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Breast Augmentation

Augmentation mammaplasty (breast enlargement) is performed to increase breast size and correct breast asymmetry. Candidates include women who want larger breasts and those who want to restore the breast volume often lost as a result of pregnancy, breastfeeding or significant weight loss. Breasts can be enlarged with implants or by fat transplantation. Augmentation mammaplasty is not a substitute for mastopexy, which is a procedure to “lift” breasts that sag significantly.

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Augmentation Mammaplasty with Implants

Silicone and saline are the two implant types used in augmentation mammaplasty. Silicone implants feel more like natural breasts than saline implants, however, they require a larger incision. Both types are safe. The newest cohesive gel “gummy bear” implants have the most natural shape.

Implants are placed behind each breast, underneath either breast tissue or the muscle that is behind the breast. The procedure takes about one hour and is typically performed with general anesthesia. Incisions are made in inconspicuous places to minimize scar visibility in the crease on the underside of the breast, around the areola, or in the armpit.

Advantages of implant placement behind the muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around the breast implant), and less interference during mammograms. Disadvantages include the possible motion of the implant when exercising. Advantages of implant placement beneath breast tissue allows breasts to move more naturally as the patient uses her chest muscles, and slight breast sagging is corrected.

Additionally, there are two different surface textures to breast implants. They can be smooth or with a textured surface. The textured surface is designed to hold the implant in place and decrease the chance of capsular contracture, where the implant feels firmer than desired. All shaped implants are textured, which eliminates the need for regular breast massage used with smooth implants to prevent capsular contracture.

Augmentation Mammaplasty with
Fat Transfer

Augmentation mammaplasty with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Augmentation mammaplasty is appropriate for women who are not looking for a dramatic increase in breast size, and want breasts that look and feel as natural as possible.

For a number of weeks prior to augmentation mammaplasty, external tissue expanders are placed to expand the breasts, and increase the amount of fat they can hold.

Unfortunately, fat transfer can be disappointing to patients because it does not afford enough improvement for most women. Another concern has been the possible confusion of calcified fat deposits from the fat transfer and breast cancer on mammograms. Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary.

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Recovery 

After augmentation mammaplasty, a surgical bra is typically worn over the bandages to minimize swelling and support the breasts. Patients return to work in one day to one week. Sutures are all dissolvable. Scars may be more noticeable at first, but blend in with time.

Risks

In addition to the risks associated with any surgery, those related to augmentation mammaplasty using implants are related to the implants themselves. The implants are guaranteed by the manufacturers.

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