Breast augmentation adds volume to the breast with a breast implant or prosthesis to increase fullness and create better balance with the rest of your figure. Your clothing options will expand tremendously, and you'll be comfortable wearing many types of clothing you were uncomfortable wearing before.

There are different types of breast implants available, and three different approaches for augmentation. The small incision can be placed under the breast, at the edge of the nipple-areola, or in a skin fold in the armpit.

There is no single best type of implant and approach for every augmentation. Breasts are extremely different, and different approaches give the best results in certain breasts.

Before and After Photos

Why Are Breasts Small?
Inadequate breast size usually results from one of two causes:
-Lack of development of breast size during puberty
-Loss of breast fullness following pregnancy.

How Pregnancy Affects The Breast
During pregnancy, breast enlargement occurs and stretches the skin envelope of the breast. When pregnancy and nursing are over, the tissue within the breast involutes or shrinks, usually to a size smaller than it was originally. The skin, however, remains slightly stretched, and the smaller fill tissue falls to the bottom of the stretched skin envelope. The result is usually a breast with somewhat loose skin, with the breast tissue in the lower part of the breast, and an empty upper breast.

How Much Can The Breast Be Enlarged?
How much a breast can be enlarged depends on the degree of stretching of the skin envelopes and your desires regarding breast size. For example, if you have never been pregnant, and have a very small A cup breast, your skin may be very tight. Dr. Smith can expand the skin during surgery to a certain degree but there are limits to the size of an implant that the tight skin will accept.

There are also limits to how the breast shape can be changed with surgery. For example, Dr. Smith can narrow the distance between the breasts and produce more fullness or cleavage, however if the breasts are widely separated, they may tend to separate after surgery especially when you lie down.

Understanding Desires And Making Choices
At your consultation, Dr. Smith will discuss your preferences regarding breast size, incision location, and most importantly exactly how you'd like your breast to look. After examining you, he will recommend a range of options for implant type and size, and incision location that will be best for your breast and balance with the rest of your figure. He will always honor your choices of alternatives if he can achieve an esthetic appearance using your choices.

Before and After Photos

Breast Implants and Breast Cancer:

How The Body Responds To Implants
Breast implants do not cause breast cancer. Excellent scientific studies indicate that breast cancer occurs in about ten percent of women, regardless of whether they have had breast augmentation.

Breast Implants And Mammography
Breast implants may make a mammogram somewhat more difficult to read. This does not mean that a mammogram can't be adequately read, simply that the mammograms must be performed and read by someone experienced in the proper techniques. When a breast implant is present, the breast tissue should be pulled forward in front of the implant before compressing the breast for a mammogram. This maneuver, combined with additional views of the breast if necessary, allows optimal visualization of the breast tissue if you have implants.

Differences Between Breasts
Differences always exist between your two breasts - they are different sizes, and the nipple locations are also different. After breast augmentation these differences will be less, but will always exist to some degree.

Reliability Of Implants
Breast implants are mechanical devices which are manufactured to extremely high standards, and we use only those implants which Dr. Smith feels are thoroughly tested. The FDA has limited the use of the silicon gel implant since 1992, however saline-filled implants are widely available and function very well for esthetic improvement in the shape and size of the breast. Silicon gel or combination implants, (saline and silicon) may be used for reconstruction of the breast and in other special situations, however the vast majority of implants placed for cosmetic purposes are saline-filled implants.

When any implant is placed in your body, the body forms a lining or capsule around it. This capsule is similar in some ways to scar tissue and can shrink or contract. If it contracts markedly and squeezes on your implant, it can distort the implant or make the breast feel too firm. There are several techniques to decrease the likelihood of developing hardness such as placing the implant under the pectoralis major muscle on the chest, but so far the risk cannot be totally eliminated since it is the result of your normal healing mechanism.

Can Implants Break? What Happens?
Breast implants should not be considered lifetime devices. Like any mechanical or medical device it will eventually wear out and need to be replaced. Usually, failure or leakage is due to folds occurring with normal motion and wearing of the outer shell. This is more likely to occur following development of hardness due to capsule contracture. Your breast should never be squeezed in an attempt to correct hardness, as this risks breaking the implant. If an implant is ruptured, saline which is your body's natural salt water, will be absorbed even many years after placement and you will become aware of the loss of volume of the breast. When this occurs you will need to return to Dr. Smith's office and have the implants replaced. Silicon gel implants that rupture may remain contained in the surrounding capsule and pose no problem, or it can occasionally escape into the surrounding breast tissue and cause a reaction producing a mass you can feel. If that occurs, we would do a mammogram, and if implant rupture can be confirmed, remove the implant and any silicon and replace it with a new implant. Saline implants should last from 8 to 12 years and carry a warranty for lifetime replacement. Other warranty information will be given at the time of the consultation.

Risks
Other risks common to all surgical procedures such as bleeding, infection and scar tissue formation occur in a very small percentage of cases. Bleeding or infection occur in only 1-3% of cases, but may require another procedure for correction. Infection may necessitate temporary implant removal and subsequent replacement. We will give you more detailed information about these and other rare risks in our written information, and encourage you to discuss any which concern you during your consultation.

Before and After Photos

The Operation
The incision for breast augmentation may be placed in the fold beneath the breast, around the areola, or in the hollow of the armpit, depending on the type and size of implant to be used and your preferences. In any of these locations, very meticulous closure of the incision minimizes the visibility of the scar and maximizes its quality. Dr. Smith will discuss your preferences about incision location with you.

Breast implants are placed either behind the breast tissue or partially behind the pectoralis muscle on the chest wall. Dr. Smith will discuss the best option depending on your preferences and the best option for your specific breast type. In either case, your breast tissue is located in front of the implant where it can be readily examined.

A pocket is created behind the breast to receive the breast implant.

After final implant placement and position is achieved, Dr. Smith will spend considerable time precisely closing your incisions to achieve the best possible scar result.

Recovery
All of your incisions will be carefully closed with stitches placed beneath the skin, so there's no chance of your having "railroad track" type marks but rather very fine line scars. You'll be able to shower or bathe immediately. A suture will be removed in approximately one week by gently pulling and having it slide out. Very little discomfort is associated with suture removal. Following breast augmentation procedures, most patients have very little pain, but rather experience nuisances or discomfort such as tightness or fullness.

Your breasts will feel very tight to you for 48-72 hours, and the tightness will gradually resolve over the next several days as the swelling decreases. You may develop slight bruising beneath the breasts a day or two after surgery which will resolve in about a week.
You may have a moderate feeling of soreness for which we'll prescribe medication. Most patients require medication for several days only.

Before and After Photos

The Stages Of Recovery
Our patients usually want to know about four stages of recovery: hospitalization time, when swelling or bruising is resolved, when they'll be able to return to work or social activity, and when they can return to full aerobic or strenuous exercise.

For breast augmentation procedures, the average...

Aerobic or strenuous activity: 2-3 weeks
We encourage immediate return to full normal activity immediately. Just don't do any type of strenuous exercise that would push your pulse over 100 for about two to three weeks. Any aerobic activity that increases your pulse over 100 also increases your blood pressure, and could make you bleed.