Breast Augmentation

breast-augmentation

“Dr. Hutchinson is a terrific plastic surgeon. She walked me through the whole process of my breast augmentation and made sure I was completely comfortable and knew exactly what to expect. I am thrilled with the results and would recommend her to everyone.” H.H.

Read more breast augmentation patient testimonials here.


Breast augmentation surgery is both one of Dr. Hutchinson’s most popular cosmetic surgeries and one of her areas of specialization and expertise. Breast enlargement or augmentation consistently ranks among the most frequently performed aesthetic surgery procedures in the US, and is an aesthetic procedure designed to enhance a woman’s appearance by increasing breast volume, restoring breast volume after childbearing and breastfeeding, and improving the contour of the breasts. In most cases, breast augmentation is achieved by using either silicone or saline breast implants, although more recently, a new method using patient’s own fat may also produce the desired results. Breast augmentation surgery allows women with small, underdeveloped, or unevenly sized breasts to achieve a fuller, firmer, better-proportioned look with saline or silicone implants. In women who desire a relatively small increase in breast volume and in women who need an improvement in breast contour, autologous fat injections to the breasts may 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. Having been in practice for over 2 decades, she has extensive experience in determining which type of implant is best suited for each patient, and in working with each patient to deliver optimal results.

Breast augmentation can achieve beautiful results in many patients 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 best 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 spends a significant amount of time with her patients during pre-operative consultations 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.

Low profile silicone breast implant

Low profile silicone breast implant

Medium profile silicone breast implant

Medium profile silicone breast implant

High profile silicone breast implant

High profile silicone breast implant

Breast implants are sterile prostheses that are either round or teardrop shaped to match natural breast shape. They are composed of an outer shell made of solid silicone elastomer, 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 are scientifically proven to be 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 position) or under the pectoralis major muscle (subpectoral or submuscular position) 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.

Breast Implant Types: Saline, Structured (Ideal®), and Silicone

Breast implants were originally brought onto the plastic surgery scene several decades ago, and after years of research and evolution in implant characteristics, women now have hundreds of possible choices for breast enhancement. The volume, projection, shape, fill material, and shell surface structure variations allow for hundreds of different permutations, which offer women the possibility of finding a truly unique look to fit their desired results.

 

Silicone gel implants with different projections: low (left) and high (right)

In the U.S. today, breast implants are available in 3 main types: saline filled implants, Structured saline or Ideal® implants, and silicone gel filled implants. All implants consist of an outer, solid silicone shell, but the internal component is what primarily differentiates the many types of breast implants:

  • saline implants are round, consist of a single outer shell, and are filled with varying amounts of saline solution;
  • structured or Ideal® implants are round, contain two chambers and a layered system of external shells, and are filled with a variable amount of saline solution;
  • silicone gel implants have a single outer shell and come pre-filled with different types of silicone gel in a specific volume; the silicone gel ranges in density to produce different feel and shape retention; the most cohesive gel implants, also called “gummy bear” implants, are available in both round and tear drop shaped styles.

After many years of evaluation, research, and data collection, the U.S. Food and Drug Administration (FDA) approved the most recent type of silicone breast implants for cosmetic breast augmentation surgery. Dr. Hutchinson is proud to offer patients many options of implants, including silicone gel-filled breast implants, with a softer texture and more natural feel, as well as the saline-filled implants, which contain natural saline solution.

Saline smooth shell implant

Saline smooth shell implant

Silicone gel smooth shell implant

Silicone gel smooth shell implant

All currently available breast implants used for plastic surgery in the U.S. have been subjected to extensive research and clinical studies, and have all been cleared by the FDA as safe and effective medical devices that may be safely used for both breast reconstruction and aesthetic breast augmentation. One specific type of breast implants made by Allergan, namely saline and silicone implants with textured shell surfaces, were recalled worldwide as of July 24, 2019. These breast implants are no longer available for implantation, due to the associated risk of developing a very rare complication known as Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL). At this time, the FDA recommends that textured shell implants be removed only in patients who have symptoms or issues with their implants, such as swelling, a mass, or fluid around the implant. However, many patients who have textured implants prefer to have their implants replaced with smooth implants regardless so as to avoid the potential development of BIA-ALCL.

