A Breast Augmentation is a prosthesis used to enlarge the size of a breast (also known as breast implants) for cosmetic reasons, to reconstruct the breast (e.g. after a mastectomy or to correct genetic deformities), or for the purposes of male-to-female sex reassignment surgery.
Typically, patients that are seeking breast augmentation surgery are usually of younger age, healthy, and are of a higher socio-economic status. Many of these patients experience a greater distress about their appearance in a variety of situations, and have probably endured more frequent teasing about their appearance.
Saline-filled implants are the most common breast implant used in the United States due to restrictions on silicone implants, but are rarely used in other countries. Good to excellent results may be obtained for most patients, but when compared to silicone gel implants, saline implants are more likely to cause various cosmetic problems such as rippling, wrinkling, and can be noticeable to the eye or the touch. Particularly for women with very little breast tissue, or for post-mastectomy breast reconstruction, many cosmetic plastic surgeons believe that silicone gel implants are the superior device. In patients with more breast tissue, however, saline implants can look very similar to a silicone gel.
Breast Implant Placement Techniques:
Breast implants for breast augmentation may be placed via various types of incisions:
* Inframammary – is an incision that is placed below the breast in the infra-mammary fold (IMF). This incision is often less than optimal because difficulties in judging the modified position of the IMF result in a visible scar at the base of the breast.
* Periareolar – is an incision that is placed along the areola border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola’s circumference.
* Transaxillary – is an incision that is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast. Transaxillary procedures can be performed with or without an endoscope (tiny lighted camera).
* Transumbilical (TUBA) – is an incision that is placed in the naval. The dissection tunnels superior ally. This approach also enables implants to be placed with no visible scars on the breast. Transumbilical procedures may be performed bluntly or with an endoscope (tiny lighted camera) to assist dissection. This technique appears to be limited to use with saline filled implants.
* Transabdominoplasty (TABA) – procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.
The placement of implants is described in relation to the pectoralis major muscle:
* Subglandular- is an implant between the breast tissue and the pectoralis muscle. This position closely resembles the plane of normal breast tissue and is felt by many to achieve the most aesthetic results. The subglandular position in patients with thin soft-tissue coverage is most likely to show ripples or wrinkles of the underlying implant. Capsular contracture rates are also slightly higher with this approach
* Subfascial- the implant is placed in the subglandular position, but underneath the fascia of the pectoralis muscle. The benefits if this technique are debated, but proponents believe the thin vascularized fascia may help with coverage and sustaining positioning of the implant.
* Subpectoral (“dual plane”)- the implant is placed underneath the pectoralis major muscle after releasing the inferior muscular attachments. As a result, the implant is partially beneath the pectoralis in the upper pole, while the lower half of the implant is in the subglandular plane. This is the most common technique in North America and achieves maximal upper implant coverage while allowing expansion of the lower pole. Capsular contracture rates have been lower after widespread adoption of this technique.
* Submuscular- the implant is placed below the pectoralis without release of the inferior origin of the muscle. Total muscular coverage may be achieved by releasing the lateral chest wall muscles (seratus and/or pectoralis minor) and sewn to the pectoralis major. This technique is most commonly used for maximal coverage of implants used in breast reconstruction.
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