Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The choice of incision is a critical decision in breast augmentation, impacting scarring and implant placement. The most common incision is the inframammary incision, placed in the natural fold under the breast. This approach offers the surgeon excellent visibility and control during pocket creation, and the scar is hidden in the breast’s shadow.
The periareolar incision is made along the lower border of the areola. This is often chosen for its cosmetic camouflage, as the scar blends with the natural transition of the nipple pigment. However, this approach cuts through the breast tissue, potentially increasing the risk of bacterial contamination from the ducts.
The transaxillary incision is located in the armpit. This remote incision allows for the placement of the implant without any scar on the breast itself. It is performed using endoscopic visualization. This technique is excellent for patients who want to avoid breast scars but requires specialized surgical skill.
The transumbilical incision involves inserting the implant through the belly button. This technique is generally limited to saline implants, as they can be rolled up tightly and inflated after insertion. It is less common due to the long tunnel required to reach the breast and limited control over the pocket.
Implants can be placed in different anatomical planes relative to the pectoral muscle. Subglandular placement involves positioning the implant directly behind the breast tissue and on top of the muscle. This is often less painful and offers a significantly projected look but requires adequate natural tissue coverage to hide the implant edges.
Submuscular placement involves positioning the implant partially or wholly under the pectoralis major muscle. This provides an extra layer of soft tissue coverage, reducing the visibility of the implant edges and lowering the risk of capsular contracture. It is the preferred method for patients with thin breast tissue.
The Dual Plane technique is a sophisticated variation of submuscular placement. In this method, the implant is placed partially under the muscle at the top and partially under the breast gland at the bottom. The muscle is released along its lower attachments to allow the implant to settle naturally.
There are three types of Dual Plane techniques (I, II, and III), which differ in the degree of muscle release. This allows the surgeon to tailor the procedure to the patient’s specific degree of ptosis (sagging) and tissue tightness, offering the benefits of muscle coverage with the shaping power of glandular placement.
Implants come in two primary shapes: round and anatomical (teardrop). Round implants are the most popular. Because they are symmetrical, there is no risk of them rotating out of place. They provide fullness in the upper breast pole, creating a lifted, youthful appearance.
Anatomical or teardrop implants are shaped to mimic the natural slope of a breast, with more volume at the bottom and less at the top. These are textured to prevent rotation. They are excellent for patients seeking a very subtle, natural profile or for reconstructive cases where the lower breast pole needs expansion.
Implants also vary by profile, which refers to how far the implant projects from the chest wall for a given base width. Profiles range from low to ultra high. A moderate profile is broader and flatter, while a high profile is narrower and projects more.
The choice of profile depends on the patient’s chest width and desired look. A petite patient with a narrow chest might need a high-profile implant to achieve volume without the implant being too wide for her frame. A broader patient might benefit from a moderate profile to fill out the chest width.
Hybrid breast augmentation, also known as composite breast augmentation, combines the use of implants with autologous fat transfer. This technique allows for the precise sculpting of the breast that implants alone cannot achieve. Fat is harvested from areas like the abdomen or thighs via liposuction.
The harvested fat is purified and injected around the edges of the implant. This is particularly useful for camouflaging the implant in thin patients, softening the cleavage line, and correcting minor asymmetries. It provides the volume of an implant with the soft, natural feel of fat.
This procedure allows for a smaller implant to be used while still achieving the desired volume. By relying less on the implant for size, the load on the chest wall is reduced, and the risk of long-term complications, such as thinning of the chest wall, is mitigated.
Hybrid augmentation is also an excellent tool for correcting tuberous breast deformity or constriction bands. Fat grafting helps expand the constricted lower pole and soften tight tissue, creating a rounder, more natural shape.
The Keller Funnel is a specialized surgical device used to insert silicone implants. It resembles a pastry piping bag and is coated with a hydrophilic lubricant. This “no touch” technique allows the surgeon to propel the implant into the breast pocket without it touching the skin or the incision edges.
Using the funnel significantly reduces the force required to insert the implant. This minimizes trauma to the implant shell and the surrounding tissues. It also allows for smaller incisions, resulting in shorter and less visible scars.
The primary benefit of the Keller Funnel is the reduction of infection and capsular contracture rates. By preventing the implant from contacting the skin (which harbors bacteria), the risk of biofilm formation on the implant surface is drastically lowered.
This technique is now considered a standard of care by many top surgeons for silicone breast augmentation. It represents a significant advancement in surgical safety and patient outcomes.
Rapid Recovery is a surgical philosophy and set of protocols designed to minimize tissue trauma and accelerate healing. It involves precise, bloodless dissection using electrocautery to create the pocket, avoiding blunt force or tearing of tissues.
This approach includes the use of specific anesthetic techniques to prevent postoperative nausea and pain. By minimizing bleeding and trauma, inflammation is reduced, allowing patients to return to normal daily activities much faster, often within 24 to 48 hours.
Another key component is avoiding ribs. The surgeon carefully lifts the muscle without scraping the rib cage, which is a primary source of postoperative pain. Additionally, arm movement exercises are encouraged immediately after surgery to prevent stiffness.
Patients undergoing rapid recovery protocols typically do not require narcotics for pain management, relying instead on anti-inflammatories and muscle relaxants. This leads to a clearer head and a faster return to functionality.
Tuberous breast deformity is a congenital condition where the breast development is constricted, leading to a narrow base, a high inframammary fold, and herniation of breast tissue into the areola (puffy nipples). Augmentation in these cases requires specialized techniques.
Placing an implant alone will not correct the shape and may even exaggerate the deformity. The surgeon must release the constricting bands of tissue internally to allow the breast to expand and drape properly over the implant.
Often, a dual-plane technique is used to provide coverage, and the glandular tissue is scored or “radialized” to allow it to spread. In severe cases, a two-stage procedure may be necessary, involving a tissue expander first to stretch the tight skin before placing the permanent implant.
The goal is to create a round, natural shape from a tubular one. Hybrid augmentation with fat grafting is frequently employed to fill out the lower pole and round out the constricted areas.
Send us all your questions or requests, and our expert team will assist you.
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“Gummy bear” is a nickname for form-stable, highly cohesive silicone gel implants. If you cut them in half, they hold their shape like a gummy candy, rather than leaking like liquid. They are designed to maintain their shape and reduce the risk of rippling.
If your nipples sit below the breast crease or point downwards, adding an implant alone might not fix the sagging and could create a “snoopy nose” deformity. A mastopexy (breast lift) combined with an implant is often required to lift the nipple and tighten the skin.
Placing the implant under the pectoral muscle (submuscular) provides a layer of natural tissue coverage. This softens the edges of the implant, making it look and feel more natural, and significantly reduces the risk of capsular contracture (hardening of scar tissue).
A standard breast augmentation usually takes about 60 to 90 minutes. If a breast lift or complex reconstruction like tuberous breast correction is involved, the surgery can take 2 to 3 hours or more.
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