mammogram examinations. Disadvantages include potentially greater patient discomfort in the first few days following surgery, and a slightly longer recovery phase. Dr. Hutchinson will discuss which option may be best for you.
After the implants have been inserted into their respective pockets and positioned beneath each nipple, the incisions are stitched closed, then taped and bandaged. The bandages may be removed after 2 days and a surgical bra or strap may be worn, depending on the placement and type of implants.
Recovery from Breast Augmentation
Most patients feel tired and sore after breast augmentation surgery, but this usually passes in a day or two. Many patients return to work within the week, but vigorous exercise should be deferred for at least 2 to 4 weeks depending on the specific type of breast augmentation surgery you underwent.
Stitches are absorbable and your body will gradually break them down during the weeks after your breast augmentation. Post-operative pain, swelling and sensitivity will diminish over the first few weeks. Scars from breast augmentation incisions will begin to fade in a few months and will continue to fade for months or years. You will have several visits with Dr. Hutchinson during the post-operative period when she will follow up with you to make sure your recovery is as smooth as possible.
Risks of Breast Augmentation
Complications following breast augmentation surgery are uncommon and many resolve on their own with time or with limited intervention. They may include capsular contracture, swelling and pain, infection around the implant, breakage or leakage of the implant (implant rupture) as a result of injury or the normal compression and movement of your breast, a change in nipple sensation, or wound healing issues.
If a saline implant ruptures, the implant will simply deflate in a few hours and your body will absorb the salt water. If a silicone implant leaks, you should be evaluated for possible implant removal or revision. Not all implant ruptures cause symptoms in patients. Sometimes they are “silent” ruptures that are incidentally found during physical examination or routine imaging studies. Regular monitoring of breast implants after breast augmentation is recommended to ensure continued breast health and implant integrity.
A very rare disease, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), has recently been identified and occurs in a very small subset of patients, primarily those with textured implants. This lymphoma, which is specific to breast implants, usually presents as a late fluid accumulation (seroma) around the implant or mass in the breast. Treatment requires surgical removal of the tumor along with the implant, capsule, and fluid.
Breast Augmentation Revision – Removing and Replacing Breast Implants
Some women who have undergone breast augmentation surgery may consider a revision surgery if they are not completely satisfied with the appearance or size of their breasts, or if there are attendant complications from their initial surgery. Breast implant revision or removal is not mandatory simply based on the length of time a patient has had implants. Often a woman’s breasts will change with time, due to many factors such as pregnancy, breastfeeding, and merely the passage of time with the normal changes in breast shape and relative composition of gland tissue and fat as she ages. Some patients will require surgery due to capsular contracture, implant malposition or rupture, or other issues related to their original surgery.
Some of the more common reasons for breast augmentation revision surgery include the following:
- Change in size of breast implant: women may wish to change to a larger or smaller implant, based on individual characteristics and preferences. With time and hormonal influences, a woman’s breasts may change in size, shape, and degree of droopiness (“ptosis”).Consequently, the implants that were initially placed at the time of their primary breast augmentation may no longer fit their ideal image, and the may wish to opt for a removal and replacement of implants with ones of a different size.
- Change in type of breast implant: breast implants have been used in women for decades, but the ones that have been available over the last decade represent the newest, most advanced, and safest implants with the lowest risks of complications relative to previous implants. Some women may wish to change from saline filled to silicone gel filled implants, from round to shaped implants, from silicone gel to highly cohesive (“gummy bear”) implants, or from silicone to saline filled Ideal Structured Implants. Some of the newest silicone gel implants have a greater fill to implant ratio and create more projection than the traditional implants with less silicone gel fill.
- Need for additional surgery to correct sagging breasts (“ptosis”): as the breast itself may lose volume and sag, the previously placed implants may no longer be in the proper position relative to the breast tissue. In these cases, a breast lift or mastopexy may be required in conjunction with revision of the implant pocket, size, or shape to produce an improved appearance.
- Suboptimal results from initial implant surgery, with the following reasons for revision surgery:
- Breast implant rupture or deflation
- Breast implant malposition or displacement up, down, to the side, or towards the middle of the chest
- Capsular contracture resulting in pain in the breast and/or distortion of the breast
- Breast implant becomes palpable or visible
- Breast asymmetry with unequal appearance of the breasts
- Unsightly or widened scars
- Nipple or areola enlargement, distortion, asymmetry, or irregularity
- Patient desire to remove implants altogether: some women may decide they no longer wish to have any implants at all, for any number of reasons. In these patients, implant removal may be offered as an option, although in some cases a secondary procedure such as a breast lift may be necessary to produce the best aesthetic results.
- A small subset of women who have textured implants made by Allergan may wish to have their implants removed or replaced, due to the recall of these implants as of July 24, 2019. The recall was initiated because of the rare incidence of Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), which is primarily associated with the BIOCELL textured surface present in Allergan implants (such as Natrelle and Inspira textured breast implants). Removal of all textured implants is not currently recommended or standard treatment, although each patient should make an informed decision after discussion with their plastic surgeon.
In addition to the more common reasons for revision breast augmentation, a rare form of breast implant associated tumor called Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) has recently been identified in a relatively small subset of patients. BIA-ALCL is distinct from and unrelated to breast cancer, and usually presents as a mass or fluid accumulation (seroma) that manifests late, usually several years after the initial surgery, and is mostly treatable with surgical removal of the tumor, capsule, and breast implant.
Dr. Hutchinson provides plastic surgical evaluations and consultations for patients who already had breast implant surgery performed elsewhere or abroad and who may be considering revision surgery for a variety of reasons. Surgical revision may include any number of procedures including changing the size, type (saline or silicone, smooth or textured) or placement (under the breast or under the muscle) of the implants. In some cases, implants may be removed altogether, or additional surgery may be advisable. Additional procedures may include surgery on the capsule around the breast implants, with either repositioning, or removing part or all of the capsule (capsulectomy). In some patients, fat injections may be performed to correct minor irregularities or contour deformities, to provide additional breast volume, or to create coverage of visible or palpable implants. Alternatively, mastopexy or breast lift procedure may performed concurrently to provide a better cosmetic result. Dr. Hutchinson will discuss all the options for breast augmentation revision available to you, and discuss with you whether or not surgery is indicated and which surgery she recommends for you.