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Birmingham, Alabama

Breast Augmentation

Breast augmentation is a procedure where prosthetic implants (saline or silicone gel) are placed beneath the breast gland and nipple to provide a patient with larger breast volume and a fuller, more lifted appearing chest. The implants can be placed above or below the muscle. We will help you during your consultation to determine which is the best option for you. The procedure can also assist with addressing mild differences in breast volume, asymmetry and certain congenital breast conditions, like tuberous breast deformities.

Who is a good candidate?

We think women with less breast tissue than they desire and minimal breast droop (ptosis) are the best candidates for a breast augmentation. This is determined by the position of the nipple in relation to the breast mound. Women who have had children, nursed and/or lost a significant amount of weight, may regain breast fullness from implant placement. Women who have significant droop to their breast may also benefit from implant placement performed in conjunction with breast lift surgery (see breast lift).

How is the procedure performed?

We perform our breast augmentations at our fully accredited operating facility. Most patients are more comfortable under a light general anesthetic although we offer local anesthesia with sedation as well. Certified Registered Nurse Anesthetists (CRNA’s) keep you completely safe and comfortable throughout. The procedure typically takes less than an hour. We use the shortest incisions (3-4 cm in length) possible to achieve the best result. The incision will be placed in the natural crease at the base of the breast, or through an incision at the lowest aspect of the nipple, or through an inconspicuous scar placed within an armpit crease. During the procedure a pocket is made beneath or on top of the muscle based on the dimensions of the implant selected. Surgical tape is placed over the incisions following surgery. A surgical support bra will be placed after the procedure to assist with support during the early post-op period. You will be able to shower the night of your procedure.

What is the post-operative recovery?

Most breast augmentations have minimal down-time and a very prompt recovery. Many of our patients feel that they can get back to their normal activities a day or so following the procedure. We recommend activities that utilize substantial physical activity and use of chest muscles to be limited for the first week or so, but most patients feel as though they can resume work and activities of daily living very promptly following the procedure. Patients describe a moderate degree of “tightness” in their breast region that gradually resolves over the first week.

What can I expect for results?

You will immediately notice an overall change in your breast appearance. There will be an improvement in the overall projection and shape of the breast mounds. Patients show a beneficial volume change in the upper half of the breast mound where volume is typically lacking. For the first week or two you may feel that the implants are somewhat “high-riding” on your chest, this will gradually improve. Your implants will settle into a more natural position, usually by week 3.

Are there any potential complications?

Like all operations, bleeding and infection are standard risks. A breast augmentation can have complications, but, fortunately they are rare. Because the procedure uses implants, we take great care during the procedure to ensure overall sterility of the devices. Grotting & Cohn Plastic Surgery offers Cosmet Assure at no additional cost to you to protect you financially if a complication does arise (see CosmetAssure). Other complications can include issues like implant malposition and tight scarring around the implant (capsular contracture) that may require revision surgery based on the degree to which they occur. Fortunately, these complications are also rare and usually can be avoided by appropriate implant selection and post-operative implant displacement exercises.

Are there additional relevant considerations regarding this procedure?

  1. What is the difference between saline and silicone implants? Silicone implants are generally thought to have a more natural feel than saline implants. This may be a consideration in women with minimal breast tissue who are apt to feel the actual implant beneath their breast or women who are having their implant placed above the chest muscle. Saline implants are also felt to have a slightly higher likelihood of rippling, which may be visible in very thin women along the outer and lower aspect of the breast implant because this portion of the implant is not covered by muscle. Saline implants do offer some advantages in that the volume placed into the implant can be adjusted to account for breast volume differences, whereas silicone implants come pre-filled and, as such, are not adjustable regarding their volume.
  2. Why are some implants “textured”? Textured implants are felt to adhere to the surrounding tissue to a greater degree than smooth implants. Some women may benefit from this adherence in an effort to stabilize the position and location of the device. These devices may have a benefit in revision surgery, when implants are being downsized in a pocket with larger prior dimensions than the new implant.
  3. How do I know if I need a breast lift as well? A breast augmentation will provide some degree of lift to the breast without performing a separate breast lift procedure. However, if the nipple position is too low on the breast or downward pointing, various procedures may be useful to provide an optimal overall aesthetic result to keep the nipple forward-facing and centered over the most projecting aspect of the new breast mound.
  4. Do my implants need to be replaced every ten years? Implants are not like car tires and do not require scheduled replacement as long as the appearance of the breast and integrity of the implants are unchanged. Many women have their original implants for multiple decades without the need for additional surgery. However, breasts, like all parts of the body, are susceptible to age-related changes and the effects of gravity. The best way to approach breast augmentation surgery is with the idea that you are making a permanent change in your breasts that MAY require some type of revision surgery over the lifespan of the implants. In most cases, women will not need any additional surgery; however, many women elect to undergo implant replacement (size changes) or breast lift procedures as their breasts age, if necessary. Choosing an appropriate implant based on your body’s specific dimensions if helpful in avoiding many of the long-term “wear and tear” changes that can occur if too large an implant is selected.
  5. Am I still able to get mammograms with implants? Yes, implants do not preclude or interfere with routine breast exams or breast imaging. Women should continue to undergo routine breast surveillance as instructed by their doctors after the procedure is performed.