Saline Implants

For women who are considering breast augmentation, saline filled breast implants may be used to increase breast volume and produce a fuller chest. Saline filled implants are round implants composed of a pliable smooth silicone outer shell and filled at the time of breast augmentation surgery with a variable amount of sterile saline solution. They are available in a wide variety of sizes and projections, which allow for providing an individualized approach to each patient’s anatomy and desired results.

Saline breast implant

Saline breast implant

Saline implants may be placed in either one of the following locations:

  • subglandular – directly under breast tissue
  • subpectoral – underneath the pectoralis major muscle

Saline implants may be inserted using any of the following access incisions:

  • inframammary – under the breast
  • periareolar – around the nipple
  • transaxillary – via the armpit

Additionally, these implants may be inserted through the incision used to perform a tummy tuck if an abdominoplasty is performed concurrently. All incisions will result in a scar in the area, but the scar is very short, usually an inch or less, because the implants are inserted deflated and are subsequently instilled with saline once they are in the proper location.

Advantages of using saline implants include:

  • very short incision
  • adjustable volume at time of surgery
  • filled with saline, which in case of implant rupture is resorbed by the body

Potential disadvantages of saline implants include:

  • feel more firm than natural breast tissue
  • only available as round, not anatomically or tear drop shaped

All surgery carries the risk of complications and untoward results. Potential complications of breast augmentation surgery with saline implants include bleeding, infection, unsightly scars, capsular contracture, asymmetry, implant deflation, palpability or visibility. In some cases, revisional surgery may be necessary.

Most breast augmentation surgery with saline implants is performed under general anaesthesia for patient safety and comfort. Dr. Hutchinson performs breast augmentation in the safety, privacy and comfort of the AAAASF certified Operating Room in her office in New York City. Surgery usually lasts 1 to 1.5 hours and patients go home after their surgery. Recovery requires restriction of strenuous physical activity for 2 weeks after surgery.

Structured Implants: the “Ideal Implant”®

The new, Structured Ideal Implant®, is the latest alternative to saline filled breast implants. Developed by a plastic surgeon in order to provide a more natural feel to saline implants, it comes without some of the risks associated with silicone gel implants, such as silent rupture and silicone gel leaking. In addition, unlike traditional saline filled implants which consist of a single silicone shell, the Ideal® implant has several layers of built in baffles that create a softer, more natural feel. In clinical studies, it also has a lower risk of capsular contracture and lower rupture rate than silicone gel filled implants.

IDEAL Toolkit_ Implant Image

Ideal Implant

Structured implants may be placed in either one of the following locations:

  • subglandular – directly under breast tissue
  • submuscular or subpectoral – underneath the pectoralis major muscle

Structured implants are inserted empty of any saline and subsequently filled with an adjustable amount of saline once they are inserted in the proper location under the breast or pectoralis muscle. Since the fill volume is adjustable at the time of surgery, asymmetry in appearance of the breasts, whether in size and shape, may be addressed by using different amounts of saline. In addition, the implants may be filled to either “high” or “maximum” volume, which also changes the shape of the implant and how the breasts ultimately look. With a “high” volume fill, the implant is more conically shaped, with more central projection, whereas with the higher “maximum” volume fill, the implant assumes a rounder shape with more lateral fullness on the sides:

idealimplant

Ideal Implant: High fill volume (left) – Maximum fill volume (right)

Structured implants may be inserted using either of the following access incisions:

  • inframammary – under the breast
  • periareolar – around the nipple

Regardless of which incision is used, a short scar will be located in that area. This scar is usually well hidden, and most often measures less than an inch.

