Many women choose to have breast enhancement in St. Louis in order to satisfy their own desire for a fuller bustline. Your breasts may not have developed to a size that meets your expectations, or one breast may be significantly smaller than the other. You may have been happy with your breasts in the past but feel that they look different now. Often, after weight loss, childbirth or as a result of aging, the breasts lose volume and their shape changes. Breast augmentation can enhance your breast size and shape and give you the more proportional figure you always wanted.
Breast enlargement will give your breasts size, shape and symmetry, making you look better in certain kinds of clothing. It is very effective in restoring fullness in the upper part of the breast and also will “lift” the breast to some degree. The end result is an improved body image and boost in self-confidence.
Breast augmentation is a highly personal decision, and we want to make sure all of your questions and concerns are addressed. The consultation will begin with a complete medical history and exam. You should tell Dr. Jones if you have any history of scarring; any history of breast surgery or breast disease; any family history of breast cancer; any history of lupus, rheumatoid arthritis or connective tissue diseases, and the results of your mammograms. If you are planning to lose a significant amount of weight, or if you may want to become pregnant in the future, you should mention this to us.
When considering breast augmentation, you will be asked about the changes you would like to make in your breast size and anything else related to the appearance of your breasts. Bring pictures of breast sizes and shapes you like. This will help Dr. Jones understand your expectations and determine whether they can realistically be achieved. Click here to Request Your Consultation at Genesis Cosmetic Surgery and Laser Center.
The examination will evaluate many aspects of your appearance, including:
Other options available to you will be discussed, including types of breast implants, location of incisions and location of the breast implants. If your breasts are drooping, a breast lift in combination with a breast augmentation may be recommended. You can see before and after photos of recent patients, and patient references are available upon request. The estimated costs of the treatment will be explained. Photographs will be taken for your medical record. Issues that will be discussed include:
Since saline-filled breast implants are supplied as an empty shell and inflated at the time of surgery, the incision used to place them can be kept very small. On the other hand, silicone gel-filled breast implants are supplied by the manufacturer inflated and require a larger incision.
Who is a candidate for Breast Augmentation?
Several feelings or conditions may verify that you are a good candidate for breast augmentation:
Whether you are a physician, a woman who already has implants, or simply someone considering breast augmentation or reconstruction, this site is designed to help users navigate the vast, often confusing and sometimes inaccurate amount of information available online about breast implants.
Around the Areola (Periareolar or Circumareolar): The incision is at the junction of areola and the skin of the breast. The periareolar incision is usually halfway around the perimeter around the areola whereas the circumareolar incision is made around the entire perimeter of the areola. This incision is especially useful for repositioning the nipple to a higher position on the chest and to lift the breast (mastopexy). Both saline-filled and silicone gel-filled breast implants can be placed through this incision.
Vertical or Anchor: This incision incorporates the circumareolar incision with a vertical component that extends from the areola to the breast crease.
Inverted-T: The incision is located around the areola, down the center of the breast from the areola to the breast crease and horizontally along the breast crease. This incision is necessary for those with the greatest drooping and skin laxity.
In the Breast Fold (Inframammary Fold): This incision is located in the skin crease below the breast. This approach is good for either saline-filled or silicone-gel filled breast implants.
In the Armpit (Axillary Approach): The incision in the axilla can be used when the implant is placed under the chest muscle. This approach is performed with the use of an endoscope. Only saline-filled implants can be placed through this incision.
Trans-Umbilical: An incision is made around the upper part of the umbilicus. Saline-filled implants are placed with the use of an endoscope.
Above or Below the Chest Muscle: The major chest muscle directly beneath the breast is the pectoralis major muscle. Breast implants can be placed above or below the muscle. Placement of the implant depends on several factors, including the type of implant and your particular physical characteristics.
Diagram of incision sites and location of implants above or below muscle.
Saline Filled: Sterile saltwater is the material inside the silicone elastomer sac. The saline is added at the time of surgery through a valve. Saline-filled implants are FDA approved for cosmetic breast augmentation. If a saline implant deflates, the surrounding tissues absorb the saline. The chance of deflation for saline-filled implants is approximately one percent per year.
Silicone Gel Filled: Silicone gel is the material inside the silicone elastomer sac. These implants are filled by the manufacturer and can be used in limited circumstances. Dr. Jones is part of a group of plastic surgeons in the U.S. involved in clinical trials evaluating the effectiveness and safety of silicone breast implants. Rupture of a silicone gel implant is not always easy to detect. The material is not absorbed by the body.
Smooth Shell: The outside silicone elastomer sac has a smooth surface.
Textured Shell: The outside silicone elastomer sac has a textured surface. Some studies suggest that a texture surface implant helps prevents excessive scarring, also known as capsular contracture, when the implant is placed above the muscle.
Round Implants: The shape of the implant is round.
Anatomical or Contoured Implant: The implant is “tear-drop” shaped, producing more projection directly under the nipple and less projection in the upper part of the breast.
In 1992, because further studies were needed to establish the safety of silicone gel breast implants, the FDA decided that silicone gel-filled implants would not be generally available for cosmetic breast enlargement. Currently, all women undergoing cosmetic breast augmentation will receive saline-filled implants. Women who qualify to use silicon gel implants include those with special tissue circumstances, those undergoing breast lift, or for breast reconstruction. New scientific data on the safety of silicone gel breast implants is being collected. In the future, it is possible that additional types of filler materials may become available.
