What is Breast Augmentation?

Breast Augmentation is a surgical procedure to enlarge small breasts, underdeveloped breasts, or breasts that have lost their fullness after pregnancy. The problem of underdeveloped breasts may have significant personal, psychological, and social impacts. Once the breasts have been enlarged, you may enjoy the benefits of a balanced figure, thus facilitating the fitting of blouses, bathing suits, and other attire.

Breast implant surgery was first performed in 1962. Breast implants were invented the year before by Dr. Thomas Cronin and Dr. Frank Gerow in 1961. Since that time, breast implants and the surgical technique have evolved to become a safe, reliable, and aesthetically pleasing procedure.

Am I a Good Candidate for Breast Augmentation?

Breast augmentation is a great procedure for improving one’s self-esteem.
Good candidates for breast augmentation include:

Feel your breasts are small and underdeveloped
Have asymmetries between the size of your breasts
Desire a better proportion between your upper and lower body
Are unhappy with your breasts losing shape and volume after pregnancy and breastfeeding, weight loss and aging
Want to lift the breast or nipple which are low or sagging
Would like your bras and clothes to fit better
Would like to improve your appearance in your bathing suit and clothes
Would like to improve your self-esteem and feel more comfortable with your body
You are in good health.

Are Smokers Candidates for a Breast Augmentation Surgery?

Smokers are candidates for breast augmentation surgery. However, smokers have a higher risk of infections and wound healing problems which may lead to breast implant exposure, infection, and subsequent breast implant removal. Thus, it is recommended that you stop smoking 6 weeks prior to your breast augmentation surgery and six weeks after breast augmentation.

Who is Not a Good Candidate for Breast Augmentation?

You are not a good candidate for breast augmentation if:

You are pregnant or breastfeeding.
You have breast cancer or an abnormal mammogram.
You are sick or have an infection.
You have unrealistic expectations or doing this for another person’s benefit.

How Old Do I Need to Be to Have a Breast Augmentation?

Currently, the FDA requires you to be 18 years old to have saline breast implants and 22 years old to have gel breast implants.

Does the FDA have any Requirements or Recommendations for those getting Gel Implants?

The FDA currently recommends that individuals who get gel breast implants have an MRI 3 years after having breast augmentation surgery and every 2 years after that. This is to determine the physical characteristics of the implant and to tell if it is ruptured. There are no FDA recommendations for saline implants.

The FDA does not consider breast implants to be a permanent device. The lifespan of breast implants varies from patient to patient and on the style of the breast implant.

How Do I Pick My Breast Implant Size?

One of the most miscommunicated aspects of breast enlargement surgery between the patient and the surgeon is the size of the breast implant. Implants are based on cubic centimeters (cc). One of the best methods to determine the size of the breast implant you would like is to use the Rice Test which is described below. The rice conforms to your natural breast thus allowing for a better breast implant sizing. Another option is to use a zip-lock bag and water. One fills the bag with water and places it in the sports bra. Water is added or removed until the desired size is achieved. The water is measured in a measuring cup. One ounce of water is equal to 30cc of water. It is wise to add 10 to the final volume to allow for changes that take place after surgery. During your preoperative visit, Dr. DeConti will take several measurements of your chest and breast to help determine your optimal breast implant size. You will also be able to use breast implant sizers placed in a sports bra to help you accurately determine the size breast implant you would like.

What is the “Rice Test”?

The Rice Test is a method to accurately determine the breast implant size you would like. In order to perform the Rice Test, first purchase a sports bra the size you desire to wear. You then fill a plastic bag with rice and place it in the bra. The rice will mold to the contour of your breasts. Rice is added or removed until the desired size is achieved. The rice is then measured. One cup of rice equals 250cc and two cups equal 500cc. It is wise to add 10 to 15% to the final figure to allow for the changes seen with surgery. Thus, if you liked the look achieved with 300cc of rice, then you should ask for a 330-345cc implant.

How Is a Breast Augmentation Performed?

Dr. DeConti has over two decades of experience in the placement of thousands of breast implants. He posses a meticulous technique and uses a ‘No Touch’ and ‘Minimal Tissue Trauma’ technique to help minimize infection, postoperative pain, and bruising. Dr. DeConti has extensive experience in the placement of larger volume implants as well as the correction of complications associated with breast augmentation procedures.

