Breast Augmentation

As a woman, there are many reasons you may want to have larger, fuller breasts.  Breast augmentation surgery, also known as augmentation mammoplasty, is the use of implants to fulfill your desires regarding enhancement to your breast shape and size.  This procedure is commonly performed for patients who wish to transform their natural breasts or to restore changes that have occurred as a result of pregnancy, weight loss, disease, illness, or natural aging.  The primary reason that women seek out breast enhancement surgery is because they feel their breasts are too small.  Heredity basically determines the size of your breasts and inadequate breast volume may be present following puberty. Increasing breast size with implants not only enhances the body proportions of a woman who feels her breasts are inadequate; it also balances pre-existing differences in breast size and symmetry.

During your consultation at Shine Cosmetic Surgery, Dr. Daniel H. Lin will listen closely to your concerns and expectations. After a thorough examination and evaluation, he will design a surgical plan tailored to your individual needs and discuss it in a conversational style that you will feel comfortable with.  Shine Cosmetic Surgery takes great pride in their customized approach to breast surgery and Dr. Lin will gladly address all of your concerns and let you know what to expect before, during, and after your procedure.

There are a number of issues regarding breast implants that require discussion prior to your breast augmentation surgery including:

  • Type of Implants
  • Size, Shape, and Texture
  • Incision Technique
  • Implant Location
  • Implant Profile

Type of Implants
All breast implants have an outer shell made of silicone elastomer but the inside filler material is composed of either sterile salt water or silicone gel.  Multiple studies have been performed on both FDA approved implants types and both are proven to be safe.  Saline and silicone implants have advantages and disadvantages and the most recent studies have shown a higher patient satisfaction rate with silicone implants.  Patients claim that silicone feels more natural with a flesh-like, real tissue consistency although sometimes it can migrate out of the capsule and into the breast tissue causing small areas of scar tissue known as granulomas.  Silicone can be processed into three forms: a fluid, a gel, and an elastomer, which is a solid rubber-like compound.

Saline implants have different advantages than silicone as research shows that saline implants have a presumed lower rate of revision surgery than silicone gel implants.  The scar for saline implants is also shorter since saline implants can be filled after they are placed, allowing a smaller incision.  The cost per pair of implants is also lower since repercussions from a rupture are not a concern.  If a saline implant shell does rupture, the saline normally leaks out and is absorbed by the body within a day or two.  The primary disadvantage of saline implants is that they tend to look round and they feel stiff and unnatural, particularly in women with modest breast tissue.  Large saline implants also have a higher rate of downward displacement than silicone because they are heavier. As with all options, the type of implant you choose is a personal decision and the risks and benefits will be extensively discussed during your consultation with Dr. Lin.

Size, Shape, and Texture
Additional options to consider when having a breast augmentation are shape, size, and texture.  Deciding upon the right implant size can be the most challenging part of your operation because cup size is not standardized.  Typically, implant sizes range from 6 -18 fluid ounces (200-600 ml) although smaller or larger implants are also available.  As the volume of the implant grows, so does its diameter and projection.

The shape of implants can be round, oval, or teardrop and the outer shell can have a smooth or rough texture.  Round implants have several advantages since they rotate freely under your breast without aesthetic consequences.  Implants that are not round are always textured so that the implant adheres to the surrounding tissue to minimize the chance of the implant turning upside-down or sideways.  Round implants will look the same when rotated in any direction and therefore do not need to have a rough surface.

Because the breast has greater fullness toward the bottom, some feel that teardrop implants provide a more natural result.  Because of their design, teardrop implants must be positioned with the fullest portion at the bottom of your breast. One disadvantage with teardrop implants is that they may rotate following your surgery and to reduce this risk, all teardrop implants are all textured.  If a teardrop implant rotates sideways or upside-down, surgery must be performed to correct the position.  At Shine Cosmetic Surgery, a range of implants is available to provide everything from a smaller, more natural appearing breast to a large, more voluptuous appearance.  Dr. Lin will take the time during your consultation to consider all of your goals and to match those with your anatomy to help find the best implant for you.

Incision Technique
Four incisions are most commonly used for breast augmentation:

  1. The Inframammary Incision: The Inframammary Incision is made under your breast hidden along the natural skin crease.  This incision heals inconspicuously and allows Dr. Lin excellent visibility for surgery.  One disadvantage is that if it heals poorly, it will be visible when you are wearing no clothing.  If Dr. Lin needs to lower your breast crease for optimal positioning of the implant, another possible problem is that your scar will show under the surface of your breast rather than in the crease.  Asymmetric breast creases are very common in women before surgery and asymmetrical positions of scars should be expected after surgery as well.  One main advantage of this incision location is that it helps Dr. Lin achieve better breast implant position symmetry. Risk of infection is also slightly lower when the implants are placed through this incision.
  2. The Areolar Incision: The Areolar Incision, also known as the Peri-areolar incision, is performed around your nipple and it is designed to conceal the scar by placing it at the junction of your breast and nipple (areola) skin.  Typically, the incision extends halfway around your areola and because of the natural color transition in this area, the scar is not easily seen.  Many physicians use this incision but a qualified surgeon, such as Dr. Lin, should only perform it because the nipple is the focal point of the breast and any flaw will be obvious.  This incision also imposes a slightly higher risk of nipple numbness and infection and because areola size limits incision size, women with small areolas may not be candidates for this incision.
  3. The Axillary Incision: The Axillary Incision, also known as a transaxillary incision, is an incision performed under your arm using an endoscope or a small rod with a fiber-optic camera on its tip.  Surgeons report having achieved good cosmetic results with this technique although because silicone implants arrive pre-filled from the manufacturer, large silicone implants may be difficult to place through this incision.  The scar from this technique is well hidden when your arms are at your sides but it will be visible when wearing a bathing suit.
  4. The Trans-Umbilical Incision (TUBA): The TUBA is a procedure where your implants are positioned through a small incision inside your belly button.  This technique is only an option for saline implants, as silicone is too large to fit through the incision.  It is typically used only for subglandular placement, as subpectoral placement through the belly button runs the risk of implant malposition and hematomas.  Patients feel there are more advantages than disadvantages with this technique even though subglandular saline implants may ripple or wrinkle.

