Breast augmentation or augmentation mammoplasty is certainly the most talked about cosmetic surgical procedure in the world today. The surgical method to improve the size and the shape of the female breast was first introduced to the world in the 1960s and it has undergone a sea change since then. Everything, including the procedure of making the incision to the material used in the breast implants, has undergone a radical change. Also, its popularity has increased by leaps and bounds. Breast augmentation is no longer the enigmatic “something” that Hollywood women do with their breasts spending truckloads of money; today it is a very affordable cosmetic enhancement which is done by a vast number of average American and European women.

Breast augmentation is the favored method of women today over the various other techniques that exist for enhancing the breasts. One of the prime reasons is that despite the heavy cost, the augmentation provides definite results, which are immediately visible to the eye. The method does not require a long-time commitment and effort on the part of the woman, as is the case with breast enhancement exercises, massages and herbal methods. Women can be up and about their business in about a week, and then they can forget their implants altogether, apart from when they would need to go in for a corrective surgery, which would be no more than four times the entire lifetime of the woman.

These are the advantages that are making women think about augmentation surgeries seriously. But one main question hounds them when planning for the surgery - what would the most suitable size of the implants be.

In order to effectively answer this question, let us look into the changes in the trends the female breasts have undergone over time. In the sixties, i.e. around the time the breast augmentation surgery was first developed, men preferred the curvaceous look in women, with a little fat. The leading ladies in films that time were a bit plump by modern standards. This was the time of the buxom look. However, times have drastically changed now. Young women nowadays prefer the petite look. They would not mind if their breasts are nothing to write home about. This ideology changes, however, as the woman steps into her thirties. This is when most women tend to become a bit traditional and want to have big breasts like the women in the good old times. This actually explains why women between the ages of 35 and 40 are the prime customers of breast augmentation surgeries.

Therefore, the woman wanting to go for a breast augmentation surgery would need to make a very concise decision beforehand whether she needs to go for the Elizabeth Taylor look or the Gwyneth Paltrow look. There is also the Pamela Anderson look, but then that is for women who are actively working in the glamour business.

Doctors state that no woman should go in for an augmentation of more than two cup sizes than the size of her original breasts. There are many stated benefits of keeping this limitation. One of them is that the woman will not look too big for people who are familiar to seeing her often. Very big breasts on small women could be off-putting to several men and, instead of gaining on sex appeal, the woman could lose it. Even biologically, bigger breasts would mean more hormonal upsets in the body. The huger breasts could exert pressures on the underlying muscles and feel quite rigid when moving. This could have adverse effects. The woman herself would feel uncomfortable with the sudden increase in her bust.

It is not necessary to go for a very voluptuous figure to make the breasts look sexy. Statistics among men reveal that they are turned on by better toned breasts than by bigger ones. This kind of toning can also be achieved through augmentation, and also by simple techniques such as massage and exercise. Hence, women could ideally go in for a smaller sized implant in proportion with the size of their bodies, and then work on improving the quality (shape) of the breasts.

When holding the preliminary discussions with the surgeon, one necessary point to discuss would be whether the implants would cause a loss of sexual sensation in the breasts. This happens if the implants are too big, as they could exert pressure on the breasts. This is one more reason for not going in for big shaped breast implants. Even when going in for corrective surgeries later on in life, it must be remembered not to increase the breast size by too much of an amount.

The most important aspect about breast augmentation is that the woman must feel comfortable with her breasts. Some women could feel initially awkward with the enhanced breasts, and hence her man should be supportive till she adjusts with the change in her anatomy.

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Your cosmetic surgeon will of course give you information on these subjects, and make recommendations after he has examined you. The decisions are best made by both you and your cosmetic surgeon together.

Am I a good candidate?

Do you want breast augmentation to please and satisfy yourself? If you want it to please somebody else, it would be best to hold off until you work through the issues around wanting to please that person. Having larger breasts does not change you as a person (although it can give you more physical confidence). Nor does it make you better liked or give you a more active social life.

However, if you?re sure that larger breasts will increase your own self-esteem, regardless of anyone else?s opinions, that is a good reason for doing it. If you have lost breast tissue after pregnancy, or if you?ve been disappointed with your natural development through the teen years, or if you?d like to have more equally sized breasts, you?ll be one of a large group of women who enjoy the benefits of this procedure.