Every year, thousands of women undergo successful breast augmentation and are very pleased with the outcome. In general 95 percent of patients who have undergone breast augmentation would do it again. However, as with any surgical procedure, there are potential risks. The following are issues to consider when undergoing breast augmentation:
There is no scientific evidence that breast implants cause breast cancer or arthritis.
The presence of breast implants does make mammography technically more difficult. It will be important for you to select a mammography technician who is experienced in taking x-rays of augmented breasts. In some instances, other types of imaging, such as ultrasound or magnetic resonance imaging, may be recommended. Placement of the implant underneath the chest muscle will interfere less with mammography. It is possible that the presence of breast implants could delay or hinder the early detection of breast cancer. This may be a special consideration for women who are at higher risk for breast cancer.
There is no evidence that breast implants will affect pregnancy or your ability to breast-feed.
The chance of infection is less than five percent. Antibiotics are used during surgery. If an implant becomes infected, it generally has to be removed. However, it can be replaced after six weeks.
Bleeding complications are unusual, less than five percent. Excessive bleeding that produces extreme pain and swelling, a hematoma, should be removed and will require reoperation.
Unsatisfactory Result-While our goal is perfect breast shape, size and symmetry, you may not perceive or have a “perfect” result. It’s very common for implants to initially appear too high on the chest until the implant “settles.” Implants can shift or be positioned too high or too low. Rarely, surgery to reposition or revise an implant position is necessary.
Capsular Contracture-When any kind of foreign material is placed in the body, such as breast implants, heart pacemakers or hip joints, the body reacts by forming scar tissue around it. When excessive scar tissue surrounds the breast implant, it can make the breast implant hard and even deformed and/or painful. Surgery may be required to correct this.
Loss of Nipple Sensitivity-This is usually temporary and improves over several weeks. Rarely, it can be permanent.
Implant Rupture or Deflation-Breast implants are not lifetime devices and cannot be expected to last forever. If a saline-filled implant breaks, the body harmlessly absorbs its contents within hours. A definite change in the size of the breast is clearly noticed. Rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause.
For saline-filled implants, the rupture rate is only one percent per year. Surgery is required to replace the ruptured implant. Both McGhan Medical and Mentor have limited guarantees on their breast implants. The terms of these guarantees are different and can be discussed during your consultation.
Implant Rippling-Folds and indentations of the implant are visible on the skin. This is more common with textured implants and those patients with thin tissues. Placing the implant under the muscle helps prevent this.
Prominent Scars-Some people, especially people of color, make prominent scars called keloids or hypertrophic scars. There is no way to know if you are one of those people unless you’ve had a past history of this occurring. There are ways to intervene to help prevent and treat prominent scars, such as silicone gel sheeting.
Immune-Related Disorders-In the early 1990′s some women with silicone gel breast implants reported problems with certain autoimmune and connective tissue diseases. However, these diseases also occur in people who have not had silicone gel breast implants. Several other clinical studies have failed to show any correlation between these disorders and silicone gel breast implants. However, patients with these kinds of autoimmune disorders should avoid foreign materials, such as breast implants.
Additional information can be found at www.fda.gov/ocs/breastimplants/bitac.cfm
The goal of Dr. Jones and the Genesis staff is to make your surgical experience as easy and comfortable for you as possible. A mammogram will be recommended if you have not had one within the past year. You will be asked to stop smoking and avoid certain vitamins and drugs that can cause increased bleeding, such as aspirin, ibuprofen and vitamin E. Additional preoperative instructions and prescription to be used postoperatively will be provided. For convenience, we recommend that you have your prescriptions filled several days prior to the procedure. Breast augmentation surgery is usually performed on an outpatient basis, and you should arrange for someone to take you home and stay with you the first night.
Your procedure will be performed in an outpatient surgery center or hospital. Dr. Jones will see you before the procedure and place ink marks on the skin. General anesthesia is used for almost everyone. Antibiotics will be administered at the time of surgery. The procedure takes one to three hours and consists of making the incision, creating a pocket under the breast for the implant, placing the implant and confirming the implant is the right size and shape. Dissolvable stitches are used to close the incisions, and your breasts will be wrapped in gauze dressings or a surgical bra.
Following surgery, you will be taken to the recovery area where you will continue to be closely monitored. Pain medications are administered to keep you comfortable. You will be permitted to go home after a few hours unless you have planned to stay overnight.
The day after surgery you can remove the bulky dressing and shower. You can expect to be sore for a few days. If the implants were placed under the muscle, the soreness will be present for three to four days. If the implants are placed above the muscle, the discomfort lasts one to two days. You will be asked to wear a special bra for the first one to two weeks. Swelling and bruising will fully resolve in about two weeks. The implants will “settle” for four to six weeks.
By three to four days you should be able to lift normal-weighted objects, drive and lift your arms above your head. You may return to work four to seven days after surgery. Activities that require extensive use of the arms and chest, including repetitive lifting, should be limited for two to three weeks. You may resume sexual activity after one week, but you should be gentle with your breasts for the next four to six weeks. At six weeks you should be back to your normal activities. The scars may be red for several months, but should gradually improve.
Breast augmentation can predictably enhance breast fullness and shape. As a result you may find your body proportions are more balanced, your clothes fit better and you have a greater self-confidence in your appearance. Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long lasting.
Remember breast implants do not stop the effects of gravity, pregnancy and aging on your breasts. Over time, the size and shape of your breasts will change. If you become dissatisfied with the appearance of your breasts, you may want to consider revision of the implants and/or a breast lift. We recommend annual follow-ups to make sure you remain satisfied with your result. For future comparison, you should have a mammogram nine to 12 months after the procedure.