With the ability to restore volume and shape, breast enhancement surgery is successful in improving self-esteem and quality of life for women of all ages. Some of us just never develop a breast size that is proportionate to the rest of our body. Many women experience significant deflation after childbearing and breastfeeding. Whether you fit into one of these categories or just wish that you could wear a spaghetti strap sundress without a push-up bra, and still have some fullness of the breasts on top, you can now explore the options of breast enhancement surgery.
“The appropriateness of the implant for the size and shape of your breast as well as the pocket that it sits in are as important as the actual size and shape of the implant itself.”
Dr. Trott’s ability to achieve the best breast augmentation (augmentation mammaplasty) result for you is due to a combination of her artistic eye and her methodical approach. During your preop visit you will have ample time to try on implant sizes so that you can best determine what you like. However, as Dr. Trott tells all of her patients, the result is not just determined by the style or even size of the implant but by how it fits the size and shape of your breast and the pocket that is created for it. Dr. Trott goes to great lengths to meticulously create symmetric “subpectoral” (below the muscle) pockets through small periareolar incisions under direct vision.
This “direct visual dissection” is one of the steps that Dr. Trott uses to prevent capsular contracture, the dreaded “hardening” of breast implants. Her other preventive measures include using a special triple antibiotic irrigation solution intraoperatively to prepare the pockets. This antibiotic solution containing Ancef, Gentamicin and Bacitracin has been shown to decrease contamination with Staphylococcus Epidermidis, a bacteria that normally lives on your skin and has been associated with capsular contracture. She also recommends Singulair™ immediately postoperatively to her patients. Singulair™ is an asthma medication which works by decreasing inflammation and may have an association with decreasing capsular contracture, although as of yet there are no scientific studies to prove it. She also instructs and encourages postoperative massage.
During the operation (while you are asleep of course!), Dr. Trott always sits you up and places a breast sizer (temporary implant) to determine that the look is exactly as you both discussed at the consultation and preop visit. As a result of all of these measures, your breasts will be as beautiful, natural-appearing and as even as possible.
Mastopexy (Breast Lift) With and Without Augmentation (Augmentation Mammaplasty)
If you have lost breast fullness, firmness and perkiness after childbearing and breastfeeding or just by getting a little older, you will probably benefit from a breast lift (mastopexy) in conjunction with an augmentation (augmentation mammaplasty). Since most women who have developed breast ptosis (sagging) want to restore some volume as well as that “push-up bra fullness” to the upper breast area, an implant is usually needed However, if you like your breast size and just want to be lifted, you may not need an implant.
Dr. Trott's experience spans both reconstructive and cosmetic breast surgery, including the vertical or limited scar breast lift (mastopexy). Traditionally, breast lifts (mastopexy) and reductions (reduction mammaplasty) have been done with an anchor scar (around the nipple, vertically down the middle and across the inframammary crease). However, over the past decade, the development of the more modern “lollipop” lift (just around the nipple and up and down) has evolved. Dr. Trott’s training at the University of California, San Diego Medical Center included performing over one hundred of these lifts and reductions on both reconstructive and cosmetic patients. This training was done under the direction of Dr. Anne Wallace, who has been director of the Breast Center at UCSD since 1995.
Dr. Trott has taken her experience one step further and developed her own technique, “The Dermal Spanning Flap”, which she has incorporated into her vertical lift and reduction surgeries. She feels that this additional procedure improves contour of the lower rounded portion of the breast and helps to strengthen the lift like an internal bra. She has presented this original technique at the 2006 joint meeting of the California Society of Plastic Surgeons and the Rocky Mountain Association of Plastic Surgeons meeting in Las Vegas.
If your breast sagging is minimal and your nipple is just a little too low, Dr. Trott can correct this with a lift that is hidden in the periareolar (border of the colored skin around the nipple) line only.
At your first consultation, you will be able to define your goals (one of which is probably to not have to wear that uncomfortable push-up bra all the time!), and Dr. Trott will present you with a customized approach to meet them. As you will see in the before and after photos, Dr. Trott makes a special effort to understand your specific vision and does everything possible to make it happen.
Your research of breast augmentation (augmentation mammaplasty) surgery may have left you even more confused, with all of the “buzz words” from the media, internet or doctor’s offices; “under the muscle”, “over the muscle”, “dual plane”, “high profile”, “low profile”, “capsular contracture” and of course “silicone vs. saline”. We hope that the following information will help give you some answers.
