Breast Augmentation

What's it like to get a breast augmentation...

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Dr. Silberblatt offers a complete range of breast procedures and services. To learn more about a particular procedure, click on a topic below:

Breast Augmentation

Breast augmentation is a surgical procedure used to increase the size and/or alter the shape of a woman's breasts through the use of an artificial implant. Women may choose to have this operation either as a reconstructive technique following breast surgery, to balance different sized breasts, or to enhance the contours of the body. Whatever the specific purpose, women who undergo breast augmentation can expect larger, firmer, and more visually satisfying breasts.


(click image to enlarge)

Breast augmentation surgery begins with an incision, made either in the crease of the breast, the armpit, or the perimeter of the areola (the dark skin surrounding the nipple). The placement of the incision will vary according to body type and the specifics of each procedure. Dr. Silberblatt enters through the incision and creates a pocket, either underneath the breast tissue or under the chest wall muscle. The implant is placed in either location, centered directly behind the nipple. Finally, the original incision is sutured.


(click image to enlarge)

Once the incisions have been closed and taped, the breasts are wrapped and supported by a gauze bandage. Patients are fitted with a surgical bra that provides support for up to several weeks. Postoperative fatigue, soreness, and discomfort may be greatly reduced through medication. Swelling gradually subsides and becomes undetectable in a month's time. Stitches are removed within seven to ten days.

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Breast Asymmetry

No woman who has two breasts that are exactly equal in size and shape. However, if your breasts are dissimilar enough for the difference to be noticeable in clothes, then the insertion of different sized implants can be helpful in both enlarging the breasts and minimizing size differences. The best way that Dr. Silberblatt has found to do this is to use implants that can be adjusted after surgery. A special valve is left under the skin through which saline can be injected or removed as desired. A patient can thus decide just how large she wants each breast to be (within the confines of the limits for the chosen implant). The most common disadvantages in using these implants are that the valve must eventually be removed (under local anesthesia and at a minimal added cost) and the possibility of mechanical problems with the valve (punctures, valve migration, etc.). Complications of this nature are rare and most patients have been very happy with the results. The ability to have some control over the ultimate size of each breast is important for many patients.

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Breast Reduction

Breast reduction surgery almost always helps women with their back, neck and shoulder pain, provided that the weight of her breasts is indeed the cause of these ailments. Medical insurance usually does cover this procedure although recent trends in managed care have made pre-approval more difficult. Self-serving insurance companies find breast reduction an easy a procedure to deny as cosmetic. It is not cosmetic when more than a pound of tissue is removed from each side.

Over the last 15 years European and South American plastic surgeons have developed ways to try and limit the amount of scarring after a breast reduction. The typical operation done for the past 40 years leaves a scar that extends from the middle of the chest, under the breast to the underarm and from the middle of this scar up to and around the areola (an inverted T). The modified operations leaves a scar only around the areola and can extend it down to the fold under the breast if needed. These new operations also seem to preserve more sensation to the breast, maintain a better blood supply to the nipple and are similar in reliability for keeping nipple sensation and the potential for nursing. These operations can be done on any sized breast and can also be used to lift sagging breasts. Occasionally, in very large, pendulous breasts, an additional small transverse scar under the breast will be necessary later but the scarring is still markedly less that with the older operation.

Patients undergoing this surgery are among the happiest of all of Dr. Silberblatt's patients with the results. Unfortunately, since the procedure takes between three and four hours to do, the costs are substantial. Operating room, anesthesia and surgeon charges come to at least $8000, sometimes more.

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Breast Reconstruction

Although removal of a cancerous tumor and irradiation of the breast is an option for some women, removal of the entire breast is still necessary in many cases. An important part of recovery for many women is the reconstruction of their operated breast. Placement of a balloon type device under the muscle and skin followed by filling of the implant once a week for about 10 weeks and subsequent replacement of this balloon with a final implant is one method of reconstructing a breast. It has the advantage of being done as an outpatient in two operations each of less than an hour’s duration. It's disadvantages are that filling and stretching of the skin take over two months and the implant can sometimes become hard and not match the other side too well.

The other major option is to use the fat of the tummy under the belly button to recreate the breast mound. The major advantage is that there is no implant and the fat looks and is shaped more like the opposite breast. The major disadvantages include a much longer operative time (usually four hours or more), hospitalization of a few days, a longer recovery time and possible problems such as hernias and lumps from fat necrosis. Nevertheless, this is the option that, when available, will usually provide the best appearing reconstructed breast.

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Q:
A few years ago, breast enlargement was considered dangerous by the FDA. Now it seems that many more women are having it done. I am interested myself but am concerned that there may be unknown dangers. Where do things stand at present?

A: In the early 1990s, a number of women who had had poor outcomes from breast enlargement surgery were featured on national TV and their stories widely publicized. A few physicians purported to have supporting scientific data and a number of attorneys jumped at the opportunity to push the matter into the courts. Because implants had reached the market before some of the current FDA regulations had been written, there was little research available to convincingly support or deny these claims. As a result, certain restrictions on the use and sale of implants were placed until more research could be done. Many construed this to be a verification of the allegations. Some women with implants panicked and had them unnecessarily removed. The number of new patients plummeted and the manufacture of implants, predominantly a US industry, shifted to other countries. Jurors throughout the US gave multimillion-dollar awards to patients complaining of a wide variety of symptoms, which they attributed to the silicone in their implants. These will eternally remain shining examples of miscarried justice.

In the past five years the results of many well controlled studies with large numbers of patients researched by a wide variety of specialists have been reported. All have failed to find ANY connection between silicone and other diseases. The reports furnished by the self appointed “experts” suggesting that silicone was at fault have been debunked as “junk science.” Silicone remains as one of the safest substances that is commonly implanted. No operation is 100% safe and breast augmentation carries many of the same risks and dangers of other common operations. However, breast augmentation continues to enjoy a 96% satisfaction rate, one of the highest. I have hundreds of patients with implants for many years whose quality of life has been immeasurably improved and would have the surgery done again in a heartbeat knowing what they know now.

 


Q:
What kind of scars should I expect from a breast enlargement?

A: Incisions for a breast enlargement can be made under the breast, half way around the areola or under the arm. The incisions are usually about an inch and a half in length and heal well. They are not normally visible when wearing a bikini top. There are some surgeons that use special instruments to do the surgery through an incision in the belly button but I am dissatisfied with the results that I have seen presented at meetings using this approach and have not offered it.

If there is drooping of the breasts, then it might be necessary to remove the extra skin in order to lift the breast to make look better after enlarging it. In this case, the scar would be around the areola and possibly a straight line extending down as well. This may be more scarring than some patients would want so it is important to determine if there is too much skin for a simple enlargement. Most scars from breast enlargement surgery heal very well and patients are rarely dissatisfied with them.


 
 

 

 

 

 

 

 

 

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