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Breast Augmentation

Breast augmentation in Tulsa, OK is a cosmetic surgery procedure designed to enhance the body contour of a woman unhappy with her breast size. It may also be used to correct volume loss after pregnancy, or to help balance breast size asymmetries, as well as a reconstructive technique following another breast surgery procedure.

While breast augmentation will enlarge the breasts, it will not alter basic defects in breast shape or form. Major asymmetries may be improved, but will not be completely corrected. A slight difference in the size or shape of the two breasts is considered normal and should not be a cause for concern. If breast size or nipple position asymmetries are severe then additional procedures to further improve symmetry may be necessary. Long experience with this operation has demonstrated it to have highly satisfactory results for the majority of patients who are considered suitable candidates for the surgery.

Breast Augmentation Incisions

At Tulsa Surgical Arts, all breast augmentation operations are carried out in our AAAHC-approved Cosmetic Surgical Center under general anesthesia on an outpatient basis. A  breast implant is placed through a small incision and then under the breast tissue or under the muscle. The incision can be made in locations such as:

  • Under the breast
  • In the armpit
  • Around the nipple
  • In the belly button
  • It generally takes one to two hours to complete the entire procedure. A breast implant is composed of an outer silicone shell filled with saline or silicone gel. The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman's needs.

    Silicone breast implants

    Silicone implants were first popularized in the 1960's. Controversy in the early 1990's led to widespread fear about the possibility of silicone breast implants causing autoimmune diseases in women. Extensive studies since then have showed no evidence that silicone breast implants have any relationship to breast cancer, autoimmune disease or any other systemic illnesses in patients. Specifically, patients with breast implants have no higher incidence of diseases such as rheumatoid arthritis, scleroderma or lupus, in comparison with the general population.

    The Food & Drug Administration approved the use of the third generation silicone gel implants in November of 2006 for women 22 years of age and older. These implants are not filled with liquid silicone, but rather a cohesive silicone gel. Dr. Cuzalina was a part of the study of these implants that led to their approval for cosmetic use. 
    The increased safety of the cohesive gel implants led to the FDA's approval of these implants for cosmetic use. Saline implants are FDA approved for breast augmentation in women 18 years of age and older. The FDA set the age of approved use higher for silicone gel implants to ensure that a woman is emotionally mature enough and fully understands the risks of these implants.

    There is no perfect breast implant and both the saline and silicone gel implants have advantages and disadvantages. The silicone gel implants feel softer and more natural, have less chance of rippling, but are more expensive and have a higher chance of developing tightening of the scar tissue around the implant known as capsule contracture. 

    The manufacturers of silicone gel implants (Mentor and Allergan) recommend that you get an MRI after 3 years and then every 2 years thereafter to ensure that your implants are not leaking. Insurance will likely not cover the cost for an MRI. The manufacturers also warn that your insurance carrier may increase your health premiums or decline coverage if you have silicone gel implants. 

    Saline breast implants

    Saline implants are very safe and if they become damaged or deflate, your body will absorb the water. Saline implants are more prone to rippling and feel less natural than silicone. We will review the implants with you at your consultation and help you to decide which implant is best suited for you.

    Our experience suggests to us that there is approximately an annual 1% risk of leakage from saline implants. The FDA clinical trials for silicone gel implants suggest a leakage rate of 8-15% over the course of 10 years. Replacement is generally a relatively simple operation. Additional cost is involved, but most implant companies offer warranties that help offset a small portion of the fees for up to 5 to 10 years.

    Living With Breast Implants

    Following breast augmentation in Tulsa, OK, routine examination for breast changes remains very important. Some studies have suggested that it may be more difficult to detect early breast cancer on routine mammography, although this has not been proven and other authorities feel that with proper technique, mammography can be as successful in augmented patients as in the normal population. 

    Special techniques should allow patients to detect cancer without significant increased risk according to most present information, as long as the implants remain soft.

    Risks of Breast Augmentation Surgery in Tulsa, OK

    As is the case in all surgery, there are certain risks that are inherent with this operation. Although the scars are usually well hidden, irregularity or thickening of scars can occur which might require revision. 