Breast Augmentation takes about forty minutes and you are placed under general anesthesia for optimum management and comfort. The procedure is performed in an accredited, private surgery center with an anesthesiologist. Dr. DeConti will meet with you and mark the location of your incisions and the breast pocket for your implants while standing. You will then be taken back to the operating room suite.

The anesthesiologist and nurse anesthetist will then gently put you to sleep with an LMA. After you are asleep, you will be prepped with a skin cleanser and sterilely draped. The incisions are then marked. The breasts and incisions are then infiltrated with a Xylocaine and Marcan mixture to help with postoperative pain control. Epinephrine is also used to help maximize the effect of the Xylocaine and Marcan and minimize postoperative bruising.

Dr. DeConti uses three types of incisions: inframammary, trans-axillary, and periareolar, for breast augmentation depending on your preference. If an inframammary incision is chosen, it is usually less than one inch in length. If saline implants are used they can be rolled up like a ‘cigar’ smaller than their actual size, placed in the breast pocket, then unrolled and inflated with saline. The incision will be larger with silicone gel implants because they cannot be compressed and made smaller. A Keller Funnel is used to help insert gel breast implants through a smaller incision. Inframammary incisions are associated with a lower risk of nipple sensation loss because it is less likely to cut the nerves to the breast and nipple.

If you choose a trans-axillary incision, Dr. DeConti has additional experience and training to place breast implants with the Endoscopic Camera System. Traditionally surgeons have dissected the pocket bluntly and blindly with a long instrument because of the distance from the armpit to the implant pocket under the nipple. This can lead to an increased risk of complications including bleeding, malposition, and bottoming out. The endoscopic camera system allows the implant pocket to be dissected under direct vision which minimizes bleeding and tissue damage, and over dissection of the pocket, thus effectively decreasing postoperative complications. It also allows visualization of placement of the implant for accuracy.

The periareolar incision is mainly used when you require a breast lift. Since this incision is on the front of your breast around your nipple, it is more visible than the inframammary or trans-axillary incision. It is also associated with a higher incidence of infection. This is because it cuts through ducts that have bacteria in them, thus causing infection.

Once the incisions are made, the pocket is created. The majority of implants are placed under the pectoralis muscle. This helps to give them greater tissue coverage so they appear more natural, may decrease the risk of rippling by producing a constant mild compression on the implant, and make reading mammograms easier due to the additional tissue plane between the implant and the breast. Implants may be placed on top of the muscle to prevent movement with the contraction of the pectoralis muscle. However, implants placed on top of the muscle have a higher incidence of palpable and visible rippling. Also, breast implants are more easily felt when they are on top of the muscle.

After the pocket is dissected, the inner inferior portion of the pectoralis muscle is released. This prevents the contraction of the pectoralis muscle from pushing on the implant and moving it down and towards the side of the chest. It helps prevent Bottoming Out. This is especially important in trans-axillary augmentation, which has a greater risk for this displacement. It should be noted that only a small portion of the muscle is released and it does not interfere or change one’s strength, shape, or function or cause malposition or bottoming out. The pocket is then irrigated with saline and visualized for bleeding, which is controlled. Triple antibiotic solution is then used to irrigate the pocket to help prevent infection.

Dr. DeConti uses smooth, round, saline or gel implants. He uses both Allergan and Mentor breast implants. You choose your breast implant style during your preoperative visit based on your personal desires.

The breast implant is opened and utilizing the ‘No Touch’ technique is rolled and inserted through the less than one-inch incision into the subpectoral pocket. The breast implant is not allowed to touch anything including your skin to help minimize any risk of infection. After being inserted, it is inflated with saline to the manufactures recommended fill volume using a closed technique.

The tissues are then released to allow redraping of the skin over the breast implant. After the opposite side is completed in a similar manner, you are visualized in both a sitting and lying down position to check for proper breast implant placement and orientation.

The incisions are then closed with a deep layer of absorbable sutures. A second layer of absorbable suture is used to close the deep dermis, and a final third layer of absorbable suture is used to close the dermis just under the skin. There are no exposed sutures to be seen or to be removed. Small butterfly tape dressings are placed over the incision.