Choosing an implant size

It?s nice to have a breast size that makes it easy to find clothes that fit well, and that complements the rest of your body shape. To achieve that, a large implant is probably not necessary. If you allow photos of movie stars and models to push you into choosing too large an implant size, know that there could be some disadvantages:

? You may be uncomfortable sleeping on your stomach

? You may need extra support, especially for physical activity

? You?ll be carrying extra weight and your muscles may need to adjust

? You may be uncomfortable about attention from unappealing men

? You may encounter envy from some other women

?Choosing the implant size is best done as a joint decision,? explains cosmetic surgeon Dr. Adrian Lo in Philadelphia, PA. ?You tell me what you?d like, and I?ll make some measurements, give you suggestions, and together we can come to the best decision.?

The size of a breast implant represents the difference between the size you start out with, and the size you end up with. Implants come in volume sizes, (ounces of fill, or cubic centimeters), not in the familiar alphabetical sizes of bras. If you are currently a 34A size and would like to be 34C, you?ll need a larger size implant than would a woman who starts off at 34B.

Implant types

Since November, 2006, when the FDA approved the use of silicone gel implants, there is now a choice which was not available before. The other type of implant is saline (filled with sterile salt water). The two types have a different feel, as silicone gel more closely resembles breast tissue. Also, the silicone gel in these newly-approved implants is cohesive, meaning that it sticks to itself and doesn?t leak. If a saline implant leaks, it isn?t a health problem, as the salt water is easily absorbed by the body.

A saline implant is inserted empty and filled afterwards, so a smaller incision is possible. Implants can have smooth or textured shells, a round or teardrop shape, varying diameters, and a low, medium, or high projection. All these options can be discussed with your cosmetic surgeon.

Implant locations

Implants can be positioned in two ways: beneath the breast tissue but above the pectoral muscle, or beneath both. When they?re above the muscle, depending on how much breast tissue you already have, sometimes the edge of the implant becomes visible. When the implant is beneath the muscle, actually only the top part of it is beneath, and the lower part is beneath the breast tissue only.

Incision locations

If you choose saline implants, there are three possibilities: ? Areolar incision (the incision is actually below the nipple at the lower edge of the areolar, although sometimes referred to as the ?nipple? incision)

? Crease incision or below the breast in the crease

? Transaxillary or in the armpit

Because the silicone gel implants come prefilled, you only have the choice between the crease incision and the areolar incision.

All surgery brings risk and side effects. Breast implant surgery is fairly straightforward, but there will still be some bruising and bleeding during the healing period. Any time the skin is incised there will be a scar, although the implant incision sites are chosen to leave you with the least visible scar possible.

Some of the risks of breast implant surgery are:

? Capsular contracture ? where the scar formation around the implant contracts too much, squeezing the implant and causing the breast to feel hard

? Possible infection ? much less likely if you do a good job of following your after- surgery instructions

? Increased or decreased sensitivity in the nipples ? which often disappears but sometimes becomes permanent

? Rupture of the implant ? and then it must be replaced

There are procedures to deal with all these possible complications. In general, breast implant surgeries are very successful.

?The decision to enhance your appearance with cosmetic surgery is an important one,? says Dr. Lo. ?Choose a cosmetic surgeon who will listen to you and work with you to arrive at the best possible outcome. This way when you wake up after your surgery there will be no unpleasant surprises.?

Tags: Breast Implant Ruptures, Breast Implant Types, Breast Augmentation in Chicago, Augmentation of the Breasts in Houston, Raleigh NC, After Breast Augmentation Complications, Incisions and Scaring, Breast Augmentation, Breast Implants, Who Wants Breast Augmentation?

As you come closer to making a final decision on whether or not to undergo breast augmentation surgery, the more informed you are, the better you will feel about your results. While it is significant to understand the importance of choosing the correct implant size for your body and insertion options, it is also vital to comprehend all of the complications associated with having this type of procedure. Below, you will find some of the problems that may arise after having breast enlargement surgery:

Common Reactions

With any type of surgery, post-operative bleeding is always a concern, as is surgical site infection and fluid collection. As the wound heals, visible wrinkling may appear, as well as the potential for implants to become exposed. When it comes to breast augmentation, additional complications may arise, such as breast pain, thinning of the breast lining, asymmetrical appearance, and fluctuating nipple sensations.

