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Charles A. Messa, III, MD, FACS

Advances in Breast Augmentation

Posted August 15, 2013 in Uncategorized

By Charles A. Messa, III, M.D., F.A.C.S.

Each woman who considers breast enhancement is a unique individual with personal appearance goals for surgery and her desired aesthetic appearance.  This individuality demands a broad range of breast implant options including varying shapes, types, projections and textures.  Since the invention of silicone breast implants in 1962, there have been significant advances in implant manufacturing, preoperative planning and surgical techniques.  As a result, 316,848 breast augmentations were performed last year making this procedure the second most popular plastic surgery sought by female patients according to the American Society for Aesthetic Plastic Surgery. Of the breast enlargement procedures performed, 70 percent of them used silicone implants rather than saline.

The old adage “bigger is better” doesn’t universally apply to breast size.  In order to achieve the ideal aesthetic result, it’s imperative that each patient is thoroughly evaluated pre-operatively with regard to desired outcome including cup size, upper pole fullness, cleavage and shape.  Proper assessment of base width, tissue stretch, and nipple to fold measurements must be taken into consideration.  It’s the balance between desired outcome and individual anatomy that ensures the best results.  Surgical planning should be based on the patient’s goals, the dimensions of their breast and body and their tissue characteristics.

In 2006, the FDA approved a new type of cohesive silicone gel implant, different from the previously manufactured Dow Corning implants in the composition of the gel, making it softer and less likely to leak, rupture or become encapsulated.  Today there are three FDA approved silicone implant manufacturers:  Mentor (memory gel). Allergan (Natrelle) and, most recently, Sientra.  Each of these implants has a different diameter and projection, and each offers various profiles (low, moderate-plus, high) as well as shapes.  With all of these variations, implant selection should be individualized, based on the patient’s desired outcome and body type.

The technique used to create the space for the breast implant has improved over the past several years as well.  Utilizing meticulous dissection under direction vision decreases trauma to surrounding breast tissue and muscle.  Previously, the space or ‘pocket’ was dissected bluntly.  This more careful operative technique results in less bleeding, less post-operative pain, a quicker recovery, and theoretically, a lower rate of capsular contracture with less blood and inflammation around the implant surface.  Smaller incisions can be used for insertion of the implant as well with the development of the Keller Funnel ™.  This device is a disposable, FDA approved, cone-shaped funnel with a special hydrophilic interior coating that allows the implant to be placed in the pocket using a ‘no-touch’ technique with less trauma to the breast and implant.

Plastic surgery is a combination of art, science, and surgery.  Techniques and materials utilized need to be continually evaluated and enhanced to ensure the optimal outcome for each patient.  Current trends in aesthetic surgery are focused on the use of autologous fat to reverse the signs of aging.  Similarly, fat grafting and lipo-augmentation procedures have been utilized for breast enhancement, both enlargement and reconstruction.  The effects of transplanted fat on mammography and potential breast cancer detection are still being studied, as the technique for breast enlargement with fat is improved.

For now, the cohesive, and soon-to-be available form-stable, highly cohesive silicone gel implants are a safe and effective way to enhance the appearance of a woman’s breast.

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