    Rarely, hemorrhage may require removal of prosthesis to control the bleeding. Infection is probably the most serious risk of breast augmentation. If an infection occurs, antibiotics alone will rarely clear up the infection unless the implant is removed. It may be necessary to leave the implant out for a period of about three months before it is safe to attempt replacement. 

    The risk of infection during the first year, as reported by the manufacturer, is between 0.5 and 1%. Our own experience is currently lower than this. Infection is usually confined to the first few weeks after surgery, however infection from certain bacteria can show up later. Fortunately the prosthesis can usually be successfully replaced at a later time after the infection has completely resolved.

    Another potentially serious complication is implant rejection. Silicone is the least reactive material used for implant construction. Most patients tolerate the material without difficulty. Nevertheless, a very small percentage will react to the material making successful augmentation impossibility. 

    This is a very uncommon problem and is more often a problem related to an implant that is too large for the soft tissue that is available or delayed wound healing. Delayed wound healing that could predispose one to implant exposure may occur in persons with diabetes, history of radiation, autoimmune disease or smokers. Implant exposure is more common in patients who smoke since this can compromise the incision or quality of tissue covering an implant.

    Will I lose sensation in my breasts after having breast implants?

    Sensory changes can occur resulting in numbness or discomfort, and while these symptoms are usually not long-standing or severe, they can be in some cases. Temporary sensory changes are common and usually last 2 to 6 months. Risk of permanent sensory loss increases with increased implant size since larger implants stretch the sensory nerves further. Implants could possibly interfere with nursing although many patients nurse after the operation without difficulty.

    What is capsular contracture?

    One problem that can occur with breast implants is related to the natural tissue capsule that forms around the implant within the body. Sometimes this capsule thickens or contracts causing unnatural firmness or shape to the breast. This condition is called “capsular contracture”. 

    In severe cases, calcium deposits can develop and the patient can also experience discomfort or pain. In mild cases, breast compression exercises may allow the capsule to stretch and soften. Although in more advanced cases, further surgery and possible replacement of the implant is required.

    For years, many surgeons believed that by applying a textured surface to the silicone implant would decrease the risk of firmness (capsular contracture). This belief was based on experience years ago with polyurethane covered implants. These implants were found to remain soft in the vast majority of patient. Recent reports by implant manufacturers suggest that this may not always be the case and that in many circumstances smooth implants may have the same rates of capsular contracture.

    Our experience suggests approximately a 1% annual risk of developing capsular contracture severe enough to indicate surgical revision following saline breast implant placement. Patients should be aware that the studies presented to the FDA indicate that the overall risk of requiring further surgery is significantly higher and could be as high as 15 to 20% within the first three years following surgery. Massage of the breast after implants may help prevent contracture but its efficacy is debatable.

    In the past, surgeons often recommended extremely firm compression (enough to tear internal scar tissue) to treat capsular contracture by a procedure known as a closed capsulotomy. Because of the risk of breaking the outer membrane of the implant, this technique is no longer recommended in most situations. 

    Correcting capsular contracture

    Currently, we use a laser or modified cautery endoscopically to release the scar tissue through a small incision. This endoscopic capsulotomy is a simple procedure that works well for mild capsular contracture, but may be inadequate for more severe scar thickening. For more severe capsular contracture a complete capsulectomy (removal of all scar tissue) and replacement of the implant may be required. Unfortunately, there is no certainty that the scar tissue will not reform.

    Rippling, or surface irregularities over the implant that can be seen or felt, is a potential problem with any type of breast implant. It occurs more frequently with saline filled implants because the water in the implant is less viscous than silicone gel. The added risk of rippling is the trade-off for the increased safety of the saline filled device. 

    Because of the potential problem, placement of the saline filled implant under the muscle may be indicated to help decrease the risk of rippling. This is because it gives more soft tissue coverage over the implant. This may be particularly true for patients who have very little breast tissue.

    Since the pectoralis muscle only covers the upper portion of the implant rippling can still occur where there is not muscle coverage. The bulk and size of the pectoralis muscle varies from individual to individual, and so there is no set rule as to how much of the implant will be protected. A major factor influencing the possibility of rippling is implant size. 