The Threat of Ruptures

Many women are under the misconception that breast implants will last a lifetime. Rupturing and deflation have been known to occur as early as three years after an initial procedure has been completed. A variety of occurrences may cause this reaction, such as from the pressure of mammograms or chest trauma. If your implant is made out of saline, deflation is quick and is easy for the surgeon to remove.

If you have received silicone implants, surgeons will most likely tell you that you?ll need at least one more operation to replace or remove the implants. When silicone implants rupture, they rarely deflate, and the silicone within can leak into the space surrounding the inserted breast enhancement. This may create another set of complications. For example, sometimes the lymph glands in the armpit area become enlarged.

Capsular Contracture

When implants are introduced into the body, capsules of collagen fibers develop as a response to the presence of a foreign material, causing a ?walling off? effect. Capsular contracture occurs when the capsule becomes quite tight, in turn, squeezing the implant. The unfortunate results include breasts that look misshapen and cause undue pain. No one really knows why this event takes place, but some theorize that bacterial contamination or implant ruptures are to blame. Surgery is needed to correct this problem, which has the potential to reoccur.

Scarring

After breast enlargement has taken place, one of the most common complications to arise is scarring, which can occur at the sight of incision, as well as around surrounding muscles.

Nipple and Breast Sensitivity

After surgery, chronic pain may accompany changes in the way the nipple and breast feels. Sometimes, patients are plagued with no feeling in their nipple or breast that can last for months and even years after the operation. The changes in sensitivity have been known to put a damper on sexual encounters, as well as the ability to nurse a baby.

Extrusion

When the tissue covering a healing incision mark becomes unstable or weak, extrusion may occur. As a result, the breast implant may show through the skin. Surgery is a remedy that may cause additional scarring, as well as the loss of breast tissue.

Tags: Breast Implants, Breast Augmentation, Breast Augmentation, Raleigh NC, Breast Liposuction, Breast Augmentation in Chicago, What Is Breast Augmentation?, Capsular Contracture, Implant Placement, Repair or Revision Surgery

Tags: Breast Augmentation in Chicago, Capsular Contracture, Augmentation of the Breasts in Houston, Breast Implant Types, Who Wants Breast Augmentation?, Breast Augmentation, Repair or Revision Surgery, After Breast Augmentation Complications, Incisions and Scaring, Breast Augmentation - Not A New Idea

Generally speaking, most patients have a similar recovery experience after breast augmentation surgery. At first, patients are stiff and sore and experience swelling, minor bruising, redness and discomfort surrounding the incision locations. Patients need to wear a special support bra, limit their movements and get a lot of rest during the first 24 hours to aid in the recovery.

During the first day or two, it is recommended that patients have a friend or loved one assist them with making meals, preparing ice packs and taking their pain medications at the appropriate times. Most patients are usually back to normal activities within the first few days and then back to work within a week of the surgery as long as their jobs do not require strenuous physical activity.

Scars from the breast augmentation surgery will usually begin to fade in about four to six weeks, and the breast shape should settle into its permanent positioning during that time. Most patients are entirely healed and enjoying the final results of their surgery between six months and a year from the time of the procedure.

Although most patients have similar recoveries overall, there are some factors that can influence the ease and length of recovery. The most important factors to consider are your age, medical history, skin characteristics and the surgical methods used by your cosmetic surgeon, including the implant type and implant placement.

Age and Pre-existing Medical Conditions

The younger you are, the easier and faster your recovery time will likely be. This is because your body is more resilient and able to heal at a quicker pace. Healing time can also be affected by other health conditions you may have or medications you must take on a daily basis. You should discuss your medical history and medications thoroughly with your cosmetic surgeon to find out if you will need special post-op care due to these factors.

Skin Type and Characteristics

Your skin type and characteristics can also impact your recovery time and the extent of scarring and bruising you experience. If you tend to bruise and scar easily, you should expect to see more bruising, scarring and a longer overall recovery than the average breast augmentation patient. Make sure to discuss this with your cosmetic surgeon so he or she can plan your follow-up appointments accordingly and ensure that you know the proper exercises for keeping scar tissue and additional post-op complications to a minimum.