The length of your scar will vary depending on which type of incision you choose to have.  Because saline implants are filled after they are placed, Dr. Lin can use a small (1-2 inch) incision.  Silicone implants are pre-filled by the manufacturer however so the incision must be long enough to accommodate the implant (2-3 inches).  Usually, scars from breast augmentation fade but occasionally they may become wider.  The final outcome of your scar depends on your individual healing process and it may take 1-2 years for your scar to fully mature.  Each type of incision mentioned above has their advantages and disadvantages and Dr. Lin will extensively discuss the options with you during your consultation.

Implant Location
Independent of the type of incision you choose for your breast implant, the location of your breast implant is another important factor to consider before having breast augmentation. Implants can be placed in one of two positions: below your breast gland and above your pectoralis muscle known as subglandular or below both your breast gland and muscle on your chest wall known as submuscular.  In either technique, they will be centered under your breast. The subglandular placement offers several advantages because the operation involves less discomfort and faster recovery since the pectoralis muscle itself is not disturbed.  After this procedure, your breasts will immediately appear more attractive because swelling is minimal.  Disadvantages of choosing a subglandular position include a higher risk of capsular contracture and greater interference with mammography.  In some cases, patients with thin skin or petite breasts may feel the implants through their skin and they are more likely to have rippling and wrinkling. Large implants may shift downward and the possibility of nipple numbness and infection are slightly higher.  Submuscular, or subpectoral placement, offers the advantages of a lower possibility of rippling, less chance of downward shifting, a lower rate of capsular contracture, and less interference with mammography.  With a submuscular placement, women with small breasts may obtain the best cosmetic results because more padding is provided between the implant and your skin.

Implant Profile
The volume you select will objectively determine the implant profile most appropriate for your surgery.  Round implants are made roughly in the shape of a doughnut and they come in three different variations: low, medium, and high profile. For any given volume, a low profile implant will have a greater diameter and lower projection than a high profile implant of the same volume and the medium profile will be between a low and high profile implant.  Again, this is an objective issue that you and Dr. Lin will discuss in detail during your consultation.

Your breast augmentation procedure will most likely be performed under general anesthesia and your actual surgery will take approximately 1-2 hours.  In the operating room, your skin will be cleansed thoroughly and monitors will be placed on you before the anesthesiologist administers anesthesia to put you to sleep.  Drapes will be placed around your body and Dr. Lin and his professional team will begin your breast augmentation surgery. After your procedure is over, once you are awake and stable you will be transported to the recovery room.  The amount of discomfort felt varies with each patient and on average discomfort is moderate.  If you do experience pain, Dr. Lin has several options to help alleviate your distress.  Swelling is usually at its peak 3-5 days after surgery and starts to improve after that.  Most patients do not bruise after breast augmentation however if you do, it will subside within a week.  Your stitch lines will be covered with gauze and you will wear a soft surgical bra for protection and support.  After 5-7 days, the gauze dressing will be removed it will be recommended that you wear a surgical or sports bra for several weeks.  Your absorbable stitches will dissolve in 2-4 weeks.

Initially, your breasts may appear firm and too high on your chest but as your swelling subsides, your implants will lower slightly assuming a more natural appearance.   Most patients return to normal leisurely activity immediately following breast augmentation although you will be instructed to minimize your arm movements.  You will be able to resume your normal routine and work within 1-2 weeks after surgery depending on the type of work you do.  Any aerobic exercise should be avoided for three to four weeks and after six weeks; most activities can be resumed carefully as directed by Dr. Lin.  You will see Dr. Lin the day after your surgery and approximately 4-5 days later depending on your healing process.  You will then be scheduled for another visit in two weeks and approximately three months after your surgery you will be released from Dr. Lin’s care.  Of course, if you have any concerns you may follow-up with Shine Cosmetic Surgery at any time.

Shine Cosmetic Surgery is an international facility of excellence dedicated to cosmetic plastic surgery of your face, breast, and body.  Dr. Lin understands that breast surgery requires not only scientific technique and skillful precision; with every patient he utilizes creative artistry and good taste to help them achieve the most natural and optimal results.  Dr. Lin has extensive training and experience with many types of breast augmentation procedures so if you are unhappy with your breasts, he understands the impact those negative feelings can have on your life.  Please call Shine Cosmetic Surgery today and let us help you change your self-image with enhanced breasts that you can be proud of.