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BREAST AUGMENTATION is a procedure performed to increase the volume of the breasts. It is a cosmetic procedure and is only covered by insurance in rare cases of extreme assymetry between the sides. We are now using the saline implants, filled with the same sterile salt water that is used in your I.V. The outer coating of the implant shell or "balloon", however, is made of solid silicone rubber. There is no silicone gel present.

The procedure is more than just inserting an implant. When properly performed, it also involves reshaping the breast and lowering the fold under the breast. This is performed in order to ensure proper position of the nipple on the larger shape. Reshaping is also performed to give upper fullness and cleavage. Careful evaluation should be done by the surgeon at the preoperative consultation to determine the appropriate method in order to acheive the best results. Options to be assessed at physical examination are position of the scars, position of the implant above or below the muscle, size and shape of the implant, and the need for associated procedures such as breast lift or mastopexy. Some of these options can be chosen by you, the patient, but some are determined as the optimal way for your physique by history and physical examination.

The scars are about 2 inches long or less. They can be placed in the fold under the breasts, above the fold (not as optimal as they can be more easily seen), around the areola, or in the armpit. Sometimes endoscopy is used either through the armpit approach or through the bellybutton or nipple.

The implant is best placed below the muscle if you have very little breast tissue coverage or very low body fat percentage. It is best placed above the muscle in cases of slight sagging or ptosis. The benefit above the muscle is earlier and fuller projection without the muscle pushing against the implant, and easier recovery. The disadvantage of placement above the muscle is less coverage with the increased chance of seeing or feeling the edge of the implant, or rippling. The benefit behind the muscle is decreased chance of rippling and palpable or visible edge, but the disadvantage is distortion of the breast shape during pectoral muscle contraction such as when pushing off from a low sofa, and a slightly longer time to recover and for the muscle to stretch to its final more relaxed and natural appearing shape. In some cases either approach is possible by examination. There is a higher chance of rippling with saline implants.

Breast lift or mastopexy may be needed with or without implant placement if there is too much sagging. A quick way to get an idea if a lift is necessary is to look at yourself sideways in the mirror. If your nipple is below the fold under the breast, then a lift is almost certainly needed. Physical examination by your surgeon is needed to make the final determination.

Size of the implant is determined by your desires and your final goal, as well as by the width of your rib cage and overall size of your torso. The two shapes most commonly used for augmentation are round and teardrop shaped. The round gives more fullness in the upper part of the breast and the tear drop shape gives more projection in the lower pole.

Risks include deflation or rupture, displacement, silicone sensitivity, capsular contracture, change in nipple sensation, bleeding or infection among others. There is also difficulty with mammography although there has been improvement in technique over the years and now two extra views are performed at each mammogram when implants are present.

Breast augmentation is being performed much more frequently now and with fewer complications. As with any elective cosmetic procedure care should be taken to make sure that you are comfortable with your surgeon and that you understand and are willing to undertake the risks involved.