Procedure and Implant Type

The exact procedure type and breast implant you select can affect your recovery time. For example, if you have selected an adjustable implant, healing time and scarring is usually decreased. This is because adjustable implants are not fully filled at the time of the initial procedure, keeping tension and pressure on the incisions and surrounding tissue to a minimum. This expedites the recovery process by reducing overall swelling and helping the incisions heal as quickly as possible.

If you choose to have your implants placed under the muscle as opposed to over the muscle, healing time will take longer. This is because there are more incisions needed to insert implants under the muscle, which causes additional swelling and bruising.

If you have additional questions or concerns about the breast augmentation recovery process, you should discuss them candidly with your cosmetic surgeon before the procedure takes place.

Tags: Capsular Contracture, Implant Placement, Breast Implant Types, Breast Augmentation in Chicago, Saline or Silicone, Breast Augmentation, What Is Breast Augmentation?, Breast Augmentation, Breast Augmentation - Not A New Idea, Who Wants Breast Augmentation?

Breast implant manufacturers Inamed Aesthetics and Mentor Corporation were asked by the FDA to conduct research on saline breast implant complications occurring in breast augmentation and reconstruction patients.

Here are the Top 10 issues after 5 years.

9% Implant is in a bad position.

10% Loss of nipple sensation.

10% Intense, painful nipple sensation.

12% Asymmetry. (breasts look different from each other)

12% Implant can be felt or seen.

12% Implant replacement / removal for any reason.

11% Capsular contracture. (hardening of breast)

14% Wrinkled appearance of breast.

17% Breast Pain.

26% Needed another operation.

Prospective studies of saline-filled breast implants approved by FDA in May 2000 showed re-operation rates of 13-21% at 3 years and 20-26% at 5 years for augmentation patients. The same studies showed re-operation rates of 39-40% at 3 years and 43-45% at 5 years for reconstruction patients.

http://www.fda.gov/cdrh/breastimplants/handbook2004/localcomplications.html

Implant Removal Rates Prospective studies of saline-filled breast implants approved by FDA in May 2000 showed implant removal rates of 8% at 3 years and 12-14% at 5 years for augmentation patients. The same studies showed implant removal rates of 23-27% at 3 years and 28-30% at 5 years for reconstruction patients.

What is a Saline Breast Implant? A saline breast implant is a sac (implant shell) made of silicone elastomer (rubber), which is surgically implanted under your chest tissues and/or muscle, and then filled with saline, a saltwater solution, through a valve at the time of surgery. They were approved by the FDA in May 2000. At the current time, Mentor Corp. and Inamed the are the only providers of implants permitted to sell in USA.

Tags: Breast Implant Ruptures, Raleigh NC, Orange County, Breast Liposuction, Who Wants Breast Augmentation?, Breast Augmentation - Not A New Idea, Implant Placement, Breast Implants, After Breast Augmentation Complications, Saline or Silicone

Background:
The body of literature documenting normative breast sensation and postoperative changes in sensation after reduction mammaplasty has grown considerably over the last several years. Despite this, only two studies have ever been published on the subject of postaugmentation mammaplasty sensory outcomes. The purpose of this study was to precisely measure sensory thresholds at the nipple-areola complex in women who have undergone augmentation mammaplasty by either the inframammary or periareolar approach.

Methods:
Twenty women underwent primary augmentation mammaplasty by either the periareolar or inframammary approach at an average follow-up of 1.12 years. Sensory testing was performed using the Pressure-Specified Sensory Device by comparing moving and static sensory thresholds at the upper and lower areola and nipple. Nine women served as size-matched, nonoperated controls in the study.

Results:
Primary augmentation mammaplasty was found to have a statistically significant negative effect on sensory outcomes when nonoperated controls were compared with women who had undergone augmentation mammaplasty via either the periareolar or inframammary approach. No differences in sensory outcomes were found between the two approaches used. Implant volume was found to be highly predictive of sensory outcomes, with an inverse relationship between implant size and the degree of sensitivity within the nipple-areola complex.

Conclusions:
Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernible differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex. (Plast. Reconstr. Surg. 117: 1694, 2006.)

