What is Breast Augmentation
Breast augmentation is the aesthetic enlargement of the breasts, usually with prosthetic devices known as breast implants. It has always been one of the most common cosmetic procedures, and it remains so today. Dr. Fox was trained many years ago by Tom Stephenson, a Los Angeles surgeon who at that time was President-Elect of the American Society Of Cosmetic Breast Surgery. Stephenson was one of the pioneers of the transaxillary approach of breast augmentation.
Trans-axillary refers to the insertion of the implants through a natural crease in the armpit. In an article published online in February 2010, an American plastic surgeon commented “Because the transaxillary approach is technically demanding and is performed relatively rarely, many surgeons never master the technique. And “…. patients given the choice sometimes choose the transaxillary approach, with the inconspicuous scar hidden in the axilla.”
The technique is almost always preferred by Asian women because of their tendency to scar poorly.
Why women seek breast enlargement
There are many reasons for seeking breast enlargement. Some of the more common reasons are mentioned below ~
“I don’t feel very womanly, because of my small size”
“My small size prevents me from wearing the clothes I would like to”
“I’d like to be the size I am when I wear a padded bra”
“I want to feel comfortable in a bikini”
“Breast enlargement will allow me to have a cleavage”
“I want to get the breasts back that my beautiful children took away from me!”
“I want to have the breasts I had before they shrank after breast feeding”
“I don’t want to look like ‘Pamela Anderson’, I just want to be in proportion and look natural”
How safe is breast augmentation?
Modern day silicone gel implants have a good safety record. The earlier silicone gel implants, (prior to 1994) contained liquid silicone (not gel) and had a thinner cover (shell). These two features of the earlier implants occasionally caused problems. The newer silicone gel implants can not leak their contents into the breast tissue if the shell of the implant develops a defect.
The claim in the early 90’s that implants were associated with various body disorders is now known to be untrue (backed by extensive research).
These days, the combination of technically sound implants, together with their lack of potential to cause body disorders makes the modern day implant a safe device.
To a large extent safety then depends upon the experience, technical skill and care of your surgeon. The only potential problem that is unpredictable and to a large extent out of the hands of your surgeon, is the occurrence of capsular contracture (see below).
Where is the implant placed in relation to the muscle?
Placement of the implant can be either in front or behind the pectoralis major muscle. The anatomy of some women allows placement in either of these planes, whereas in some women there is a strong indication there is a strong indication of one of these planes but not the other.
If there is significant breast ptosis (sag) then placement behind the muscle can produce an unnatural double fold in the lower part of the breast, a natural breast producing one curvature and the implant another. This is the so-called ‘double bubble’ effect.
If there is extremely small breast volume, than placement in front of the muscle (behind the breast itself) can produce an unnatural curvature to the top of the breast. That is, the shape of the implant itself becomes more evident.
It is said that capsular contracture is less common with implant placement in the plane behind the muscle.
What is Capsular Contracture?
This is a most common potential problem to spoil an otherwise good result. Minor grades are not uncommon but cause no significant problem. Fortunately, major grades are far less common.
The body treats every implant as a foreign body and surrounds it with a layer of collagen to isolate it from the rest of the body. Within a matter of a few weeks this becomes a complete thin but strong layer surrounding the implant. This capsule usually remains thin or at most becomes a little thickened without causing any significant problems.
It is only when this capsule thickens significantly that it causes an undesirable change in the feel and appearance of the breast. At its worst the patient would want the capsules removed. The implants are usually replaced at the same time. The occurrence of major grades of capsular contracture is often unpredictable. It is believed that irritation of the capsule by anyone of a number of factors causes the thickening. There is also a genetic factor.
Important in its prevention is meticulous attention to sterility at operation, the vigorous but appropriate use of antibiotics at operation and the removal of debris from the pockets made for the implants.
What are breast implants? And what are the different types?
Materials ~ All implants have a solid silicone shell (cover). The content can be silicone or saline (salt water).
Silicone Implants–Prior to 1994 the silicone content was liquid, and occasionally when the shell developed a defect, the leaked silicone produced problems. Since 1994 the silicone content has been a cohesive gel which cannot cause problems by leaking into the surrounding breast tissue should the shell develop a defect. At the same time the shell quality was improved. Silicone gel implants are by far the most popular with both surgeons and patients since they cannot leak like the liquid ones.
Saline implants do not drape as well as gel implants and have the potential to leak from the filling valve.
Polyurethane coated implants (also known as ‘Furry Brazilians’) are made by coating a silicone gel implant with polyurethane. The first ones were produced 20 years ago and caused problems. The more modern PCIs’ do not have the same problems as the original ones, but are the most difficult implant to manipulate (insert) into position.
The polyurethane coating dissolves in the body over a period of months after insertion. If the implants had to be removed for any reason within this time, potentially it could be very difficult to remove the partially-dissolved polyurethane coating intact. The main reason for their use has been a low capsular contracture (CC) rate.
A new generation implant is now available with a claimed lowest ever CC rate. It is manufactured in the only fully automated facility for implant production in the world. Also, the company has access to the purest silicone, having originally been a manufacturer and distributor of silicone.
Shapes~ The two basic shapes are round and anatomical (tear drop). Round implants are dome-shaped and simulate a normal breast with a person in the horizontal position. On standing, under the effect of gravity, they assume the ‘classical’ breast shape. They are overwhelmingly the most popular implant.
Anatomical implants (‘tear drop’) are made of a firmer cohesive gel and are breast shaped. They have limited popularity because of their potential to rotate. Another problem is the need for a lengthy incision in the crease beneath the breast in order to insert them.
Shell (outside cover) ~ This can be either smooth or textured. A textured surface is produced by a fine ‘roughening’ of the smooth surface in the last stage of manufacture. Texturing was devised on theoretical grounds to reduce CC. It is still debated whether it achieves this aim. It is probable that it does reduce the rate of CC.
Size and Projection ~ Most women prefer significant enlargement and yet a natural appearance. ‘Projection’ refers to the forward projection of the breast, as distinct from volume (breast size). There are several available projections ranging from low to very high. The ideal projection for any particular person depends on their anatomy and that persons perception of an aesthetic appearance. This is discussed at length during the consultation.
Before & After Gallery
Please note that all the photographs in our before and after gallery for breast augmentation (Breast Implants) are actual patients of Dr.Bruce Fox. These photographs have not been digitally enhanced or altered in any way. Augmentation is the only procedure which has been performed on these people. For more information about Breast Augmentation please contact Dr Bruce Fox’s rooms.
