Breast Augmentation Is A Womans Choice
The pursuit cosmetic improvement begins with the first consultation. Its essential that the surgeon listens to the patient– not only to discuss the procedure and its inherent risks, but to tailor the discussion to the factors that make each of us different and challenging. A careful examination is also directed toward explaining to the patient what positives and negatives her unique anatomy brings to the table.
At the end of the consultation, you will receive a price quote. Typically this quote is for everything except your postoperative medications.
A second visit is needed by virtually all cosmetic patients. At that visit consent forms are reviewed, a detailed description of the anticipated recovery is discussed and preoperative photographs are taken. For breast augmentation patients, a sizing is also done.
In talking to patients who have undergone surgery elsewhere, the single most common complaint was: “I was told I’d be a particular cup size, and I’m not that size.” In some practices sizings are created by putting patients in their postoperative bra and letting them try sizer implants in the bra with a top and in the bra alone. This isnt a perfect means of selection, it does give patients the opportunity to see the difference 50 or 100 ccs makes in their final appearance.
Surgeons offer our advice when it comes to the final decision but, firmly believe that the patient not the spouse, significant other, or doctor is the one who needs to be happy with the ultimate choice. Most surgeons offer patients the opportunity to come back in before surgery a second time, if they wish, to confirm their decisions.
Plastic surgeons use saline implants made by Mentor and Allergan(formerly McGhan). While some plastic surgeons use one brand exclusively, some women “fit” better in one brand or the other. Both manufacturers stand behind their products with generous warranties and both have proven time and again their safety.In more petite patients who desire larger implant sizes, high profile implants may be an alternative. In most cases, when implants get larger they also get wider.
In more petite patients this can lead to the implant extending into the armpit. High profile implants offer more implant volume with a narrower base giving the desired volume without the negative effects of traditional implants.
Some plastic surgeons believe in overfilling of saline implants. The tendency of saline implants to ripple is well known and in some patients it can be not just felt but seen when the patient bends forward. Placing the implant below the muscle is certainly a consideration to minimize rippling but, overfilling the implant by 10% can turn a good result with palpable rippling to a great result without it.
Occasionally patients ask about anatomic (teardrop shaped) implants. The plastic surgical literature is replete with cases in which these implants have rotated within the pocket resulting in a “strange” looking result which often needs to be corrected surgically.
There are three standard implant incisions: inframammary, periareolar and transaxillary. Each has its advantages and disadvantages. The incisions are typically small, well concealed and closed with dissolving sutures which do not need to be removed.
Subglandular implants (over the muscle. When implants were first introduced, most were placed under the breast but over the chest wall muscles. In patients who are small breasted, placing the implant over the muscle results in a very round appearance to the upper portion of the breast. Some patients complain of a “fake” or “Baywatch” appearance and others can have visible rippling over the cleavage. For these reasons, some surgeons generally prefer subglandular implants only in patients with enough of their own breast tissue to minimize these negatives.
Submuscular implants (under the muscle) Most patients prefer a more natural postoperative appearance. In these patients, we often recommend submuscular implant placement. Placing the implant under the muscle not only improves the postoperative appearance. Capsular contracture (scar tissue formation around the implant which can distort the shape of the breast) is much more common in implants over the muscle. Mammograms are easier to read when the implants are under the muscle and the likelihood of being able to breastfeed postoperatively is increased. The benefits must be weighed against more pain in the immediate postoperative period.
Dave Stringham is the President of LookingYourBest.com an online resource for plastic surgery. Learn more about breast implants and cosmetic surgery procedures at http://www.lookingyourbest.com and http://www.robertfrankmd.com
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