In my Louisville Cosmetic Surgery practice I occasionally have a patient request a breast reduction with an implant placed. This really isn’t possible for a few reasons so I thought I would elaborate. After fielding this request several times, I asked why in the world someone would want to make their breasts smaller via the reduction then put an implant right back in. Seemed counter-intuitive. Well, what the patients were envisioning was having all of their breast tissue shelled out and then the skin tightened around the implant. The ultimate goal being a more firm, perkier breast.
It doesnt really work that way though.
When we do Breast Reductions we leave a central portion of the breast intact with the nipple attached to protect the blood supply to the nipple. Without adequate blood flow, the nipple dies. That is a bad thing. So we cant just shell everything out. If we then elevate the muscle to place an implant in behind, this can compromise the blood supply and result in a disaster. Also, it would be difficult to shape the breast.
Now, I can, after the breast is well healed, perform a breast augmentation behind a previously reduced breast to increase upper pole fullness. This isnt a very common request because the last thing most reduction patients want is to get that weight back on their chest but it has been done.
As part of my Louisville Plastic Surgery practice, I recently completed continuing education for maintenance of my Plastic Surgery Board Certification. An interesting fact that many patients find surprising concerns breast augmentation and antibiotics. The lowest rate of infection, and this has been verified by several scientifically sound studies, results from one dose of IV antibiotics an hour before surgery. So, in this case, less is more!
Breast Augmentation can be carried out through a variety of incision sites. The choice of site depends on your preference, your breast shape and size, your nipple size and surgeon preference.
Under the breast is the most commonly used access point. It is very flexible for surgeon, allows any type of implant to be placed, and the scar is well hidden and typically heals quite nicely.
An armpit, or Trans-Axillary, approach has the main advantage of leaving no scar on the breast, but it is very difficult to place a silicone implant through this incision and the implant must go under the muscle. So, this route is normally used for saline implants to be placed under the muscle.
This is a topic that comes up a lot with my younger patients who are considering Breast Augmentation for obvious reasons. The answer “No”, implants have no bearing whatsoever on a woman’s ability to breast feed.
When an implant is placed it is either under the muscle/breast complex or the breast itself. But what most patients are confused about is how the space for the implant is made. When I create the pocket for the implant I seperate the undersurface of the breast from the muscle, the entire breast lifts forward, and the implant slides in under it. If the implant is going under the muscle then the breast is basically undistrubed as it and the muscle are lifted and the implant slides behind the muscle.
Now, where the implant can make a difference is when we talk about incision site. If you choose to have your implant placed through an incision around the nipple, this can definitely affect breast feeding as some milk ducts will be divided. There is little to no milk producing tissue in the crease under the breast so that is a good choice. An armpit incision is also safe to use, though not as commonly chosen.
In the Plastic Surgery literature there is a new technique being described to enlarge the female breast. In contrast to traditional Breast Augmentation, no type of implant is used. The breasts are being transiently enlarged using a Brava system, and then fat grafted.
The Brava system consists of two domes that fit over the breast and create a suction. This expands the breast. Once the breast is expanded fat is suctioned from elsewhere in the body, and grafted to the breast to maintain the size.
Now before everyone goes running to their favorite Plastic Surgeons office, because have fat suctioned from you rear and put is your breasts has been joked about for years, please remember that these techniques are new and long term safety has not been established.
But if this works and the results are safe and reproducible, it will be a very nice alternative.
The answer is “Yes, we can.” Fat grafting is nothing new in Plastic Surgery. It has been used for years for facial rejuvenation. Recently its use has increased in breast surgery. The problem is if the fat cells don’t survive the transfer they can die, form masses, or even calcify. This can wreak havoc on cancer surveillance and thus the controversy.
This technology will continue to be evaluated, in the meantime I think it safest to stick with traditional implants until more is known.
In my Louisville Breast Implant practice I frequently encounter the woman with a more normal breast width. As opposed to the very petite woman with very small breasts, this patient may benefit from something other than a high profile implant. This is the patient for whom the Moderate (Allergan) or Moderate Profile Plus ( Mentor) implants were developed.
These implants have a a slightly wider base yet still offer a nice amount of projection. This allows me to give you a full appearance while still filling the entire width of the breast. Overall, the implants are shaped such that they give a nice full, yet perky appearance to the breast.
Implant choice can really only be decided at your consultation.
A common situation I encounter in my Louisville Breast Augmentation practice is the woman with more narrow breasts. It is this patient where a high profile breast implant is useful. The high profile implants are made for a woman whose breast is more narrow. These implants fit behind the natural boundaries of the more narrow breast giving a more natural appearance.
In addition there are moderate profile and low profile implants available for women with a more broad based breast.
The choice of implant is best determined at your consultation.
A recent journal article published in the journal Plastic and Reconstructive Surgery addresses an unresolved problem in breast augmentation surgery, Capsular Contracture.
What the paper concluded was nothing new. Textured implants had lower contracture rates than smooth breast implants. Patients preferred the feel of smooth implants. Implants placed under the muscle, saline and silicone, have lower contracture rates.
I’ve heard this complaint thousands of times in my Louisville Cosmetic Surgery office and a lot of the time the breasts are not droopy…technically.
The fact that the upper part of the breast has lost its fullness with age and babies does NOT constitute droop in Plastic Surgery terms.
Droop, or Ptosis ( toe-sis) as we call it, is all based on where the nipple rests in relation to the crease under the breast (Infra-Mammary Fold or IMF). By definition, if your nipple sits above your IMF you do not have ptosis and a breast lift or Mastopexy may not be needed. A Louisville Breast Augmentation will often correct this situation.
If your nipple sits at or below your IMF you do have ptosis and a Louisville Breast lift will be necessary in most cases.
Now, a lot of times her nipple is well situated above the IMF but the bottom part of the breast sits below the IMF. We call this pseudo-ptosis and depending on the severity and the size of your breast, this situation may also call for a mastopexy (lift).