Inadequate breast size usually results from one of two causes:
- Lack of development of breast size during puberty
- Loss of breast fullness following pregnancy
During pregnancy, breast enlargement occurs and stretches the skin envelope of the breast. When pregnancy and nursing are over, the tissue within the breast involutes, or shrinks, usually to a size smaller than it was originally. The skin, however, remains slightly stretched and the tissue falls to the bottom of the stretched skin envelope. Usually, the result is a breast with somewhat loose skin with breast tissue in the lower part of the breast and an empty upper breast.
This depends on the degree of stretching of the skin envelope and your desires regarding your breast size. For example, if you have never been pregnant and have a very small A cup breast, then your skin may be very tight. If this is the case, Dr. Sonderman would be limited by your skin envelope and elasticity. If you have lost breast volume, but have loose skin, Dr. Sonderman needs to fill the skin envelope and will choose an implant size and shape that will fill your skin envelope.
At your consultation, Dr. Sonderman will discuss your preferences regarding breast size, incision location, and most importantly, exactly how you would like your breast to look.
Often, women want to achieve more cleavage. The ability to have cleavage is dependent on the position of the breasts on the individual woman’s chest wall. Even with a significant breast augmentation, you may not be able to have cleavage.
After examining you, he will recommend a range of options for implant type, size, and incision location that will be best for your breast and balance with the rest of your figure. He will always honor your choices of alternatives if he can achieve an aesthetic breast using your choices.
Breast implants do not cause breast cancer. Excellent scientific studies indicate that breast cancer occurs in about ten percent of women regardless of whether or not they’ve had breast augmentation.
Breast implants can make a mammogram more difficult to read. This does not mean that a mammogram cannot be adequately read, but simply that the mammograms must be performed and read by someone experienced in the proper techniques. When a breast implant is present, the breast tissue should be pulled forward in front of the implant for a mammogram. This maneuver, combined with additional views of the breast if necessary, allows optimal visualization of the breast tissue if you have implants.
Differences often exist between your breasts – they are different sizes, and the nipple locations are also different. After breast augmentation, these differences will remain, and in some cases may be exaggerated.
The implant choice is an ever-changing selection at this time. For the first six years of Dr. Sonderman’s practice, we were only allowed to use saline filled implants. Most recently, we’ve been able to use silicone gel implants for augmentation purposes in conjunction with an outcome study set up by the FDA and implant manufacturers. These studies have a cap on the number of women we can enroll so we are not always able to offer silicone gel implants. Saline implants are always available.
In addition to the implant filler, there are many other decisions to be made such as the shape and size of the implant, implant placement in the breast pocket (under or on top of the pectoralis muscle) and incision placement.
When any implant is placed in your body, the body forms a lining or capsule around it. This capsule is similar in some ways to scar tissue and can shrink or contract. If it contracts markedly and squeezes on your implant, then it can distort the implant or make the breast feel too firm. This is called capsular contracture. It happens in approximately ten percent of women who have breast implants. Several techniques are used to decrease the likelihood of developing hardness, but the risk cannot be completely eliminated because it is the result of your normal healing process.
If a saline implant shell breaks (we tell our patients to expect that the implant will break some time in their lifetime), then the saline is absorbed into the blood stream and excreted through the urine. The saline used is the same solution used in the I.V. solutions you receive during surgery.
The silicone gel in implants that are used today is more cohesive (thicker) than the silicone gel that was used 15-20 years ago. You can cut the implant with a knife and it separates, but doesn’t leak.
Risks common to all surgical procedures such as bleeding, infection and scar tissue formation occur in a very small percentage of cases. Bleeding or infection occurs in only 1-3 percent of cases, but may require other surgical intervention for correction. Infection may necessitate temporary implant removal and subsequent replacement. We will give you more detailed information about the inherent risks that concern you during your consultation.
Breast augmentation is performed at an outpatient surgical facility. It takes approximately one hour and is done under general anesthesia (you go to sleep).
The incision for breast augmentation can be placed in the fold beneath the breast, around the areola, or in the hollow of the armpit.It depends on the type and size of implant used and your personal preferences. In any of these locations, meticulous closure of the incision minimizes the visibility of the scar and maximizes its quality. Dr. Sonderman will discuss your preferences about the incision location with you.
Breast implants are placed behind the breast tissue, not within it. In some cases, the implant can be placed partially behind the pectoralis muscle on the chest wall. Dr. Sonderman will discuss the best option for your specific breast type with you. In either case, your breast tissue is located in front of the implant where it can be readily examined.
After the final implant placement and position is achieved, Dr. Sonderman will spend considerable time precisely closing your incisions to minimize visible scarring.
Your incisions will be carefully closed with stitches placed beneath the skin. You’ll have very fine scars instead of “railroad track” type marks. You’ll be able to shower and bathe immediately after surgery. None of the sutures will have to be removed because they simply dissolve.
Following breast augmentation procedures, most patients say they are achy-sore and have a sensation of tightness, but do not experience a lot of pain.
Your breasts will feel very tight to you for 48-72 hours and the tightness will gradually lessen over the next several days as the swelling decreases. You may develop slight bruising beneath the breast a day or two after surgery. This will heal in about a week.
We’ll prescribe medication if you have a moderate feeling of soreness. Most patients require medication for only 2-3 days.
Typically, our patients want to know about four stages of recovery: (1) hospitalization time, (2) when swelling or bruising will diminish, (3) when you’ll be able to return to work or social activity, and (4) when you can return to full aerobic or strenuous exercise. The average for breast augmentation procedures is:
- For outpatient surgery you’ll be in and out of the hospital on the same day.
- Bruising and swelling diminishes in 3-10 days.
- Patients often return to work and social activity in 3-5 days.
- Patients often return to aerobic or strenuous exercise in 4-6 weeks.
We encourage an immediate return to full normal activity within the first week. But, don’t do any type of strenuous exercise that would push your pulse over 100 for the first week. This type of strenuous excercise increases your blood pressure and increases the chances that you’ll bleed.