    Larger breast implants tend to stretch and thin out the overlying tissue resulting in less natural coverage over the implant. For that reason, rippling is more common in patients who select very large implants. This is a factor to be taken into consideration selecting implants size. Implant texturing may also increase the chance and severity of rippling. Smooth surface implants seem to have less of a chance for rippling than textured surface implants

    Our experience has shown that while a significant percentage of patients are aware of some rippling, relatively few find it of sufficient magnitude to be objectionable. If it is a problem, a possible treatment consists of over filling of the implant. This is a surgical procedure in which additional saline is placed inside the implant. By over filling, the ripples are smoothed out to a certain degree by the added pressure of the fluid placed within the implant. The result of the operation is a much firmer implant, but hopefully with decrease rippling. Another option for patients who suffer from implant rippling is exchange of the saline implants for silicone gel filled implants.

    In selecting the size of the implant, the general choice should be jointly made by the patient and the surgeon prior to surgery. While ultimately, the choice of size is made by the patient, she should recognize that there are advantages to a conservative selection. 

    Capsular contracture and rippling are more common with larger implants. Postoperative numbness and long term sagging are also more common the large size selected. However, despite the increased problems with larger implants, it is rare that our patients complain of being too large following breast augmentation in Tulsa, OK. In general, our patients say they are extremely pleased with their new size, with 3-5% saying they might have gone slightly bigger if they had to choose over again. 

    Choosing the Size and Shape of Your Breast Implants

    The shape of your augmented breasts depends on the implant size and shape along with how your breast appear prior to surgery. The same size and shaped implant on one patient can look completely different on someone else. Therefore, one should avoid picking a size or shape solely on what ‘looks good' on someone else.

    Implants may be round or teardrop-shaped (anatomical). While teardrop (anatomical implants) may seem like a good idea they have some drawbacks. Teardrop implants widths are different than their length and any rotation may produce an unwanted asymmetry. Round breast implants are the same diameter all around but not ball shaped. They come in a variety of widths and varying amounts of projection to suite various patient desires.

    Many patients desire fuller cleavage. Although larger implants will give more cleavage, the patient's nipple position, chest shape and breast shape largely determine the amount cleavage that can be achieved. During your consultation and pre-operative visits our surgeons and nurses will with help you determine the implant size by placing actual filled implants of various sizes in special surgical bras to help estimate the size you desire. You may want to bring different shirts to see how your new look appears in different clothing.

    Some women find it effective to pad a bra by using baggies filled with birdseed or rice to estimate the approximate additional volume they desire. The final decision is yours and you will need to decide on an implant size at your preoperative appointment the week before surgery.

    Surgical Placement of Breast Implants

    The breast normally covers a muscle on the chest wall called the pectoralis muscle. Breast implants can be placed above or below this muscle. When implants are placed below the muscle, it is called a submuscular placement or a subpectoral placement. When the breast implant is placed above the muscle, it is called a subglandular or submammary placement, meaning that it's below the mammary gland.

    Submuscular Placement

    We generally prefer to place breast implants below the pectoral muscle. A possible advantage of submuscular placement is that it may allow better mammography and thus less chance of missing a breast lesion. Another advantage of submuscular placement is that the implant is entirely beneath the breast tissue, decreasing the possibility of interference with breast function. Research indicates that implants placed below the muscle are less likely to develop firmness (capsular contracture). This may be the result of pressure or internal massage of the implant by muscle movement.

    Disadvantages of submuscular implant placement include a slightly more painful and prolonged recovery compared to subglandular placement. The most severe pain lasts for one week on average. We tell our patients to avoid lifting anything more than five pounds the first week and 10 pounds the second week. 

    Patients should also avoid raising their elbows above shoulder level the first 10 days. Overuse of the arms and pectoralis muscles can cause the submuscular implant to ‘ride up' initially. Implants place below the muscle so require more time to settle than submammary implants. Slight flattening beneath the breast should be expected initially. This requires one to two months on average for the breast tissue to stretch and soften in order for the breast to ‘round out' in the lower half.

    Patients who have moderate sagging of the breast may be at risk for a problem known as the ‘double bubble' deformity. This deformity can occurs when implants are placed below the muscle in women with some drop to their breasts. The deformity presents as a ridge in the lower pole of the breast where the previous inframammary fold was located.

