My goal as a woman and as a surgeon is to help a patient become more comfortable
and relaxed with her body or face. She can then let go of any anxiety related to body image and let the positive attributes in her intellect, beauty and personality become the focal points for her.
When a woman comes in for a consultation regarding her breasts, it is obviously a very personal discussion.
She may feel anxious or even “vain” because she is focused on changing a part of herself that, at some level, she believes is inadequate. My responsibility is to give surgical options and to educate a potential patient regarding her choices. Often, by surgically providing what nature did not, or refining what is there, a sense of confidence is gained. There is then much less worry about how a dress will fit or what bathing suit will provide camouflage.
Plastic surgery is a blending of surgical skill and artistic vision. Key issues to consider with regard to breast surgery are your goals and your surgeon’s ability. As a potential patient, it is important to assess your expectations so that your surgeon can facilitate changes as expertly as possible. That ultimately allows building on your baseline anatomy to give the most aesthetic result.
In your initial consultation, you will want to discuss several issues. Most implants used in the United States are saline- or saltwater-filled surrounded by a silicone shell. They have been proven to be very safe in a variety of independent studies. Specific questions to be addressed are positioning of implants above or behind the chest wall (pectoralis muscle), round or teardrop-shaped implants, smooth or textured surface, and choice of incisions. Beyond these basic questions, the patient and her surgeon must decide on size of enhancement, measured in milliliters or ccs by surgeons and cup size by women. The amount of cleavage desired and whether a lift procedure, or mastopexy, would be of benefit should also be discussed.
There are pros and cons for every choice, but generally many surgeons strive to place implants at least partially under the muscle to provide maximum coverage of the implants and prevent palpability of the implants. This approach also makes mammography more easily interpreted and gives some protection against excessive firmness, or capsular contracture of the breasts. The recovery period is slightly longer with this approach because the muscle must relax over time to accommodate an implant. Some women have enough of their own breast tissue to provide coverage of an implant on top of the muscle, and, again, it is a very individual choice. With regard to textured or smooth implants, textured implants may show some rippling or waviness of the implant beneath the tissue, but may have a slightly lower rate of scar tissue forming around the implant. Round vs. teardrop-shaped implants still stir debate in our field and both offer some advantages. Personally, I tend to use round implants for most patients unless they are reconstructive surgery patients.
Occasionally, patients are certain they want teardrop-shaped implants, and should have that choice. The only real negative is that the implant pocket must be slightly restricted at the upper portion of the breast, and the breast may be slightly tighter in this area. Round implants may rotate within the pocket, which gives a natural movement to the breasts. Incisions are generally small, about 3.5 cm, and may be placed in the inframammary fold, (the natural crease at the base of the breast), periareolar (around the margin of the colored portion of the breast) or axillary (under the arm).