Breast Augmentation
About Breast Augmentation Surgery in New York
What does the operation involve?
The main principle in the operation of Breast enhancement surgery is the creation of a pocket behind the breast which will accommodate a breast implant. There are however a number of details in the approach to this surgery which one needs to understand beforehand.
What kinds of Incisions are there?
The infra mammary incision, is made under the breast at the fold or crease line. The incision is about 4 cm in length. This is the most common incision, and the natural fold of the breast usually hides the scar quite well. It will probably always be covered by any clothing—even the smallest of bikini tops. Because the incision gives immediate access to the space where the implant will be placed it is possible to very accurately create the size and shape of the pocket for the implant, and the carefully control the position of the implant within that pocket.
Another method is the peri-areola incision, which is made around the edge of the areola (the darker skin around the edge of the nipple). The disadvantage is that the scar is not hidden by any folds, and subsequent scarring may interfere with milk expression in breast-feeding.
The third method is the axillary incision, which is made in one of the crease lines of the armpit. This is used less often because it is more difficult to get proper placement of the implant in some patients, and if there is a problem in the future, an additional incision on the breast may be required. Although some patients thinking about this surgery may believe this approach is the least conspicuous, in truth this may not always be the case, particularly in light of sleeveless open type clothing which expose the armpit area quite readily and frequently.
Regardless of where the incision is placed it is important to remember that a scar will always be present. The scars normally settle quite well and become less conspicuous with time. However no surgeon can ultimately predict the appearance of any particular scar.
Where do you place the implant? In front of or behind the muscle?
There are two locations or pockets made where the implant may be placed; the sub glandular (in front of the pectoralis muscle) and the sub muscular (behind the pectoralis muscle). The pectoralis muscle is the chest muscle that is commonly developed in body builders.
Sub muscular placement increase the padding overlying the implant offering more coverage and camouflage to the shape of the implant. This is particularly helpful in women bearing very little or no breast tissue at all. By providing this extra padding in these circumstances, one then substantially decreases some of the adverse effects on the appearance mentioned above. Another advantage is that mammography has been reported to be slightly more effective. The disadvantages are that there may be a bit more pain, or discomfort, after surgery and that the breast will move with certain actions of the muscle.
In the U.S. the sub glandular placement is probably the most common location used. The disadvantage is that the outline of the implant may be more prominent or visible in very slim women. In these situations one can therefore sometimes detect a "step-off" appearance or "stuck-on" look of the breasts on the chest. In these situations you will be advised to have the implant placed sub muscularly.
There are however some breast shapes that are better suited to the sub glandular approach. These women typically have breasts that at one time were much larger than the present. When there is a very large volume decrease and there is little or no shrinkage in the size of the skin envelope surrounding the breast tissue, then the shape approaches that of an "empty bag". Under these circumstances it is sometimes better to place the implant in the sub glandular position in order to allow the implant to fill out the skin envelope of the breast.
In the event that the skin envelope has stretched to the point where the nipple is below the breast fold, it may be necessary to reposition the nipple upward again and reduce the size of the skin envelope by means of an uplift or mastopexy. Again, this will be determined at the time of the consultation.
The decision, as to which location the implant should be placed in your case, will be discussed at the time of the consultation.
What type of anesthetic is used and how long does the surgery take?
The operation is mostly performed under general anaesthesia and is done on an outpatient basis.
Is breast augmentation painful?
Some pain will be experienced following a breast augmentation. It is always difficult to quantify how much pain any one individual will experience. Whilst some women find this procedure extremely painful others report very little pain postoperatively. Placement of the implant behind the pectoral muscle is associated with a greater degree of pain, as it is necessary to cut the muscle in order make space for the implant.
It would be fair to suggest that most women experience a moderate degree of pain for the first five days, which will require regular painkillers. After a week however most women report a considerable improvement in their symptoms and in fact do away with any regular painkillers.