Breast Augmentation (Augmentation Mammaplasty) and Breast Lift (Mastopexy) FAQ’s
Q) What is “under the muscle”? What is “over the muscle”? Which is better?
A) Most breast augmentations (augmentation mammaplasty) today are done “under the muscle” which means the implant is placed in a pocket under the pectoralis major muscle. This muscle originates from your rib cage and inserts into your upper arm. As do most plastic surgeons today, Dr. Trott completely releases the lower border of the muscle so that the implant will sit naturally in the correct position. The lower part of the implant is covered by breast tissue and the upper part is covered by the muscle, thus the technique is named “dual plane”. The advantages to this subpectoral (under the muscle) approach as opposed to subglandular (over the muscle) are as follows:
- The top part of the implant is covered so they look more natural
- Now thought to be associated with a lower rate of capsular contracture
- Less sagging of the breasts over time
The advantages to the subglandular as opposed to the subpectoral approach are:
- Easier postoperative recovery because no muscle work is done.
- Minimal risk of a "Snoopy" deformity.(See Breast Revision photos)
Q) What are the different options for the incision?
A) Breast augmentation (Augmentation Mammaplasty) incisions can be hidden in the periareolar line (the border of the colored nipple skin) or made in the axilla (armpit) or at the lower edge of the breast (inframammary crease). Dr. Trott chooses to do most of her breast augmentations (augmentation mammaplasty) through small incisions around the nipple for several reasons. First, there is a natural line there so the eye is not drawn to what becomes an almost imperceptible scar. Secondly, the nipple is in the center of the breast and therefore doing the surgery through this incision allows her to have a clear view and access to all corners of the breast when the pocket is created from the inside. She feels that this is very important to control bleeding so as not set up the formation of a capsular contracture. It is not always possible to hide an inframammary incision if a woman has very small breasts that do not sag at all. In addition, silicone implants, which are the preferred implant used today by most Board-Certified Plastic Surgeons, cannot be placed through the umbilicus or the Axilla.
Q) Will I lose nipple sensation after a breast augmentation (augmentation mammaplasty)? Won’t an incision around the nipple give me a higher chance of losing nipple sensation than if it is made elsewhere?
A) Loss of nipple sensation is always a possibility with any breast surgery. Therefore, Dr. Trott recommends that if nipple sensation is really important to you, you should never have elective breast surgery. However, in a straightforward breast augmentation (augmentation mammaplasty), the risk of permanent loss of nipple sensation is very low—probably less than five percent. Many women actually find that their nipples become hypersensitive (more sensitive) for awhile after surgery. The location of the breast augmentation (augmentation mammaplasty) incision actually has nothing to do with the incidence of loss of nipple sensation. Nipple sensation is supplied by the fourth intercostal nerve, which comes from your lateral chest wall and is underneath the muscle. Loss of nipple sensation after breast augmentation (augmentation mammaplasty) is usually due to injury of this nerve, which is more common with very lateral pocket dissections (far out on the sides of your chest). Since Dr. Trott understands that you do not want your breasts hanging to the sides after the surgery, she avoids this very lateral pocket dissection.
The incidence of loss of nipple sensation in breast lifts (mastopexy) is slightly higher than in simple reductions, because there is more rearrangement of breast tissue as the nipple is raised—probably closer to ten to fifteen percent.
Q) Will I be able to breast feed after having breast augmentation (augmentation mammaplasty)?
A) The data on this subject is not very accurate because some women just cannot breast feed anyway, and it has nothing to do with their previous breast augmentation (augmentation mammaplasty). However, most women who want to breast feed after having breast augmentation (augmentation mammaplasty) are able to do so. The chances that you would not be able to breast feed after a breast lift (mastopexy) or breast reduction (reduction mammaplasty) are higher, probably about 30%.
Q) What if I plan to get pregnant?
A) Dr. Trott recommends that if you are planning to get pregnant within the next two years you should wait to undergo breast augmentation (augmentation mammaplasty). The dramatic changes that your breasts may undergo during pregnancy may ruin the result. If you are planning to have a breast lift (mastopexy), you should most likely wait until after you are done childbearing.
Q) How soon after pregnancy can I have a breast augmentation (augmentation mammaplasty)?
