About Breast Augmentation
Dr. A Jay Burns' goal in breast augmentation is to achieve a natural appearing breast at the size that the patient desires without an unnatural appearance or a sign that the patient has breast implants. Breast augmentation by our board-certified plastic and reconstructive surgeon can reshape your breast for an enhanced, fuller look. It is considered one of the most popular cosmetic surgeries in the United States, and Dr. Burns performs many breast augmentations in Dallas, TX each year. If you are searching for a breast augmentation doctor, you have found one of the best cosmetic surgeons in this area, who is a leader in clinical practice and product research. Rest assured, you are in great hands.
During a private consultation at Dr. A Jay Burns Cosmetic Surgery, he will assess your chest width, bone structure, skin laxity and most importantly, the amount of breast tissue you have to begin with as it determines the eventual outcome. He will listen to why you want to have breast implants, what your aesthetic goals are, and how you perceive your body. Then, he will make recommendations as to how to approach your case, provide all augmentation options, and create a tailored treatment plan to meet your goals.
The choice to have breast augmentation is a personal one. If you are considering this procedure it is important that you do it for the right reasons, and not for anyone else. Ideal candidates should be physically healthy with breasts that are fully developed, and of the appropriate age to receive implants. If you are unhappy with the look of your breasts because they appear too small, flat, or deflated, or if you have asymmetrical breasts, you may benefit from having this surgery. In addition, if your breasts have lost their youthful look due to age, pregnancy, or weight loss, breast augmentation can bring them back to life with increased volume and shape. It is also a nice enhancement for women who lift weights, have limited native breast tissue, or lack overall mass.
About Breast Implants
During the consultation, the appropriate breast implant will be recommended based on your body shape, lifestyle, and desired outcome. There are many factors to consider when choosing the right implant and that is why we strive to gain as much insight as possible during the consultation. Breast implants come in different types, sizes, shapes, profiles, and textures — all of which are taken into consideration to achieve the desired outcome. The most commonly used implants today are still saline or silicone, both approved by the Food and Drug Administration (FDA) and widely used. Candidates considering saline implants must be at least 18 years old, and those considering silicone must be at least 22. Gummy bear implants (form-stable implants) are also another option, in addition to using a fat transfer for an autonomous approach. Once the decisions is made as to which type of implant will be used, there are a few other factors to decide.
Breast implant size is determined based on the number of CCs (cubic centimeters of saline or silicone) used. To determine the appropriate amount, we look at how much native breast tissue you have, as well as the size you wish attain. During surgery, it is common to place several implants to get an idea of the right fit.
Breast implants come in either a round or teardrop shape. The majority of our patients go with a round shape. It tends to look more natural and add a fullness to the upper breast that most patients desire.
Implant profile refers to the projection of the implant. This is what you see when you look at the breast from the side view. Most implants come in either a low, intermediate, high, or extra high profile shape.
While all of these options may seem overwhelming, choosing the right implant is actually quite simple. Gaining an understanding of your specific aesthetic goal is important to accomplish during the consultation. This aspect, blended with surgeon experience, will help pinpoint the right implant so that the desired outcome is achieved.
Plan Your Procedure
- Procedure Recovery Location
During surgery, an incision will be made and the implant inserted into position. The doctor will utilize two popular incision approaches to breast augmentation, inframammary and periareolar (through the nipple/areolar complex). The inframammary approach is the most popular among his patients, as these patients typically want to minimize any scar or the small, but slightly increased incidence of decreased sensation when going through the periareolar nipple complex. The inframammary fold scar is approximately 1 to 1-1/3 inches long depending on the anatomy of the patient and is well hidden underneath the breast. In the upright position, this scar is unnoticeable in almost every circumstance.
Two primary methods are used for implant placement, including submuscular placement (under the pectoral muscle), or submammary/subglandular placement, which is directly behind the breast tissue, but over the pectoral muscle. The decision as to where to place the incision and implant are based on many factors, including the type of implant chosen, your overall body structure, the degree of enlargement, and surgeon recommendation. This is discussed during the consultation because scarring is also something we discuss. Most of the incision points, however, leave minimal to no scarring.
What to Expect
Breast augmentation is an outpatient procedure. Prior to surgery, you will receive general anesthesia or intravenous sedation. After the implant is placed into its final position, the incision is closed with skin adhesive sutures and you will be taken into recovery and monitored before being released to rest at home. You will be instructed to wear a support bra for a few days to help with swelling. Within a few weeks, the breasts will slowly settle into a normal position and over time, will begin to look and feel more natural. You should be able to resume activities, such as exercise, within 6 – 8 weeks. Breast augmentation produces gorgeous, natural results. It can oftentimes be a life-changing surgery for our patients, allowing them to feel more self-assured in certain clothing and confident in the way they look and feel.
What are the possible complications from this procedure? There are several possible surgery complications from a breast augmentation surgery: capsular contracture, rate of deflation, skin sensation changes, infection, bleeding, cancer, auto immune disease, and fold flaws, wrinkles, irregularities, and asymmetries.