The body of literature documenting normative breast sensation and postoperative changes in sensation has grown considerably over the last several years. This is especially true in women following reduction mammaplasty. In addition to anatomic studies that have outlined the innervation of the nipple-areola complex, precise sensory measurements have been performed on patients who have undergone reduction mammaplasty by several different techniques, including the inferior pedicle, medial pedicle, and breast amputation–free nipple graft approaches.1?6 Despite the expanding knowledge base on this subject, only one study has been published since 1976 on the comparably larger subset of patients who have undergone augmentation mammaplasty.7 As previous studies have demonstrated, women with macromastia are considerably less sensate in the region of the nipple-areola complex than age-matched controls with small to normal-sized breasts.6,8,9

The causal relationship of this finding has been speculative and is thought to be related to nerve traction injury and decreased innervation density in patients with gigantomastia. Although evidence is anecdotal, women with macromastia who present for reduction mammaplasty are primarily motivated by chronic symptoms of pain and discomfort, the inability to engage in vigorous physical activity, and intertriginous infections. Concerns regarding sensory outcomes are usually secondary and frequently inconsequential, since preoperative sensation is diminished. In contrast, women who present for augmentation mammaplasty are highly sensate in the region of the nipple-areola complex, and in the course of the preoperative consultation there are frequently questions about postoperative sensory outcomes. In women with micromastia, sensation of the nipple-areola complex is often of paramount importance and, in some women, an important source of stimulation during intimacy. Until now, informed consent regarding this issue has been achieved by the operative plastic surgeon by suggesting that sensory loss is a potential outcome, but that sensory outcomes are uncertain and variable.

It is also the practice of some plastic surgeons to discourage the periareolar approach of implant placement in women who voice concerns about the loss of sensitivity, because of the risk of transection of nerve fibers leading directly to the nipple-areola complex. Although other techniques of performing augmentation mammaplasty, such as the transumbilical and the endoscopically assisted transaxillary techniques, have gained popularity over the last several years, the vast majority of breast augmentations today are performed via either the inframammary approach or the periareolar approach. Unlike the two previous studies on the subject of sensory changes associated with augmentation mammaplasty,7,10 we utilized the Pressure- Specified Sensory Device (Sensory Management Services, Baltimore, Md.). Previous studies have employed modalities such as light touch, pain perception to electrical currents, vibratory stimulus, and Semmes-Weinstein nylon monofilaments. Relative to the technologically advanced sensory testing modalities available today, the techniques used in the two previous studies on this subject are considered unreliable and inaccurate.11 Thus, the purpose of this study was to quantify the sensation of the nipple-areola complex following breast augmentation using the Pressure-Specified Sensory Device and to compare the inframammary and periareolar approaches with respect to sensory outcomes.

PATIENTS AND METHODS
A total of 29 women were included in this study; nine of them were nonoperative controls (group 1), 13 had undergone breast augmentation through an inframammary approach (group 2), and seven had undergone augmentation via a periareolar approach (group 3). All women agreed to a 1-hour sensory examination that was performed in the presence of a female chaperone. No financial or other compensation was provided for enrollment in the study. The breast sensory testing protocol was accepted by our institutional review board, and all study subjects gave informed consent for sensory testing to be performed. No woman enrolled in this study reported a history of diabetes mellitus, thyroid disorders, collagen vascular disease, alcoholism, pernicious anemia, known neurological impairment, or history of previous breast surgery. Sensory evaluation was performed in all 29 women (58 breasts) by one examiner using the sensory device. Women were seated in a reclining chair with one breast exposed for testing and the other draped with a sheet. Women were asked to close their eyes so that the computer screen or the breast being tested could not be seen.

A button linked to the computer was placed in the hand opposite to the breast being tested and the women were instructed to press the button to indicate perception of the test stimulus. The nipple and upper and lower halves of the areola were selected as testing sites. At each test site, five readings were recorded. The highest and lowest values were discarded to eliminate outliers, and the mean of the remaining three was reported as the pressure threshold in grams per square millimeter. One-point static and moving pressure perception threshold was measured within a continuous range of 0.1 g/mm2 to 100 g/mm2. Data were entered into an Excel spreadsheet (Microsoft Corp., Redmond, Wash.). Statistical analyses were performed to compare the one-point moving and static sensibility measurements among groups 1, 2, and 3 using the Mann-Whitney nonparametric test between each group. Data for each of a subject?s breasts were averaged for each woman, since the left and right sides are highly correlated.

