It is summer of 2021, and breast augmentation remains the most popular plastic surgery procedure in my Toledo practice. It is a rewarding procedure that allows women to restore their breast look and shape, or enhance their breast look and shape, when they have never had the breasts that they wanted. A Breast Size Satisfaction Survey published in 2020 by the peer-reviewed Body Image journal found that 70% of women worldwide were dissatisfied with the size of their breasts, with nearly half wanting larger breasts. This helps explain why breast augmentation is the second most popular cosmetic surgery procedure in the U.S. (according to ASPS annual statistics). Only liposuction, which is performed on both men and women, is ahead of breast augmentation.
Breast augmentation is an outpatient procedure. I do what is called a rapid recovery procedure which means that the patient can wake up from surgery with no binding or large dressing. The patient can lift their arms overhead, walk around, go home, take a shower, and go out to dinner and shopping. Patients are back to the gym in 3 weeks. Lifting small children at 1-2 weeks is also ok. When it comes to the procedure itself, there are a lot of considerations to determine the best solution for each patient’s situation.
What Happens During a Breast Augmentation Consultation?
I feel it is important to spend time with the patient initially to understand what bothers them about their breasts and to see exactly what brings them to the office. Often it is something such as the top half of their bra gaps, or it isn’t full, sometimes it used to be a little fuller in the top half of the bra, or they had a child or two and their breasts, although slightly small, seem to have disappeared. Perhaps they always wanted slightly fuller, larger breasts more proportionate with the rest of their body. Sometimes the main concern for the woman is just that she wants what she would call fuller, firmer breasts but not necessarily bigger. Another point of discussion is that the patient is interested in the fact that the breasts have become a little bit droopy or have always been a little bit droopy or have always been more uneven than average, but all those discussions are really for a separate topic (breast lift) another day.
Harmony of the Breasts
The biggest discussion that I have with people is about their breasts in general, and how we are going to deal with what bothers them. I try to explain to people that their breasts need to be in harmony before they consider breast implants. The harmony of the breasts means that the nipple relates correctly to the breast mound, and the breast mound relates correctly to the fold or crease under the breast, and also that the nipple relates correctly to that crease as well. When there is not harmony a breast lift may be needed.
When the harmony of the breast is good, then the next discussion is the fact that all 34A cup breasts or B cup breasts aren’t the same, even if the women are the same height and weight. The difference is the soft tissue envelope of the breast and the volume of the breasts. How the current volume of the breast and the soft tissue envelope or skin envelope of the breasts relate to each other results in the look of the breasts. A woman that has thicker, tighter, elastic skin with thicker firmer breast tissue is a different pre-operative candidate than a woman that has thinner breast tissue and stretchier skin.
Besides the harmony of the breasts, I also spend a lot of time discussing with the patient that I feel this operation is dimension based. I would say it is more dimension based than volume based. Dimension based means that there are certain physical or measured limits to the breast area that need to be respected at the time of surgery. I don’t want to use an implant that is excessively wide for the patient’s chest area, or an implant that has excessive projection or volume for the patient’s breast envelope. By assessing the envelope in terms of the thickness and stretch of the envelope and the dimension of the envelope, we can determine many of these factors pre-operatively and come up with a good recommendation. This assessment requires a physical exam. I use VECTRA 3D imaging to help the woman see how her body looks in 3D before surgery, and how it might look after surgery.
What Is the VECTRA 3D Imaging System?
The VECTRA system uses specialized simulation software to provide breast augmentation patients with 3D previews of potential results using different sizes of implants. The process takes only a few minutes, and patients have the opportunity to review images during their initial consultation and at home on their own computer.
What Breast Implants Are Right for You?
The implants themselves are now fifth generation. They are more cohesive than previous implants. It is a gummier style implant than 15 years ago or even 10 years ago. It is not a shaped implant in most cases, these implants are smooth. We also have a saline filled breast implant as an option. The fifth-generation implant tends to keep volume in the upper aspect of the implant when the woman stands up better than the older style implants. It still flows and moves and looks normal and feels natural. Any implant can be palpated in a woman’s breast, but some implants palpate more naturally than others, and trying to determine the right implant for the woman’s breast is something that I discuss specifically with each woman.
The Procedure: Incision Locations and Implant Placement
The procedure itself is not a very long procedure. It isn’t rushed and it isn’t rough. No drains are required. A short incision is made either around the nipple area or more commonly below the breast in the crease. It could also be placed in the armpit area. The inframammary or below the breast incision offers the most exact placement, which helps preserve the natural borders of the breast and provides an exact placement of the implant. In most cases the implant is going to be under the breast and under the muscle or behind the muscle. The reason for placing the implant under the muscle is that it looks more natural. There are less issues with capsular contracture with under the muscle placement. There are a few specific cases where I wouldn’t recommend placing the implant under the muscle, but those are very individual, and that discussion doesn’t really apply to today’s blog.
What Is Rapid Recovery Breast Augmentation?
The operative procedure itself is outpatient. You wake up and go home with a small waterproof dressing over your incision. As I stated above, you can lift your arms up over your head every hour, no bra is required, and you can take a shower and go out to dinner. We use numbing medicine in the surgical area, as we operate to make the patient more comfortable. We even have numbing medicine that can last 2 or 3 days as an option. All of our patients take Motrin if they are allowed for about a week, and some prescription medicine for a day or two if necessary. The results are essentially immediate, but the actual, natural look of the breasts takes 3-6 months depending on the patient. That said, patients are very happy almost immediately with their new look. Long-term follow up is recommended and I prefer to see all my patients yearly. In the near future, we will have high resolution ultrasound to image the patients’ breast implants during follow-up.
Dr. Colville is one of the leading breast augmentation specialists in the nation. Breast augmentation patients travel to his Toledo, Ohio, practice from throughout the region to have him perform their procedures. If you’re thinking about getting breast implants, contact us using the online form to request a personal consultation with Dr. Colville. Or call his practice at (419) 534-6551 to schedule an appointment.