A) Dr. Trott recommends that you wait until at least six months after you have finished breast-feeding. This will give your breasts time to go back to their normal size and also to prevent infections that can occur if there is still milk left in the ducts.
Q) Do breast implants have to be redone every ten years?
A) See “breast revision surgery” for the answer to this question.
Q) What is the difference between silicone and saline implants?
A) Both silicone and saline implants have a solid outer silicone “shell” that is identical. Saline implants come empty and are filled with sterile saline intraoperatively by your surgeon. Silicone implants come pre-filled with cohesive gel that has the consistency of “jello” so that it does not leak. Silicone implants feel softer and more natural than saline. Saline implants deflate 1% per year and eventually start rippling.
Q) What is the “gummi bear” implant?
A) All silicone implants today are really “gummi bear” implants since they are all made of cohesive gel however, the “gummi bear” nickname specifically refers to a cohesive gel implant that is even more solid than what has been approved by the FDA for general use today. Since it is stiffer than the standard cohesive gel, it does not move or change shape at all with your movements. Since it so solid, it requires that the surgeon make a bigger incision to place it into your breast. It is available only on trial studies. It's main indication right now is for breast reconstruction, for which it may have its advantages. Since it is “form stable”, rather than the implant taking the shape of your breast, the breast takes the shape of the implant. For all practical purposes, all silicone implants today can be considered "gummi bear" implants, as they are all made of cohesive gel.
Q) What is high profile? Moderate profile? Teardrop shaped?
A) High profile implants are narrower and have more projection from your chest. They are often the implant of choice for women who have had sagging breasts and are undergoing a breast lift (mastopexy) with implants, or for women who always want to have that “push up bra” look even when they are not wearing a bra at all. Dr. Trott most often uses a "Midrange or Moderate-Plus" implant that is a compromise between the two. Moderate profile implants are wider with less projection and tend to give a more “natural, teardrop shaped” appearance. Silicone teardrop shaped implants have not been approved by the FDA. Studies have shown that the teardrop shaped implant does not necessarily translate into a teardrop-shaped breast. As Dr. Trott emphasizes, the appropriateness of the implant and the creation of the pocket that it sits in are as important as the actual implant itself in achieving the look that you want.
Q) What is the difference between textured and smooth implants?
A) Textured implants have a textured or “rough” shell, while smooth implants are just smooth on the outside. In the past, textured implants were thought to have a decreased rate of capsular contracture. However, that is not the case today and most plastic surgeons use smooth implants.
Q) Which is better—silicone or saline?
A) As do most board-certified plastic surgeons who do a significant number of breast surgeries, Dr. Trott recommends today’s “third generation” cohesive gel silicone as the superior implant. All of the previous fears of association with autoimmune diseases have been scientifically disproved, and board-certified plastic surgeons in the United States are very happy to have silicone implants available for their patients again. It should be noted that we were the only country in the world that used saline implants to replace silicone. Silicone implants are more natural in look and feel than saline implants, and last longer. The cohesive gel does not “leak” the way the more liquid gel-filled implants of the past did.
Q) What is capsular contracture? What causes it?
A) Capsular contracture is the hardening of the scar or “capsule” that forms around a breast implant. The formation of the capsule itself is normal, but in approximately ten to fifteen percent of women this scar can become extremely hard, and unattractive. The etiology of capsular contracture is thought to be related to blood being left in the pocket that the implant sits in, setting up an inflammatory reaction, and contamination with Staphylococcus epidermidis, a bacteria that lives on your skin. Other than that, the main cause has to do with your individual body and how you heal. As described above, Dr. Trott takes great measures to prevent capsular contracture including subpectoral implant placement, direct visual dissection with meticulous hemostasis, irrigation with triple antibiotic solution, and postoperative use of Singulair™ and massage.
Q) What is the down time after a breast augmentation or augmentation mammaplasty?
A) As Dr. Trott tells all of her patients, everyone is different. It is putting the implant under the muscle that is the uncomfortable part of the procedure, and this is tolerated differently in everyone. Some women are sore for a couple days while others feel no discomfort. Dr. Trott recommends taking a week off work and taking it easy for that week to be on the safe side. You will first wear a special surgical support bra for that time and then you can switch to a more attractive support bra of your choice. You should not wear underwire for six months, so the Victoria’s Secret Wireless Ipex™ is a good choice. If you are just having a lift without an implant, you should still take the week off, but you will have less discomfort since there is no muscle work involved.
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