Group 1: Normative Controls
Nine women served as nonoperative controls. The average age of the participants was 28 years (range, 19 to 38 years SD, 6 years). Breast size among participants ranged from 34A to 36C. A total of 18 breasts were tested and the results were averaged. Data on these patients have previously been published.6

Group 2: Inframammary Approach and Group 3: Periareolar Approach
A total of 20 women underwent augmentation mammaplasty by either the inframammary incisional approach (13 patients; 26 breasts) or the periareolar incisional approach (seven patients; 14 breasts). In study participants in whom the periareolar approach was utilized, the incision was designed from the 4 o?clock to the 8 o?clock position at the inferior border of the areola. Implants in both groups were placed in either the subglandular or submuscular plane. Study group participants were not further subdivided according to the plane of implant insertion, because study cells would suffer from small sample size and inadequacy for statistical analysis.

Preoperative breast sizes ranged from 32B to 36C among study participants. The average duration between surgery and sensory evaluation was 1.12 years (range, 102 to 1512 days). The average age of participants at the time of testing was 33 years (range, 20 to 47 years SD, 7 years). There were no significant differences in age at time of testing or in the interval between surgery and testing between the groups of women who underwent augmentation mammaplasty by either approach. The average implant size used was 375 cc (range, 340 to 475 cc) in the periareolar incisional approach group and 428 cc (range, 315 to 700 cc) in the inframammary incisional approach group; this was not statistically different (p _ 0.05).

RESULTS
Cutaneous pressure threshold values for the nipple-areola complex were determined for study participants in all groups (Tables 1 and 2). There were no statistically significant differences (p _ 0.20) in values between the upper and lower halves of the areola for each group for one-point moving and static tests therefore, values for the upper and lower halves of the areola were pooled. Sensory measurements for both nipple-areola complexes of each participant were averaged for each participant (left and right nipple-areola complex), and the nonparametric Mann-Whitney test for two independent groups was performed (Tables 1 and 2). No statistically significant differences were found between women who underwent augmentation mammaplasty by the inframammary approach and those who had the periareolar approach (p _ 0.51 for each test, nonparametric Mann-Whitney test) (Table 1). Groups 2 and 3 were therefore pooled and compared as a single group (n _ 20) to normative controls (group 1, n _ 9) (Table 2). Significant differences were found, with p_0.03 for each test. Mean cutaneous sensory thresholds were nearly 10 times greater in women who underwent augmentation mammaplasty by any approach compared with unoperated controls with breast cup sizes ranging from 34A to 36C.

Groups 2 and 3 were pooled and then subgrouped into two categories by length of time from the date of surgery to testing. Six study participants were found to have a follow-up time of between 3 and 6 months. Fourteen study participants had a follow-up time of between 6 months and 4.1 years. No statistically significant differences were found, with p _ 0.50 for each test (nonparametric Mann-Whitney test). In comparing sensory threshold variations by age at surgery, incision type, and preoperative cup size, a regression analysis was performed and in each case was found to have a p value greater than 0.05. Once each of the nonsignificant variables was dropped from the statistical model, regression analysis revealed that 50 percent of the variation in sensation was found to be attributable to implant volume (p _ 0.02).

DISCUSSION
The postoperative sensation of the nipple-areola complex after operative procedures on the breast is being investigated with increasing frequency. Despite an increasing body of knowledge on this subject following reduction mammaplasty, there is a paucity of information about sensation after augmentation mammaplasty. No studies, before this one, have compared sensory outcomes utilizing different incisional approaches or sensory outcomes based on differences in implant volume.

Although there are a variety of ways to assess sensation, computer-assisted quantitative neurosensory testing represents a significant advance in our ability to perform continuous measurements. The Pressure-Specified Sensory Device is a computer- assisted instrument that uses a hemispheric probe attached to a force transducer to make continuous measurements of cutaneous pressure possible. It allows for one-point static (Merkel cellneurite complexes, Ruffini complexes), one-point moving (Pacinian and Meissner corpuscles), and moving and static two-point (innervation density) discrimination.12 Unlike nylon monofilaments, which provide only an estimate of the logarithmic range of cutaneous pressure thresholds that cannot be intuitively assessed without advanced statistical transformations, the Pressure-Specified Sensory Device provides continuous measurements of cutaneous pressure, making such statistical analyses and comparisons possible. Normative data for breast sensibility of the nipple-areola complex obtained using the device have been previously published.6 This study represents the first quantitative sensibility analysis that compares postoperative sensation of the nipple-areola complex after augmentation mammaplasty via the inframammary and periareolar approaches.

