Perhaps the most talked about and sometimes even the most controversial cosmetic surgery is breast augmentation. Simplistically, breast augmentation involves enhancing a woman's breast size and shape. However, as with all cosmetic surgery, there is a great deal to consider, including implant surfaces, types and positioning.

Most women have some preferences regarding size and shape and should discuss this thoroughly with their board-certified plastic surgeon during pre-op consultations. Sometimes, pictures brought in by the patient can help to communicate her preferences to Dr. Lugger.

In regards to implant size, the implant volume does not always directly relate to cup size. For example, it will usually take a larger implant to attain a "C" cup for a woman with a large broad "thick" chest, than for a smaller woman. Implant shape may also be confusing, as there are "round" and "tear-drop" (so called "anatomic") shaped devices. According to Dr. Lugger, the "round" device may actually be more "tear-drop" shaped as it sits in the breast area than one would imagine.

The implant surface is another factor to consider, with "textured" surfaces possibly cutting down on the incidence of "hardening" or scar tissue development (called capsular contracture) forming about the implant. The cause of such "tightening" is not understood and remains an inherent risk of the surgery. Fortunately, the actual incidence of capsular contracture seems to have decreased in recent years whether it be related to the quality of implants or the surgical techniques utilized to insert them.

Saline Implants

Saline implants have proven to be safe and reliable alternatives to other fill mediums such as silicone, although their viscosity or thickness is less like that of the thicker fill products such as silicone and therefore they can have a rippling feel even when fully inflated. This may be less noticeable when the implant is placed beneath the muscle, however a patient's anatomy such as the inherent thickness of her tissues may play a role in this situation.

There are several incision choices for this procedure. The most common incision employed is the Inframmary approach where it is very difficult to see since the augmented breast usually covers the incision. Other incisions include axillary (through the armpit), which although it leaves no breast scar, it is difficult to ensure proper placement and any further surgery regarding the implants is best accomplished through another approach. Periareolar incision (beneath the nipple) usually results in a minimal scar, but according to Dr. Lugger, many patients don't like placement of this incision so near the nipple.

A fourth way to perform augmentation is through the umbilicus or belly button, however there are significant limitations with this method including implant dislocation which is difficult to treat, In addition, the implant cannot be placed under the muscles with this technique.

If you are considering breast augmentation, contact Dr. Lugger's office for a personal consultation.

Safety

During the '90's there was concern and "controversy" about the safety of silicone gel implants, and although saline implants remained a viable option, their use too dropped off as plastic surgeons and the FDA looked to establish the safety of these devices. The FDA ruled on May 10, 2000 that saline filled implants manufactured by Mentor and McGhan corporations could continue to be marketed and used in women over 18 years of age for breast augmentation.

A number of studies have looked at these safety issues as well as various somatic complaints (e.g. aches, pains in the neck, trunk and extremities) and most conclude there was no connection between "autoimmune" disease and "somatic" complaints and breast augmentation. Over 50% increase in breast augmentation procedures was seen between 1998 and 1999. My personal preference in recent years has been to use saline implants which can be adjusted for asymmetry in breast volume between the two sides. The location I prefer is inframammary which provides the most direct approach to the implant pocket and after healing, this incision is difficult to see under the curve of the breast.

Other incisions are located under the arm and along the bottom curve of the pigmented areola. I often put the implant beneath the muscle as this provides an extra layer of tissue to protect the implant and the muscle contraction during normal activity may keep the implant softer by keeping the implant moving. "Round" implants are quite satisfactory and they are probably assume a more "tear drop" or "anatomic" shape in the body.

There are indications for other types and shapes of implants and placement above the muscle which options are best discussed with the patient during consultation. Deflation rates for saline implants are low and most manufacturers provide replacement implants in these instances.