You are visualized one last time in the sitting and lying down position to make sure the breast implants are symmetric and in the proper position. A gauze dressing is then placed over the incisions. You are gently awakened from the anesthesia and taken to the recovery room. You will be in the recovery room for about one hour.

How are saline breast implants filled?

After the incision is made, all air is removed from the implant and it is rolled up like a cigar. This significantly decreases the size of the implant, thus allowing the use of a smaller incision as compared to the incision used for a gel implant. It is then placed through the incision into the new breast pocket and unrolled. A silicone sleeve may be used to protect the implant during insertion. A hollow-fill tube has been connected to the valve of the implant. The other end is connected to a syringe or Fill Kit. The syringe is then disconnected from the tube, filled with saline, reconnected to the tube, and the saline is injected into the implant. This step is repeated until the desired volume is achieved. This is considered an ‘open technique’ since the saline comes in contact with air. This may increase the risk of implant contamination or infection. The fill tube is removed from the implant and the valve is closed.
The Fill Kit technique is a ‘closed system’. The Fill Kit is connected directly to the saline bag with IV tubing and the kit has a special one-way valve. This allows the saline to be injected directly from the saline bag into the implant without being exposed to air. This may have the theoretical benefit of decreasing the risk of implant contamination or infection.

Where is the Procedure Performed?

Breast augmentation is performed on an outpatient basis at an outpatient surgery center. The operation is done under general anesthesia. Breast augmentation surgical time is usually less than 1 hour.

What Should I Expect During My Breast Augmentation Recovery?

After the procedure, you will be wearing a special dressing placed by Dr. DeConti. You will have medication to help with any nausea or discomfort you experience after the procedure. The discomfort is mainly due to the implants being placed under the muscle. The implants stretch the muscle which feels like a dull muscle pain on the chest. Dr. DeConti does perform a nerve block which helps with the discomfort. The majority of Dr. DeConti’s patients state the discomfort is not as bad as they had thought since he performs a nerve block to minimize any discomfort. The breasts will have swelling which will improve over the next few weeks. You will be able to move your arms around and above your head. Dr. DeConti recommends limited activity for the first few days after the procedure and lifting no more than a magazine or book.

At your first postoperative visit, your dressing will be removed. Your breasts will be swollen and the implants may appear “high”. They will gradually “drop” over the next few weeks to months. Due to Dr. DeConti’s experience and meticulous “no-Touch” technique, there will be essentially no bruising. You will be able to shower and gradually increase your activity. You will then wear a soft camisole or sports bra. The stitches are placed under the skin and are dissolvable. Thus, there are no stitches to be removed. You can usually return to work in a week. Strenuous activity is limited for four weeks. Massage therapy may be started after two weeks if needed. You will then be followed regularly by Dr. DeConti for the next year.

What are the Complications and Risks of Breast Augmentation?

Breast augmentation is very safe and has a very high satisfaction rate. Rarely, one may experience complications after breast implant surgery.

Breast augmentation risks and complications include:

Bleeding
Infection
Breast and implant asymmetry
Capsular contracture. This is scar tissue that can tighten around the implant. This can range from being imperceptible to increased firmness in the breast.
Changes in nipple sensation.
Implant rupture
Implant malposition including Bottoming Out, Double Bubble, Uniboob, and Symmastia.
Scars may widen or thicken.
BIA-ALCL Breast Implant-Associated Anaplastic Large Cell Lymphoma

In order to decrease your risks of surgery Dr. DeConti performs all surgeries:

In a highly accredited out-patient surgery center accredited at the same level as the hospital.
With a Board Certified Anesthesiologist and Board Certified Nurse Anesthetist to ensure the safest anesthesia.
With the same preop, postop, and operating room team members who understand the procedures, instruments, and Dr. DeConti’s routine in order to provide the safest and most personalized care.

All patients are followed closely after surgery to ensure a safe and speedy recovery with the most optimum results.

Will I be able to Breastfeed after Breast Augmentation Surgery?

The majority of females can breast-feed after breast augmentation surgery. The inframammary and transaxillary incisions cause the least amount of trauma to the breast nerves and ducts.

According to a study in the December 2016 issue of Plastic and Reconstructive Surgery, the authors found a high percentage of woman with breast implants achieved breastfeeding.