Precise anatomic studies have previously elucidated the dual innervation of the nipple-areola complex medially and laterally from cutaneous branches of the third through sixth intercostal nerves.13,14 It has always been a theoretical risk that transareolar techniques of augmentation mammaplasty place the sensory outcome of the nipple-areola complex at risk, because of the direct disruption of nerve fibers traversing the inferior pole of the areola. This study has demonstrated that there is no statistically significant difference in sensory outcomes when augmentation mammaplasty is performed via the periareolar or inframammary incisional approach. In the design of this study, women were not subdivided based on plane of dissection (submuscular versus subglandular pocket position). This was because the number of women within each subgroup was not large enough for a statistically valid comparison. The neural anatomy of the nipple-areola complex has been well described, so there is no reason to suspect that implant position, either above or below the pectoralis muscle, would affect sensory outcomes.13,14 Our study design was also limited by the lack of preoperative and postoperative sensibility data on the same patients. A preoperative study, in which study participants serve as their own preoperative controls, is planned. Since the first published report on sensory outcomes after augmentation mammaplasty, a great deal has been learned.

This study disputes the conclusions of the 1976 landmark article by Courtiss and Goldwyn10 that demonstrated a return to normal nipple-areola complex sensation by 6 months after augmentation mammaplasty. Utilizing a far more sensitive testing apparatus than crude touch and pinprick, this study has demonstrated a nearly 10- fold decrease in sensory thresholds after primary augmentation mammaplasty. It was interesting to find that there was no progressive diminution of sensory loss when study participants with an interval of between 3 and 6 months from surgery to testing were compared with participants with a follow-up of 6 months to 4.1 years.

One might have expected to find some amelioration of sensory loss with time as the skin envelope of the breast stretches to accommodate the implant, but no discernible differences were recognized. This suggests that sensory impairments found at 3 to 6 months are not likely to improve with time. The relationship between implant volume and sensory outcome was another primary focus of this study. There was demonstrated to be a strong inverse relationship between implant volume and sensory outcomes. Although this relationship was found to be linear, implant sizes from 315 to 475 cc were found to have the least variability with respect to sensibility outcome. Sensibility outcomes were most variable with implant sizes greater than 475 cc. The relationship found between implant volume and sensory outcome is perhaps best explained by the same forces that act on large pendulous breasts in cases of gigantomastia. In an earlier study, it was demonstrated that control women with relative micromastia (34A to 36C cup size) were far more sensate than control women with gigantomastia (36DD to 46EE cup size).6 It was purported that volumetric differences in the breast were likely related to sensory outcomes because of nerve traction and innervation density, both of which are highly predictive of sensitivity.

There are additional factors to consider, however, with respect to skin tension and the size of the skin envelope relative to the size of the implant. It would be expected that a large implant in a breast with a substantial skin envelope would create less tension than a large implant in a breast with a smaller and tighter skin envelope, which would consequently cause more nerve traction. In the vast majority of women who choose to undergo breast augmentation, there is an improvement in overall body image.7 Despite the fact that significant statistical differences have been found between women who have undergone augmentation mammaplasty and those who have not, it is not clear whether there is any clinical significance to these findings.

Erogenous sensation is a cortical transfer function and is not necessarily correlated to sensory thresholds. The provision of this information regarding sensory outcomes to our patients is only one facet of the informed consent process that patients should undergo before having augmentation mammaplasty. Plastic surgeons should feel comfortable counseling patients that augmentation mammaplasty by either the inframammary or periareolar approach results in no discernable differences in sensory outcomes. Furthermore, women who choose very large implants relative to their breast skin envelopes should be warned about potential adverse sensory sequelae within the nippleareola complex.

Tags: Repair or Revision Surgery, Breast Augmentation in Chicago, Breast Augmentation - Not A New Idea, After Breast Augmentation Complications, Saline or Silicone, Breast Augmentation, Augmentation of the Breasts in Houston, Incisions and Scaring, Implant Placement, Capsular Contracture

A few questions you might have concerning breast augmentation:

Breast augmentation surgery has become a common form of plastic surgery. Most women choose to enhance their breasts because they wanted to look better, without or in clothes; because they wanted to feel better about themselves, or more confident, or less self conscious. A very high percentage?94% of respondents to a recent industry survey of 5,000 women?would recommend the procedure to friends or family members.

