BREAST AUGMENTATION

Long the most commonly performed plastic surgery in the United States, breast augmentation (often referred to as a “boob job” by patients) is a procedure that involves making incisions in the breasts to allow the insertion of silicone-shelled breast implants. More than just breast enlargement, breast augmentation can improve firmness and fullness in addition to overall size. There are multiple potential incision sites, as well as a range of techniques—all designed to allow each breast augmentation patient to get truly personalized results.

Note that while breast augmentation is an ideal approach to improve breast volume, it is not intended to correct the sagging that can develop over time. For this problem, a breast lift is a more appropriate surgery. For some patients, a breast augmentation and lift can be combined to elevate drooping breasts on the chest in addition to giving them a fuller look and firmer feel.

Dr. Buinewicz will discuss your options with you in detail and help you to choose the best procedure or combination of procedures for achieving your goals.

As noted above, patients will start their breast augmentation with Dr. Buinewicz by having a thorough and discreet consultation. He will talk to you about the cosmetic issues you would like addressed, your goals for the surgery, and your medical history. This is also when you will be able to ask him questions about techniques he would recommend, the risks and rewards of specific breast augmentation strategies, what breast implants cost, and anything else you would like to know in order to make an informed decision and be totally comfortable with your path forward.

Based on your unique anatomy, goals, and other details, Dr. Buinewicz will work with you to choose the specifics of your breast augmentation procedure.

One of the main variables to consider is the type of breast implant you want: saline or silicone. While all implants consist of a silicone shell, the filling varies.

Saline breast implants are filled with sterile salt water, which is commonly used in a wide range of surgical applications. These implants are known for being less expensive and requiring a shorter incision for placement. This is because they can be inserted deflated through smaller incisions, then filled once in place. Another factor some breast augmentation patients consider is more long-term: If a saline implant ruptures, the body will naturally absorb the saltwater solution that leaks out. The resulting deflation can result in a rapidly noticeable decrease in breast size. Furthermore, some breast augmentation patients believe that saline breast implants do not look or feel as natural as silicone breast implants, and that they may be more prone to ripples or wrinkles that are visible through the skin.

Silicone breast implants are filled with a gel that is much thicker and firmer than water. This type of implant can be further divided into other options depending on how “cross linked” the silicone gel is. There are different degrees of “cross linking” of the silicone filler, allowing implants to feel either softer or less likely to feel folds. Since the gel inside the implant is thick and can hold its shape well, many breast augmentation patients feel it can provide a more natural breast appearance. These implants are also less likely to ripple or wrinkle than saline implants, but if a silicone implant ruptures, the problem may not be noticeable right away since the gel leaks slowly if at all. For this reason, regular monitoring of silicone breast implants via imaging tests is recommended.

For the surgery itself, patients are typically given general anesthesia, which keeps them “asleep” throughout the breast augmentation procedure. Pain blocks are performed by an anesthesiologist to decrease the amount of discomfort postoperatively and lead to an easier and faster recovery. Dr. Buinewicz will make the necessary incisions in a position previously agreed upon by the patient. Inframammary incisions are made in the crease beneath the breast. This approach is the most commonly used breast augmentation technique. It allows Dr. Buinewicz to directly access to the implant pocket and has a low risk of complications.

Periareolar incisions are made around the edge of the areolas (the darker-colored circles around the nipples) and are often used when Dr. Buinewicz needs to reshape the breast or adjust the position of the nipples as part of the breast augmentation procedure.

Transaxillary incisions are made in the underarm area and represent a popular choice for breast augmentation patients who want to avoid scars on the actual breasts, however there are visible scars in your armpits.

No matter the incision used, Dr. Buinewicz will next create a pocket for the breast implant. This pocket may sit directly beneath the breast tissue (known as a subglandular pocket) or deeper beneath the chest muscle (a submuscular pocket) or a combination of both (dual plane placement).

As with all aspects of breast augmentation surgery, the specific placement of the incisions and the breast implant pockets depends on the patient’s anatomy, body type, implant choice, and other factors.

Once the implants are in position—and filled, as is necessary for the saline option—Dr. Buinewicz closes the incisions. The entire breast augmentation process typically takes about two hours.