Breast augmentation is an important decision and you need to assess both your present and future goals and desires. An important question we often address is which surgical incision best fits each individual body type and personal aesthetic goal. Dr. Totonchi will help you in determining which surgical incisions options will best help you to achieve not just your present goal, but your future breast enhancement planning.
There are many reasons why women choose breast enhancement surgery, and you may be a candidate for breast augmentation if your breasts are fully developed, which means you over the age of 18, and you experience one or more of the following:
•your breasts lack desired fullness/volume
•you are dissatisfied with the size and/or shape of breasts
•breast shape or volume has decreased significantly
•breasts have not fully developed normally
Dr. Totonchi, in Cleveland, Ohio, offers both saline and silicone implants to his patients. Both types of implant have an outer shell made of silicone. Saline implants are filled with sterile salt water by the surgeon at the time of surgery, which allows more surgeon control when it comes to choosing the implant volume. In the event of rupture, the saline solution will leak and the implant will immediately deflate, causing the breast to change shape and size. There is no health risk associated with the body’s absorption of the saline solution; however, surgery will be required to remove the shell of the implant and a new implant can be inserted.
Silicone implants come pre-filled with a silicone gel which arrives sealed by the manufacturer. The silicone gel is a viscous material that is reported by many women to look and feel more natural. The silicone gel mimics the look and feel of fat, which breasts are naturally comprised. In the event rupture, the body does not absorb the silicone that has leaked from the implant. Instead, the gel becomes trapped in the tissue surrounding the implant. The silicone which has leaked into the surrounding tissue can cause pain or discomfort in addition to possibly changing the shape and/or size of the breast. Many times the rupture of a silicone implant can go undetected by the patient, which is why MRI scans are used to monitor the condition of silicone implants every 2-3 years after placement. It is recommended that ruptured implants are surgically replaced in order to avoid any further complications.
There are three main types of incisions for breast augmentation which Dr. Totonchi, plastic surgeon in Cleveland, Ohio offers to his patients, which include:
*Trans-axillary incision, which is the most technically advanced method, is often preferred by patients due to the lack of visible scarring surrounding the breast. The trans-axillary incision is made at the crease of the armpit, and can be done endoscopically or by using a traditional open approach. The trans-axillary incision is more technically demanding, since the incision is not made directly on the breast, and requires a high level of surgical expertise, which Dr. Totonchi is highly trained, and recommended. Once the incision is made, a path to the breast is created, and a pocket is made where the implant will be placed. Both saline and silicone implants can be used with this incision type, however, saline is generally preferred since the implant can be inserted empty, and filled once it has been placed inside the breast pocket, thus keeping the size of the incision as small as possible. The trans-axillary incision scar typically heals well and often goes unnoticed, which tends to make this method most popular. The trans-axillary incision type is further away from the breast which leaves the surface of the external breast tissue surgically untouched. This method is least likely to damage mammary glands, therefore making it desirable for women who may plan to breastfeed in the future. The drawback of the trans-axillary incision is that the incision site cannot be used again in the event of future breast surgeries. Finally, due to the location of the incision, there is a possibility for a loss of sensation in the armpit or hand/arm in the rare event that nerves are severed or damaged during the surgical procedure.
*Periareolar incision, which entails a half circle incision which is typically made at the lower edge of the areola, where the areola meets the lighter pigmented breast tissue. The benefits to this incision type include the fact that the surgeon has more control and precision in the placement and positioning of the breast implant due to the direct access provided by the location of the incision. The risks associated with this technique include a potential loss of breast/nipple sensitivity and the potential of severing milk ducts and nerves, which can impede breastfeeding in the future. In addition, recent scientific data suggests that this method is related to a higher rate of capsular contracture. Scarring with the periareolar incision typically fades over time, and is often well hidden due to the difference in skin color and texture at the juncture of areolar and breast tissue.
*Inframammary incision is made underneath the fold of the breasts, where the lower portion of the breast meets the chest wall. This incision method is often chosen in order to minimize visible scarring and allows for direct access to the breast tissue and implant insertion site. This incision site can be used for future breast surgeries, which reduces the number of potential scars in the event that future surgeries are required. The inframammary incision type is often chosen because the scar is easily hidden by a bra, bikini, or the breast itself. One potential downside to the inframammary incision is that the scarring location makes it difficult to change breast size in the future. This is due to the fact that the scar would move up in the event that a patient was to switch to a larger implant. Conversely, the scar would move down if the patient decided to decrease the size of her implants or remove them altogether. Finally, it may be more difficult for the surgeon to precisely position this type of incision in patients with smaller breasts prior to augmentation, or those with a minimal natural crease at the breast/chest juncture.
The speed of recovery varies depending on each individual. Patients are generally advised to rest for three to five days following a breast enhancement procedure, which allows the body to recover from anesthesia and for the management of any postoperative pain. During this time, it is normal to experience fatigue and some drowsiness due to pain medication and the effects of anesthesia. Patients can begin light walking as tolerated immediately following surgery, but it is important to take things slow and listen to your body. Immediately following the procedure, the implants are likely to be positioned high on the chest wall, this is normal, and over the course of the next three months, the implants will settle and become softer and more mobile. You will be provided with a post op surgical bra which you will wear for 2-4 weeks after surgery. Some patients experience numbness or hypersensitivity on or around the nipple after surgery, this is also normal and should subside in 3-6 months. Patients can generally resume their regular activity, including strength training and weight lifting four to six weeks after surgery, but this should be done under the discretion of the surgeon and the individual recovery of the patient.
Some risks are common to all surgeries, such as those related to anesthesia, bleeding, infection, pain, and the possibility of breast revision surgery being required at some point in the future. Other risks, however, are unique to breast augmentation procedures. These include changes in nipple and/or breast sensitivity, the formation of tight scar tissue around the implant itself, rippling or wrinkling of the skin, wrong/incorrect placement of implant, implant rupture or leakage, poor scarring, and/or fluid accumulation.
Proper post-operative care is essential and will increase the likelihood of proper healing and a desirable outcome. The most important aspect of post-op care is to be sure to keep all postoperative appointments. Recovery speed and progress depends on the individual patient and the personalized advice of Dr. Totonchi, who closely monitors his patients in order to optimize healing.
In addition to short-term postoperative care, breast implants require additional long-term care, which begins with regular postoperative breast examinations in order to evaluate the condition of the implants. While implants can last a lifetime, manufacturers of the implants do not label them to be “lifetime devices”. This means that implants can require being replaced due to deflation, rupture, or other reasons related to patient preference. Notable fluctuations in breast size due to pregnancy, menopause, or weight loss can result in the altered appearance of augmented breasts over the course of time. This change alone may be enough for some women to consider changing the size or shape of their implants.
If you are considering breast enhancement surgery, call for a consultation with Dr. Totonchi in Cleveland, Ohio, 440-461-7999.