Advantages of using structured implants include:

  • natural feel, closely resembles normal breast tissue
  • adjustable volume at time of surgery
  • filled with saline, which in case of implant rupture is resorbed by the body
  • short scar in imperceptible location

Potential disadvantages of structured implants include:

  • feel slightly firmer than silicone gel filled implants
  • only available as round shape

All surgery carries the risk of complications and untoward results. Potential complications of breast augmentation surgery with saline implants include bleeding, infection, unsightly scars, capsular contracture, asymmetry, and implant deflation, palpability or visibility. In some cases, revisional surgery may be necessary.

Most breast augmentation surgery with structured implants is performed under general anaesthesia for patient safety and comfort. Dr. Hutchinson performs breast augmentation in the safety, privacy and comfort of the AAAASF certified Operating Room in her office in New York City. Surgery usually lasts 1 to 1.5 hours and patients go home after their surgery. Recovery requires restriction of strenuous physical activity for 2 weeks after surgery.

Silicone Implants

Silicone gel filled breast implants are used for breast augmentation to increase breast volume and produce a fuller figure. These implants are available in a wide variety of options including size, shape, and type of gel used for the inner fill. The outer shell is composed of either smooth or textured silicone, and the inner gel ranges from softer or less cohesive to highly cohesive (“gummy bear”) gel. Depending on the type of gel and other characteristics of the implants, different types of cosmetic results may be obtained for any given size of implant. Silicone implants are available in a wide variety of sizes, shapes and projections, all of which are considered to provide an individualized approach to each patient’s anatomy and desired results.

Silicone smooth shell implant

Silicone smooth shell implant

Silicone gel textured shell implant

Silicone gel textured shell implant

Highly cohesive silicone gel shaped implant

Highly cohesive silicone gel shaped implant

Silicone gel implants are also available in a denser, more cohesive gel as either round shaped or tear drop shaped, which mimic an anatomical breast shape. These implants are filled with highly cohesive silicone gel, sometimes referred to as “gummy bear” implants. Originally used for breast reconstruction, they were subsequently cleared by the FDA for aesthetic surgery and are now also an option for cosmetic breast augmentation patients over age 22. Many alternatives exist with variations in height, width, projection, and type of tear drop shape of the implants allowing to match the implant with each patient’s unique characteristics and goals.

Silicone implants may be placed in either one of the following locations:

  • subglandular – directly under breast tissue
  • subpectoral – underneath the pectoralis major muscle

Silicone gel filled implants may be inserted using either of the following access incisions:

  • inframammary – under the breast
  • periareolar – around the nipple

All incisions will result in a scar in the area, and although the incision is made as short as possible, larger implants require longer scars for implant insertion. Advantages of using silicone implants include:

  • closely match feel of natural breast tissue
  • available both as round and anatomically shaped
  • highly cohesive gel does not spread in case of implant rupture

Potential disadvantages of silicone implants include:

  • require slightly longer incision for insertion than saline implants
  • highly cohesive gel feels firmer
  • may undergo “silent” rupture that may not be visible or palpable on examination and requires imaging (mammogram, ultrasound, or MRI) for definitive diagnosis

All surgery carries the risk of complications and untoward results. Potential complications of breast augmentation surgery with silicone gel filled implants include bleeding, infection, unsightly scars, capsular contracture, asymmetry, implant rupture, palpability or visibility. In some cases, revisional surgery may be necessary to improve the ultimate result.

Most breast augmentation surgery with silicone gel implants is performed under general anaesthesia for patient safety and comfort. Dr. Hutchinson performs breast augmentation in the safety, privacy and convenience of the AAAASF certified Operating Room in her office in New York City. Breast augmentation surgery usually takes about 1 to 1.5 hours and is performed as outpatient surgery, i.e. patients go home on the same day of their surgery once they have adequately recovered. Recovery requires restriction of strenuous physical activity for 2 weeks after surgery.

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 intravenous 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 allows for access to the breast tissues and for creation of the surgical plane 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 degree of 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 with each of her patients which option may be best for her.

After the implants have been inserted into their respective pockets and positioned beneath each nipple, the incisions are sutured 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 after surgery. 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, and seems limited to those with current or prior 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. Dr. Hutchinson provides consultations and evaluations of patients who have textured implants and are concerned about swelling, a mass, or fluid in the breasts, and formulates the most appropriate plan for managing their implants.