The prospective cohort study compared breastfeeding in 100 patients with breast implants to 100 patients without breast implants. The study found that 93% of patients with breast implants could successfully breastfeed their babies versus 99% of patients without breast implants could successfully breastfeed. There were no statistical differences between the two groups.

Does Breast Augmentation Increase the Risk of Breast Cancer?

There is no evidence that breast implants increase the risk of breast cancer. In fact, studies have shown there is less risk of breast cancer in patients who have undergone breast augmentation than the general population. This is most likely due to breast augmentation patients have less breast tissue to begin with, thus fewer breast cells which can later form breast cancer.

Will There Be Scarring and What Will My Breast Augmentation Scars Look Like?

Dr. DeConti uses the most delicate and meticulous technique to prevent and minimize scar formation. However, anytime the skin is cut, you will heal with a scar. Since the scars are placed in natural tissue lines, inframammary, periareolar, and transaxillary, they should heal as a fine white line. Initially, the scar will have a pink color and may be raised. It then gradually fades and flattens to a white scar over a year. If you elect to use saline breast implants the scars will be about an inch in length. Placement of Gel breast implants will require about a three-inch scar.

What can I do to limit breast augmentation scar formation?

Avoiding smoking for several weeks before and after your procedure
Stay out of the sun and wear sunscreen to protect the incisions
Eat nutritious foods and drink plenty of water during recovery
Follow Dr. DeConti’s physical activity guidelines after breast augmentation

What are my options if I do form bad scars?

The following are options to help reduce breast augmentation scar formation;

Mederma or Scarguard
Silicone gel sheeting
Laser skin resurfacing
IPL treatments

How Much is a Breast Augmentation?

The average breast augmentation cost in Virginia is $5500 to $8000. This breast augmentation cost includes the operating room, anesthesia, breast implant, and procedure fees. There is an additional fee if you have a breast lift and augmentation. Cohesive silicone gel implants, i.e gummy bear implants, cost more than saline implants. DeConti Plastic Surgery does offer breast augmentation financing through CareCredit.

What is Mondor’s Cord or Mondor’s Disease?

Mondor’s Cord or Mondor’s /Disease is a spontaneous thrombophlebitis of the superficial veins of the breast, anterior chest wall, and abdomen. It occurs in 1 to 2 percent of breast augment patients, and is self-limiting. It usually involves a vein extending from the inframammary breast crease to the upper abdomen. It looks and feels like a cord. It poses no danger of systemic embolization. It will resolve without treatment in several weeks. Warm compresses and non-steroidal anti-inflammatory agents can be used for symptomatic relief.

What are the Effects of Pregnancy on Breast Augmentation?

The breasts will initially engorge or swell as they normally do with any pregnancy. They will become more firm as they fill with milk. The areola complex will also get larger and become darker. One may be able to visualize more vessels in the skin, especially veins, as well as stretch marks. Breastfeeding may also contribute to these changes. After the pregnancy and/or breastfeeding, the breasts will lose their volume. They may return to their pre-pregnancy state. However, if they lose a significant amount of volume, the breast tissue and skin may stretch and sag. This may make the implants also sag and rest too low on the chest wall. If the implants remain in their original position, then only the nipples and breast tissue may sag down over the implant. This causes the nipple to be too low in relation to the implant causing a ‘snoopy dog’ deformity. These situations may require either replacement with a larger implant or a breast lift procedure.

Dr. DeConti’s Experience with Breast Augmentation

Dr. DeConti is considered one of the best breast augmentation surgeons and has over 30 years of experience. He has performed over 6000 breast augmentation procedures. As a highly credentialed surgeon with the American Board of Plastic Surgery and specialized training in Cosmetic Breast Surgery and Body Contouring, he is an expert in the intimate details of breast and body anatomy. This knowledge allows Dr. DeConti to perform breast and body cosmetic surgery for the finest and most optimum results with the least amount of risk.

Contact Us to Learn More About Breast Augmentation

To learn more about how Breast Implants and Breast Augmentation can help you look your best, call 804 673-8000 and schedule a consultation at DeConti Plastic Surgery today.

Learn more:

Breast Augmentation Before and After Photos
The Myths vs. Reality About Breast Augmentation
Breast Augment Technique 3D Animation Video
The American Society of Plastic Surgery
The Aesthetic Society of Plastic Surgeons