Many of the articles in this series have addressed plastic surgery technology, and this one will continue that trend focusing on breast augmentation. Since the inception of the operation in the 1960’s, there has been a continued stream of technological innovation yielding better and more predictable results. While a full discussion of that technology vastly exceeds what can be covered in the scope of this article, it is insightful to consider the options available for today’s patients including implants, the planning process, surgical technique, and pain control postoperatively.
The overwhelming majority of patients in my practice seek to achieve a natural fullness which is proportionate to their body size and shape. While this may seem simple, accomplishing it requires significant planning before surgery as well as an accurately performed operation. Implant size selection is one of the most critical factors and we place significant emphasison it during the planning phase.
Each surgeon must develop their own process for selecting implant size. Our process relies on the patient to make the majority of the decisions. A series of chest measurements are made to determine a range of implant sizes which will fit. Then, we ask the patient to try on implants in that range. Implants are sized according to volume and dimensions, not bra cup size. Trying on implants provides the patient a good understanding of how implant volume translates into appearance on their own body. Technology can also help in size determination with the use of computer simulation. While these methods are not entirely exact, we have found this system gives the best chance of achieving the patient’s goals.
Likewise, selection of implant type is a decision based both on patient preference and the technical demands of the procedure. There are two basic types of implants available to U.S. patients today; saline filled implants and silicone gel filled implants. The newest implants are highly cohesive gel implants, more commonly known as “gummy bear” implants. We use all of these implant types and work to select the best implant for the individual patient’s needs.
Both gel filled breast implants and the highly cohesive gel implants come from the factory with the gel sealed inside the implant. Until recently, this fact sometimes limited our choice of incision and necessitated a larger incision. The development of implant funnel technology has allowed us to minimize incision length and facilitate use of standard incisions located in the armpit, at the nipple, or underneath the breast. Implant funnels may also minimize risk of some complications of the surgery.
Placing implants under the muscle is the most common method of performing a breast augmentation. While this method has numerous advantages, it has a tendency to be more painful than placing implants on top of the muscle. Here again, technology has helped with the development of a long-acting numbing medicine. It is used in the operating room prior to starting the procedure. With all of our surgical procedures, anything we can do to minimize pain and patient recovery time is a priority.
As with all plastic surgery procedures, it is important to seek out a surgeon certified by the American Board of Plastic Surgery. Only surgeons who have attained that certification may be members of the ASPS (American Society of Plastic Surgeons). Board certified surgeons who devote significant attention to cosmetic surgery may also seek membership in the ASAPS (American Society for Aesthetic Plastic Surgery) as an added credential. Look for the ASPS and ASAPS logos when you choose a surgeon to ensure that the highest standards of training have been met.