Breast Augmentation

There are many reasons why women consider having breast augmentation surgery. Many just want to be able to wear a bathing suit that fits better. Others want to obtain the flattering figure they always desired. Moms seek breast augmentation surgery because they lost their breast size after breast-feeding. There are also physical reasons, such as small, underdeveloped or unusually shaped breasts or size reduction due to weight loss.  When a breast is lost to breast cancer, breast reconstruction is an option many women chose.

With today’s availability of options, financing and accessibility, breast augmentation is one of the most common plastic surgical procedures performed today. The augmentation is accomplished by inserting a breast implant, silicone or saline, to achieve the desired volume while adjusting the breast shape when appropriate. This results in an aesthetic change to the overall appearance of the breast that might result in aesthetic changes with proper proportion, symmetry and balance affecting the entire body.

Both saline and silicone gel breast implants are proven to be safe, effective and long lasting.

About half of the breast surgeries performed at the Clinique of Plastic Surgery are to correct, or revise, previous breast surgeries. Dr. Drehsen’s “Inner Bra” Subfascial Breast Augmentation technique is one of our signature procedures at the Clinique of Plastic Surgery. While popular even as a first time procedure, this innovative breast augmentation technique uniquely addresses the needs of athletic and physically active women who have had previous implants migrate causing a loss of cleavage and fullness. The displacement is corrected by placing new implants under the fibrous layer (fascia) of the pectoral muscle instead of under the muscle fibers.

Types of Breast Implants

Saline and silicone implants are available in multiple increments of volume and width to fit individual chest and breast configurations.

Saline Breast Implants

For people concerned about silicone implants, saline breast implants are a good choice because they require a smaller incision. Saline implants are more adjustable than silicone but have a more bouncy appearance. The saline implant option allows implants to be adjusted to correct any possible unevenness.

Silicone implants

Silicone implants come prefilled with a safe, sterile silicone gel and in many sizes. They look and feel natural. However, since they are prefilled with silicone, any slight unevenness will not be able to be corrected.

Since implant degradation or rupture is not as obvious as saline implant deflation, the prevailing recommendation is to replace the implants every ten years.

There are several types of approaches or incisions for breast augmentation. The incision choice generally depends on the work to be done to improve the gland shape or position.

Breast Augmentation Incision and Placement Options

Once the incision is made, the surgeon will lift breast tissue to create a pocket. This pocket will either be under the breast tissue (subglandular), or underneath the pectoral muscle cover (subfascial), or under the muscle itself (submuscular). After the pocket is created, the surgeon will place a breast implant inside.

One of our favorite approaches to create well-shaped breasts is the armpit incision, which leaves a virtually invisible scar. Additionally, there are several choices for implants, which our doctors will discuss in a formal consultation. Different types of implants are available to fit your specific needs, your budget, as well as the ultimate shape you would like to obtain.

Indications for Breast Augmentation Procedures

You are a good candidate for breast augmentation surgery if you can identify with any of the following:

1. Cosmetic breast augmentation of underdeveloped breasts
2. Asymmetrical breasts
3. Abnormal breast shape such as conical deformity
4. Post delivery, weight loss, tissue sagging, and loss of volume
5. Breast reconstruction after surgical removal. (Total or partial)

Choice of Breast Implant Position

Classically, patients have been left with two choices; a submuscular placement, which was widespread with saline implants, and subglandular. Unfortunately, these two choices can have some significant drawbacks. The constant muscle activity over the implant inherent to a submuscular placement has often led to implant displacement (with loss of medial cleavage) inferiorly (bottoming) or superiorly (wide chest look or snoopy breast) sometime within a couple of years.

These late displacements are, unfortunately, not totally predictable or preventable and more likely to happen in people with large implants, loose tissue, or with repeated physical activity. The subglandular approach, on the other hand, appears to maintain the cleavage better, however, in some cases of loose tissue, may show more secondary sagging and rippling.

Subfascial placement is often recommended by Dr. Drehsen, particularly for athletic or physically active women. In this approach, the fibrous layer covering the outer surface of the muscle is elevated from the muscle, allowing support of the implant by a strong fibrous sheath. This, in Dr. Drehsen’s experience, reduces implant displacement since the muscle activity does not affect the implant placed in front of it and also may reduce wrinkling and sagging due to the presence of this stronger supporting fibrous sheath. The procedure is slightly longer due to the tedious nature of the creation of a subfascial pocket.

NOTE:The subfascial placement can only be done through an inframammary approach or in selected cases using a trans-areolar approach. The key to making the scar inconspicuous is placing the incision in the projected new fold, not in the existing one. This subfascial approach eliminates many of the problems described below and also maintains the new cleavage more effectively than submuscular or dual plane placement. The subfascial approach can also be used to correct moderate sagging and nipple mal-positioning without external incisions.

As an alternative, a Dual Plane Placement is sometimes performed to avoid post surgical deformities such as a "double bubble" deformity (original breast shape visible on top of the implant), "snoopy breasts" (a submuscular implant placed too high under the muscle) or to help correct nipple position asymmetry and early sagging. The procedure involves working under the muscle (totally or partially to position the implant) and under the gland to help correct shape or position problems.

We are looking forward to serving you, and would love to talk to you about your interests to help you achieve your ultimate dreams of beauty! Call us at 1-800-942-1606, email a question, reserve a consultation or register for an event.

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As with any medical procedure, there are certain inherent risks that should be discussed. Costs vary depending upon the extent of the surgery and areas treated.