Breast Augmentation

Augmentation Mammoplasty

The problem of small breasts (hypomastia) can be very difficult for many women, causing problems with self-esteem and confidence. Breast augmentation is one of the more dramatic procedures in plastic surgery, because of its ability to quickly and dramatically improve a women’s appearance. In addition to naturally-occurring small breasts, women who have had children and breastfed will notice a change in the size and shape of the breast. With breast-feeding and pregnancy, the skin becomes stretched and the breast loses its firmness and size. In addition to the loss of size, the breast will also appear to sag (ptosis). Breast augmentation replaces breast volume that was never there or that has disappeared over time.

With the recent FDA approval of silicone implants, patients can now choose between silicone and saline. In general, silicone implants feel more natural but require a slightly larger skin incision to place them. Implants can be placed either under the chest muscle or the breast itself. I generally prefer to place the implant under the muscle, which creates a more natural appearance and has a lower incidence of scarring around the implant (capsular contracture). The skin incision can be placed under the breast (inframammary), around the nipple (periareolar), or in the armpit (transaxillary). Each incision can be well hidden and the choice is primarily dictated by patient preference. Well-done breast augmentation will restore a tear drop shape to the breast in a size that is in proportion to the patient’s body, with minimal scarring. For patients with significant sagging of the breast, it may be necessary to perform a breast lift (mastopexy) at the time of augmentation to restore the shape of the breast. For most patients, it is advisable to get a preoperative mammogram.


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