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 skin quality, 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, leakage, 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.

The Breast Augmentation Patient’s Frequently Asked Questions

Q: Am I a good candidate for breast augmentation surgery?

A: Once your breast development is complete, you may wish to undergo breast augmentation surgery if you experience any of the following:

  • feel that your breasts look too small or are underdeveloped
  • lost breast tissue volume after pregnancy and/or breastfeeding
  • are unhappy with your overall body image because of your breasts
  • have low self-esteem due to small breasts
  • have breast asymmetry where one breast is significantly smaller than the other and would like better symmetry

Q: What should I expect during my breast augmentation consultation?

A: Your initial consultation with Dr. Hutchinson includes the following:

  • a comprehensive in-person discussion with Dr. Hutchinson when she will obtain your medical history and you will have time to explain what bothers you about your breasts and what results you hope to achieve with surgery
  • after your conversation, you will be seen in a private examination room where she will perform a detailed physical examination and assess your unique physical features
  • you will be shown different breast implants with different characteristics (volume, projection, and saline and silicone gel fill) in order to help educate you on the many breast implant options available for your augmentation
  • she will also take medical photographs which provide additional information when discussing your surgery
  • following your examination, Dr. Hutchinson will discuss surgical options, determine the best customized surgical plan for you to achieve your goals, and review your medical photographs with you
  • Dr. Hutchinson will also provide you with specific details regarding the bespoke operation she creates for you as each patient’s plan is based on individual features and desired outcome
  • she will also inform you of what is required from you before and after your surgery to ensure a successful operation and smooth recovery
  • you will be given ample time to ask any questions you have in order to feel comfortable with your decision
  • you will also have an opportunity to schedule your surgery once you have decided to proceed

Q: What cup size will I be after my breast augmentation surgery?

A: Bra cup size is variable between brassiere manufacturers and is not entirely reliable as a measurement of breast size either before or after breast augmentation. In order to help you understand what results can be achieved with breast augmentation surgery and what is the best possible option for you, Dr. Hutchinson will discuss with you specific details of your current breast size and physical characteristics.  Factors that may impact your results include the following:

  • your current breast size, including:
    • breast volume
    • breast width
    • amount of breast sagging (“ptosis”)
  • position of your nipples
  • skin features, such as:
    • amount of excess or loose skin
    • skin quality (elasticity and tone)
  • pectoral muscle development and tone
  • inframammary fold position and tightness
  • breast asymmetry or differences between the breasts in terms of:
    • breast volume, shape, and width
    • breast sagging (“ptosis”)
    • nipple position realtive to the breast

Q: How should I prepare for my breast augmentation surgery?

A: Dr. Hutchinson provides her patients with detailed and precise instructions to be followed prior to surgery, which include the following:

  • Dr. Hutchinson will make recommendations for each patient including:
    • breast imaging including mammogram, sonogram, and/or MRI as necessary
    • requirements for medical clearance and bloodwork prior to surgery
  • patients should be active participants in optimizing their wellness, including:
    • maintaining a healthy lifestyle, diet, and weight
    • avoiding smoking
    • not taking medications that can increase risk of complications

Q: What should I expect after my breast augmentation surgery?

A: Every patient will have her own personal experience and recovery after breast augmentation, although some common aspects of their post-operative course include the following:

  • results are immediate and long lasting
  • some discomfort, swelling, and bruising are normal in the first few days after surgery
  • you should wear the surgical brassiere, bra strap, or breast garment provided after surgery
  • it is essential you refrain from strenuous physical activity after surgery and closely follow the detailed instructions provided by Dr. Hutchinson
  • breast implants require constant assessment and monitoring: you should undergo regular post-operative checkups including office appointments and breast imaging studies as recommended, for as long as you have implants.

 

Contact Us today!

If you are interested in learning more about our services or would like to schedule an appointment with Dr. Hutchinson, please contact us or call us at 212-452-1400.

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