The Breast Enhancement Institute^TM
What you want to know about breast augmentations:

A brief note on "Where to Start":

Below are some common questions

Where is the breast implant placed...under the muscle, or breast gland?

What are my incision choices?

Can breast augmentation affect my ability to breast feed?

Can breast augmentation affect the "feeling" in my breast?

What is in the future for Breast Augmentation?

How do I choose the right size implant?

1. Where is the breast implant placed...under the muscle, or breast gland?

When performing the breast augmentation a breast implant is placed within your breast tissue through a small incision that is usually either in the bottom breast fold, around the lower half of the areola-nipple area, or in the armpit (axilla).

The implant itself is placed in a space, or “pocket” that is created either under the breast gland, or the "pocket" may be even deeper-under the chest muscle (called the pectoralis major).

Although we perform the procedure by placing the implant in either of the two positions, the majority of cases our patients have decided to have the implant placed under the pectoralis muscle. The benefit of this under-the-muscle position is believed by many plastic surgeons multi-factorial. By having the muscle overlying the implant it offers more of one’s own tissue covering the implant thus allowing for a more natural feel to the breast- especially when choosing saline-filled implants.

In addition, by the effect of the chest muscle’s own natural contraction it produces a massaging benefit on the underlying implant- this is believed to help in minimizing the incidence of capsular contracture formation around the implant. Another advantage is that many Radiologists prefer to have the implant under the muscle because it makes it easier for them to isolate the actual breast tissue- and thus better read the mammogram
.

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2.What are my incision choices?

With regards to the location of the incison the choices are made with the goal to have the most discretely placed incision that is right for you. Here are some of the nuances.

The three common incisions are under the arm, around the nipple, or within the inferior breast fold. These are referred to as the transaxillary, peri-areolar, and inframamary fold incisions respectfully.

The transaxillary incision under the arm often requires the pocket to be made with the aide of extended length instruments and often a camera is needed. There are some sensory nerves in this area that can be injured, and thus resulting in persistant numbness or chronic pain. The plastic surgery literature shows a higher incidence of revision, or corrective surgery with this approach. And many times, as with the TUBA ("belly-button") technique the only way to correct some assymetry that may result is with using one of the more traditional incisions- such as at the inframammary fold (IMF).

The peri-areolar incision is commonly placed in the lower half of the areola, just at its border with the skin. This incision has a higher incidence of potentially affecting breast feeding.

The inframammry fold incision (IMF) is hidden beneath the breast unless one is lying back, or raising their arm. It allows the surgeon the most direct access in creating the "pocket" and positioning/seating the implant.

Sometimes of our patients have requested an incision through the "belly button", or TUBA (transumbilical breast augmentation). We feel that it our responsibility to let them know that this approach may have a higher need for later touch-ups, or corrective surgery, and it may invalidate the manufacturer's warranty. This technique is not available with silicon-filled implants.

With regards to possible changes in sensation in the breast all incisions have a similar low potential. In most cases the changes in sensation to the breast, or nipple area, are temporary. However if a patient expresses a strong concerned that they may lose, or have a change in the sensitivity, Dr. Maggi strongly recommends to avoid breast enhancement surgery.

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3. Can breast augmentation affect my ability to breast feed?

Yes, it can.

We tell all our prospective patients that the surgery may affect their ability to breast feed. If the ability to breast feed is critical to a patient then Dr. Maggi will not recommend they have the surgery, or at least wait until after they are done having children. Although the likelihood is relatively low of this happening no one can guarantee that it has a zero percent possibility.

Additionally, some incisions- as in the periaereolar incision- have a higher incidence of this potential problem. Of the other incisions no relationship has been found.

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4. Can breast augmentation affect the "feeling" in my breast?

Yes, it can.

With regards to possible changes in sensation in the breast all incisions have a similar low potential. In most cases the changes to sensation to the breast, or nipple area, are temporary. However cases of permanent changes to sensation have occured. If a patient expresses a strong concern that they may lose, or have a change in the sensitivity, Dr. Maggi strongly recommends to avoid breast enhancement surgery.

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5.What is in the future for Breast Augmentation?

Although there are currently many very good options available to the cosmetic breast surgery patient, much research is taking place in alternative types of breast implants. This is particularly true with regards to the fill material for the breast implants.

Additionally, clinical research is being done studying the role of using one’s own fat tissue and injecting it directly into the breast for augmentation purposes. However, due to the potential significant complications this may produce this procedure is not expected to be available any time soon.

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6. How do I choose the right size implant?

Choosing the right breast implant size is a rather important decision. The best way to achieve a size you will be happy with is good communication with Dr. Maggi.

One would think that breast implant sizing would be simple, that you can just ask for a C cup sized implant and be done with it. But breast implants do not come in cup sizes but are measured in terms of cubic centimeters (CC's). To further complicate matters the final result in terms of breast size is a combination of how much breast tissue you have plus the volume of the implant. So you can imagine that three women with three different sized breasts who all get the same sized implants will end up with three different sized breasts.

There are other considerations as well such as the shape of the size of your rib cage, chest wall and the specific type of implant that will be best suited for you. Most implants come in different styles that determine how much the implants protrudes from the chest wall. These are usually called something like standard, moderate, and high profile.

You can get a headstart (and help Dr. Maggi) by trying your own sizing experiment at home... The rice test is an experiment you can do at home to get a rough idea of what size implant you will feel comfortable with.

Ideally you should have a bra that is about the size you want to be. Then you need uncooked rice and a few zip lock bags to put the rice in. Some prefer to put the rice in the toe of an old nylon stocking because it is more comfortable and moldable when placed into a bra.

Start with a half a cup of rice in each bag and place them in your bra. Try some clothes on and see how you look. See if that size fits you in different clothes and is comfortable with your lifestyle. Not big enough add more rice. Too big take some out. We recommend trying the experiment until you find out how much is clearly too little, and clearly too much.

One cup of rice is about 237 cc. You should know that on average each increase in cup size is 189 cc. So 1 cup of rice = 237 cc = 1.25 cup sizes. Once you settle on an amount of rice (or at least a range), write the number to you can bring that information to your consultation to discuss with Dr. Maggi.

When you come for your consultation you should bring a bra that is about the size you want to be and a fitted shirt or or sweater. At the consultation I will have you try what are called sizing implants (basically breast implants) that you can place into your bra and look at yourself in mirror and see what you think. We can discuss how you feel about the various sizers your try and come to a consensus that you are comfortable with.

For Other Common Questions Regarding:

- Breast Implants (please click here).

- Breast Lift Procedure (please click here).