Breast Augmentation

2012-04-04

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Breast augmentation is a cosmetic surgery procedure that thousands of women consider each year. During the procedure, an implant is inserted through an incision made under the crease under the breast, around the areola (dark tissue around the nipple), or through the armpit. The implant may be placed under the breast tissue or beneath the chest wall muscle. Women may choose to have saline or silicone implants. Breast augmentation is an outpatient procedure which usually takes 1-1.5 hours under general anesthesia. Stitches absorb on their own but the incisions are usually covered with tape for 1-2 weeks. Most patients return to routine activity within the first week but aerobic activity and strenuous upper body activity are limited for 3-4 weeks.

Both of the breast implant placement options have their own advantages and disadvantages that must be appropriately weighed when deciding where your breast implant will be placed.

Over the Muscle
Placing the breast implant over the muscle, but beneath the breast tissue is the most common breast implant placement.  During this procedure, the breast implant pocket is made just above the pectoral muscle.

By placing the breast implant above the muscle, a larger implant can be initially implanted because there is no muscle tissue limiting the size of the breast implant pocket.  Also, the recovery time for breast augmentation where the breast implant is above the muscle is shorter because the muscle is not cut at all.

However, when breast implants are placed above the muscles, the results are generally less natural-looking, because the transition from the chest to the breast is not as smooth.  Also, the appearance of rippling and folding is more visible because there is less tissue covering the breast implant.

Under the Muscle
Placing the breast implant beneath the muscle is becoming more and more popular as women see the results it produces is just as good, or even better, than placing the breast implant over the pectoral muscle.

When the breast implant is placed beneath the pectoral muscle, the muscle is cut and a breast implant pocket is made behind the muscle.  It is believed that by placing the breast implant here, the chance of capsular contracture is lessened.  Also, the transition from the chest to the breast is more natural-looking and the chance of visible rippling or folding is lessened because the muscle covers the implant.

The downfalls of placing the breast implant behind the muscle is that the recovery time is longer because the muscle tissue must also heal, and patients are unable to receive especially large implants during the first breast implant procedure.

Revision Breast Augmentation

If you have had a previous breast implant surgery and desire a size change, a revision augmentation is necessary.  Additionally a revision is the only means of correcting problems associated with rippling, implant rupture or excess scar formation termed capsular contracture.  Revisional breast surgery attempts to restore breasts that are soft and symmetrical. 
Revisional surgery usually consists of either removing the scar tissue that inevitably forms around an implant, called a capsulectomy, or releasing the scar tissue called a capsulotomy.  These two procedures attempt to recreate the pocket or space where the implant sits, and thereby restore a more natural feel and appearance.  In some cases a revision can be performed through your previous scars, but often times additional incisions are necessary particularly if excess skin is to be removed at the same time.  Depending on how long your implants have been in place, it may be advisable to replace them with a new set of implants.