    If we notice significant droop of your breasts we will recommend a breast lift or placement of the breast implants above the muscle to avoid this problem. Realize though that placing an implant above the muscle in breasts with droop will ultimately result in larger droopier breasts with time. 

    Even in ideal situations, submuscular implants will likely have a ‘flexion deformity' noticeable when a patient flexes their pectoralis muscle causing a temporary crease along the edge of the muscle over the lower implant. While noticeable briefly it is of no major concern and the breast should appear normal at all other times. 

    A thorough consultation and pre operative screening with your surgeon is critical to determine your options and ideal treatment plan. We offer the choice of implant placement, either above or below the muscle to our patients. Currently, most of our patients elect to have their implants placed beneath the muscle.

    Techniques for breast augmentation incisions

    There are several ways in which the breast implant can be inserted. An incision can be made under the breast (inframammary), in the armpit (transaxillary), around the bottom of the areola (periareolar), or through the belly button (TUBA-transumbilical breast augmentation). 

    Tulsa cosmetic surgeons Dr. Cuzalina offers all of these incision choices, but he prefers using the transaxillary incision in most cases. The incision under the breast (inframammary) is the most common, but is our least favorite for a number of reasons. First, it is the area that most people relate to breast enlargement surgery. Also, it may not always end up in the new inframammary fold where it would be hidden the most. 

    More importantly, this approach places the scar very close to the implant. If the incision should get infected, it may be more likely that the infection could reach the implant. 

    Finally, although inframammary scars usually heal well, we have seen some instances of scar thickening that were very difficult to improve. However, the incision has been used for decades and remains a viable option that usually has no major problems.
    The periareolar incision is made in a semicircular fashion around the lower half of the areola approximately 4-5 centimeters in length. It offers the advantage of keeping the incision far away from the implant and allowing good surgical exposure of the entire pocket. The incision may have a slightly higher risk for loss of nipple sensation as compared to the transaxillary incision, but remains an excellent incision option.

    The transumbilical breast augmentation (TUBA) is a method of augmenting the breasts through a small incision in the belly button. This approach is reasonable when the implants are being placed above the pectoralis muscle. Although this approach can be used for placement of implants below the muscle, it is much more involved than using any of the other incisions. The advantage of this approach is the small hidden incision. The disadvantage is that the abdomen can remain swollen for a longer period of time and only saline implants can be placed with this method.

    Endoscopic Transaxillary Placement of Implants

    Cosmetic surgeon Dr. Cuzalina prefers the transaxillary incision because it offers several advantages. The incision is approximately 4 centimeters in length placed high in the armpit. The incision usually heals very well leaving no visible scar on the breast itself. Because of its distance from the breast, an endoscope can be used for direct vision dissection and much better visualization of all muscle, nerves and vessels.

    Since blood around the implant can organize and eventually lead to thickened scar tissue, it is important to perform the surgery in as bloodless a field as possible. The use of endoscopic surgery has allowed us to carry out breast augmentation with more precision and less bleeding. 

    Special instruments designed for this purpose allow us to work through very small incisions, monitoring the operation on a video screen. The dissection is performed under close observation using an endoscopic telescope with a built in video camera to project the inside of the pocket on a large operating room screen. The pocket then is tailored under direct vision rather than the traditional blind dissection. The improvement is obvious since it is always better to see clearly what one is cutting.

    Recovering from Breast Augmentation in Tulsa, OK

    Anesthesia is provided by a registered nurse anesthetist or by an anesthesiologist. A layer of elastic tape will be used for 7 days to help support the breast along with a light compression bra. Patients usually return to light activity with two to three days after surgery. Full activity is resumed within two or three weeks but no vigorous bouncing type activities (jogging or horseback riding) is recommended for 6 weeks. Although the breasts usually look good almost immediately after surgery, there is an improvement in the shape over the following several months.

    Breast enlargement has been performed for decades and continues to increase in popularity. It is easy to understand why this operation has remained such a popular cosmetic operation for women. Breast augmentation in Tulsa, OK is a safe procedure that has produced pleasing and satisfying results for many women. With the improvements in technique and implant technology, many of the problems of the past seem to have been largely minimized. Certainly those patients who are psychologically stable and have realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you. Call Tulsa Surgical Arts or send us an email to schedule your breast augmentation consultation.