Many who are considering surgery have natural questions about the procedure. Answers to some of these questions will help the patient to choose their surgeon or identify a hospital. A patient will choose a surgeon on the basis of experience, reputation, and successes for example, a patient may prefer a doctor who is affiliated with the American Academy of Cosmetic Surgery, industry?s professional association. A patient may consider the status of a hospital?s Joint Commission on Accreditation of International Standards or recognition from the US National Health Services, to be an important part of their decision.

Professional association research has identified the typical patient seeking a breast enlargement to be a 34-year old woman with two children. Specialists in plastic surgery consult with patients to specify procedures so that patients choose, with the benefit of their doctors? counsel, between silicone gel and saline breast implants. Typically, a plastic surgeon will inform a patient that they will spend a few days in the hospital to be followed by a little over a week?s recuperation.

Tags: Raleigh NC, Breast Implants, Saline or Silicone, What Is Breast Augmentation?, Capsular Contracture, Who Wants Breast Augmentation?, Breast Liposuction, Breast Augmentation Financing, Breast Implant Ruptures, After Breast Augmentation Complications

Tags: Breast Implant Ruptures, Incisions and Scaring, Who Wants Breast Augmentation?, Breast Implants, Capsular Contracture, Repair or Revision Surgery, Raleigh NC, Orange County, Breast Augmentation, Saline or Silicone

No single approach to breast augmentation surgery is the best for every woman. If you are considering enlarging your breasts with breast augmentation, then you need to understand the options for the surgical process because you will need to discuss them with your plastic surgeon.

Women seek to enlarge their breasts with breast augmentation surgery for various reasons. Foremost is the desire for a fuller bustline and a well-proportioned figure, but breast augmentation can also rejuvenate breasts that lost some of their form and volume during pregnancy and nursing, correct a bustline in which the breasts differ in size, or reconstruct breasts after they have undergone a previous other surgery. This procedure is sometimes called breast enlargement and breast enhancement as well as breast implants.

Your Body and Breast Augmentation

Your body type will influence the results of breast augmentation as well as your surgeon’s decisions about the surgical approach. This is not a bad thing. It just means that the unique characteristics of your body and your goals for breast augmentation will guide the process. Your plastic surgeon will describe to you what results you can reasonably expect.

As for the surgical approach, your surgeon will seek to limit the visibility of the scars from your surgical incisions. For breast augmentation, the incisions can be made beneath the breast in the crease where it meets your chest, around the areola (nipple region) or at the armpits. You should discuss with your surgeon the pros and cons of these approaches and consider how you feel about where the scars will be.

What Happens During Breast Augmentation Surgery

You may be placed under general anesthesia so that you will sleep painlessly through the entire operation. In some cases, the option of only using a local anesthetic along with sedation might be appropriate for your situation as well. Your preferences along with the surgeon’s judgment will guide the decision about your anesthesia.

Once you are anesthetized, your plastic surgeon will make the incisions to access the breasts, insert breast implants (either saline or silicone) and position them behind your nipples. At a minimum, your soft breast tissues will be lifted and the implant placed underneath them. However, there is the option to also lift the pectoral muscles of your chest and put the implants beneath the muscle and breast tissue.

Where the implant is placed in your body, whether beneath only breast tissue or all the way beneath the muscle tissue, is an important option to be discussed with your plastic surgeon. The choice of implant position depends on your anatomy. For example, if you have some drooping of the breasts the final appearance often looks more natural if the implants are placed under the breast tissue itself and over the muscle.

The type of breast implant used is also a very important consideration. Saline or silicone breast implants each have their advantages and disadvantages that your plastic surgeon will help you assess as your surgery is planned.

At the conclusion of the surgery, which may last up to two hours, your incisions will be stitched and taping is often used to further hold the breasts in place while you heal. Sometimes gauze dressings will be applied as well.

As you consider this elective cosmetic surgery procedure, it is important to obtain as much breast augmentation information as possible. The careful choices you make about the location of scars, placement of implants, and what type of implants to use will increase the likelihood of a good outcome as you seek to enhance your body.

About the Author:

Dr. Lloyd Krieger is a plastic surgeon and Los Angeles breast augmentation specialist. You can read more breast augmentation information.

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