Capsular contracture is the most significant complication of breast augmentation as it is the most common. It is a hardening of the breasts themselves; the implants do not harden. It is the scar tissue around the implants that squeezes the implants causing them to be hard. Once the scar tissue is removed, then the implants relax. It is much like a water balloon that is squeezed tight in your hands, but if it is placed on a table one can depress the water balloon very easily as it remains soft. The capsular contracture rate is widely reported and varies from 10 – 30%, but suffice it to say that it is higher with silicone implants than with saline on average 5 – 7% higher. Dr. Burns will make a pocket adequate and a larger size than the implant and the patient has the responsibility to move the implants in all 4 directions post operatively for several week and months on a regular basis to maintain the pocket. Once this is done then the results are genetically determined with regard to capsular contracture. It is very common for capsular contracture to develop only in one breast. Everything is done by Dr. Burns to maintain the capsular contracture rate, and the infection rate at the lowest possible state. The pocket is irrigated with antibiotic solutions. There is current evidence that antihistamines and anti-inflammatory given pre and post operatively for 6 months may limit the rate of capsular contracture. We will always try to stay on the cutting edge of this technology and minimize complications as much as humanly possible.
Rate of Deflation
The rates of deflation vary again, but are noticed more with saline implants. They usually occur with a fold or a wrinkle in the implant underneath the breast and a slow, constant rubbing against the capsule that eventually causes a pinpoint leak of the saline. This is not dangerous as saline is simply expelled in the urine, but is noticeable as a deflated implant. One simply calls the office and an implant exchange is carried out within a few days.
Skin Sensation Changes
It is not uncommon for the skin to have decreased sensation, especially on the inner aspects of the breast, if one starts with lateral breasts and wants cleavage or breasts that are close together in the midline. When dissecting near the midline of the chest, nerves are divided in order to get the breasts to move to these positions. However, this does not translate into decreased nipple/areolar complex sensation. Every precaution is taken to avoid decreased sensation to the nipple/areolar complex and this loss of nipple/areolar sensation should be in the range of 1 – 2%. It is not uncommon for there to be temporary decreased or even increased sensation in the nipple/areolar complex (sensitive to the touch); however, any sensation at all will almost uniformly result in a return to normal sensation in the nipple/areolar complex. Please note, the incidence of nipple/areolar sensation loss is substantially increased for revisionary work since the nerve that supplies the nipple/areolar complex is bluntly pushed aside during the original breast augmentation surgery and is therefore lying on the capsule in the scar tissue around any breast augmentation.
Infection is uncommon with breast augmentation, but is extremely problematic and inconvenient if it does occur. The problem exists in that if breast infection occurs the implant must be removed and left out for approximately 6 months until the breast softens and then the implant can be replaced. The incidence of infection is approximately 1% or less in our practice. A special bra can be fitted if only one implant is infected which can be utilized for the time until the implant must be replaced. If you have one infection it does not mean that you are at higher increase with the next augmentation. Dr. Burns has documented only two infection cases from breast augmentation surgery in the 13 years he has been performing them.
Bleeding can occur, albeit rarely, after breast augmentation. If it does occur it is usually accompanied by painful, swollen breasts within the first 2 – 3 days, and usually the first 24 hours post operatively. This requires a return to the operating room, evacuation of the blood, thorough inspection of the dissected pocket, and replacement of the implant.
There is no increased risk of cancer with breast augmentation. There is some evidence that would even suspect that there is a decreased risk with breast augmentation, although this is not clearly understood. Although the risk is not increased, every woman with breast augmentation still runs the same risk of 1:9, 1:10 of developing breast cancer in their lifetime. It is also well known that a small percentage of the breast is not seen on routine mammography; therefore, one extra view is required for women with implants. It is imperative to perform monthly self-examinations. This responsibility must be taken seriously by every woman considering breast augmentation.
Autoimmune disease was highly touted as possibly being caused by breast augmentation with silicone implants in the late 80’s to early 90’s. Although many lawsuits arose from these accusations, it has now been proven that there is no correlation between silicone breast implants and autoimmune disease. In 1987, the American Academy of Rheumatology concluded that they could find no cause and effect between breast augmentation and rheumatologic disorders. This should allay one’s fears even more when knowing that the unwarranted concerns were dealing with silicone implants. Today saline implants are used for primary augmentations in the United States today.
Fold flaws, Wrinkles, Irregularities, and Asymmetries:
These can occur in any breast augmentation. There can be subtle shifts. There can be irregularities, and it will be pointed out at the time of consultation any irregularities or asymmetries in the patient’s breasts pre-operatively. It is rare to find a patient with symmetrical breasts, and when breasts are augmented these asymmetries may be more noticeable.
Fold flaws and wrinkles can be noted and they are more common with textured implants and implants that are not slightly over inflated. These are also more common for patients with larger implants and smaller breast pre-operatively.
Keep in mind that the smaller the breast tissue coverage, the more likely it is for the implant to be seen. This cannot be totally avoided in certain patients, but can be minimized greatly by surgical technique of placing the implants under the muscle or over the muscle and by slightly over inflating the implants to avoid fold flaws and wrinkles. We place the majority of patients of primary breast augmentations underneath the muscle. This provides more tissue between the external environment and the implant; thereby maximizing contour and a natural appearance. There will also be slightly less implant masking breast tissue on mammography if placed under the muscle; however, this is a minor consideration. The exception to this rule is that it is occasionally beneficial to place the implant above the muscle in patients who have mild droopiness of their breasts and at least a B breast or greater, (i.e., enough breast tissue to cover the implant adequately). If enough breast tissue is present but is droopy, a more direct lift on the breast can be done above the muscle and may save the patient a more extensive lifting procedure.
Get the Look You Want
Cosmetic breast surgery is popular for many reasons. It is safe, effective, and produces gorgeous and exciting results. With so many enhancement options available today, patients can attain the look they desire and feel confident in their own skin. Our Dallas, TX plastic surgery office is proud to offer this outstanding procedure and we welcome you to learn more by calling our practice tos schedule your consultation.