Breast Augmentation | Billings Plastic Surgery

Breast Augmentation

Simply put, breast augmentation increases the volume of the breast. Many of our patients have very little breast volume, having never developed much breast tissue, and are lacking proportion to their figure. Others find that pregnancy expanded their breasts, and later left them without the volume but with plenty of extra skin. Addition of volume to the breast can improve the proportion of a figure and also rejuvenate a sagging breast.

What do I need to know?

We’ve found the happiest patients are the best informed patients. We will carefully examine you and explain to you all the factors that go into successful augmentation. We will show you how the shape of your chest wall, the width of your chest, the fold under your breast, the amount of skin you have, and the position of your breast all play into the decisions we make. Our approach is to carefully listen to your wants and needs, and thoroughly educate you in the entire process. We have a very detailed sizing procedure we go through with you to choose the size you want.

How is the operation done?

The operation is done under general anesthesia, and it lasts around an hour. You will stay 2 or 3 hours after the operation for recovery. Incisions are made under the breast or around the areola. We are not currently doing the axillary (armpit) procedure because we have seen too many problems from other practices with this approach. The transumbilical (TUBA) approach is advertised a lot, but it requires saline implants only and most of our patients are choosing gel implants. There are also problems with this approach in terms of the precision of the implant placement. After incision, a pocket is created under the pectoralis muscle. Implants placed under this muscle have fewer complications such as scar tissue formation or visible rippling. We check the size and position of the implant in the operating room prior to closing the incisions with dissolvable stitches and a layer of skin glue. We are currently using a medication called  Exparel to improve postoperative comfort. This is a local anesthesia medication that is injected into the are where implants are placed during the operation while you are  still asleep.  The medication is slowly released over the following 72 hours, and has dramatically improved the comfort of our patients during their early recovery. We will place you in a surgical bra to hold the implants in shape as you are healing.

What is recovery like?

You may return to work and normal activity as soon as you feel like it. If something is comfortable, it is probably OK. Vigorous upper body activity is probably best avoided for a month or so. Walking or jogging is fine when it is comfortable. You may shower right away. Sexual activity can be resumed when comfortable. Implants usually take a few months to settle and become more natural looking, and may appear high at first. Scars take about 6 months to a year to fade. Silicone tape can help with scar maturation.

What about saline vs. silicone?

We’ve studied this, read all the articles, given talks on it, and have generally worked this issue to exhaustion. The bottom line is that all implants have their issues. They are not a lifetime device for most people, and we figure a range of 15-30 years for their longevity. Some patients have them forever, and some will fail early. Saline and gel implants have a similar incidence of problems. Saline implants can get a hole and deflate. Silicone implants can break down and get hard when the body reacts to them. Neither implant has been shown to cause illnesses such as arthritis, connective tissue disorders, or autoimmune diseases.

Saline implants have the advantages of lower cost and a smaller incision. They can be placed through remote incisions. Most patients feel they are harder, show more ripples, and are less natural. That said, we did saline implants exclusively for a number of years and patients were okay with that.

Gel implants cost more, require a larger incision (by a half inch or so), and can’t be placed through remote incisions like the belly button. Most patients, however, feel they are more natural and softer. During your consultation, you will examine and handle both types of implants to make up your own mind.

What are the risks?

Infection and bleeding can occur but are uncommon. In rare cases, the implants may have to be removed. There may be temporary, and very rarely, permanent numbness of the nipple. Scars may be visible even after time. There may be some degree of asymmetry (sides not the same), which usually reflects differences in the native breasts, magnified by the increase in volume. Later complications can include capsular contracture, which is when scar tissue forms around the implant and makes it hard. The implants may leak and either deflate or get hard. Despite all this, problems are remarkably few and satisfaction high. We believe that with meticulous examination, planning, and education the problems are minimized. Billings Plastic Surgery is not an augmentation factory, doing as many procedures as fast as we can to make the most money. We are serious surgeons, highly trained, who are very thoughtful and careful. This is your body and your life, and you should have the best.