Breast Enlargement & Enhancement in New Jersey
Breast augmentation is the most common procedure that Dr Friedlander performs, and the second most common plastic surgery procedure performed in the US today. It is intended to restore, enlarge and improve the size shape and appearance of the breast. Like all plastic surgical procedures, the result is a collaborative effort between the surgeon and the patient. Here, as with any other cosmetic procedure, the surgeon has the ability to use the structural integrity of the breast, add fullness which is otherwise lacking or misplaced and create a breast which provides harmony to the psyche and soul.
If you are like most women seeking breast augmentation, you have been considering the operation for many years. Some of you are looking to have natural appearing breasts that bring your body into balance while others are looking for an increase in size without the telling signs of surgery. It is performed to enhance breasts which appear to be too small as a result of inadequate development, post pregnancy shrinkage or large fluctuations in weight. It may also be used to correct breasts which are asymmetrical. The result is intended to enhance the physical appearance, and improve self esteem and inner confidence.
Breast augmentation is a procedure that involves the placement of an implant to enlarge the size of the breast. It is not a generic procedure as there is a great deal of planning that goes into creating an excellent result. Few women are symmetrical. The differences between the breasts may be subtle, but can be magnified by the procedure. When we look at ourselves in the mirror, we focus on the shape and size of the breast. Other considerations for the plastic surgeon include the position and size of the nipple, the location of the natural fold, and the distribution of tissue. Breast augmentation is intended to restore fullness to the breast. Visually, the implant needs to be centered behind the nipple. Variations in chest anatomy such as curvature created by scoliosis, a prominent rib cage, nipples which naturally are located to the side or one breast being higher than the other will need to be addressed by the surgeon to create an aesthetically pleasing result.
Pregnancy and nursing often contribute to the issues we wish to address, such as areolar enlargement and nipple hypertrophy (increase in size and projection). During pregnancy the breasts enlarge stretching the skin. There is a loss of elasticity of the skin, which typically is not appreciated because the skin retracts afterward. The breast can easily accommodate a larger implant, restoring the fullness that we all liked during pregnancy. The use of extremely large implants can contribute to further stretching and should be thoroughly discussed. Often times the nipple and breast tissue descend downwards and require additional techniques such as breast lift or mastopexy(see below) to correct.
There are many different variables, such as location of the incision, the size, shape, and type of implant, as well as the location of the implant (under or over the muscle) that play a role in planning the surgery. Dr. Friedlander prefers to place the implant behind the muscle, as this may decrease the potential for capsular contracture (scar tissue) and will interfere less with future mammograms. This is also associated with less implant visibility (particularly rippling) and creates a more natural appearance, especially in thin women.
Surgical procedures are safe, and carry few risks in healthy patients. It is important to disclose any health problems and any medications (prescription and over the counter) that you are taking as they may impact the surgery, such as the use of baby aspirin, a blood thinner. There are risks with any surgery such as infection, bleeding or altered sensibility. These are not specific to breast augmentation. The implants may leak or rupture, and may need to be replaced. There is a common misconception that implants need to be replaced every 10 years. This is of course untrue. Issues requiring revision may include rupture, capsular contracture or a change in size.
The procedure is performed on an outpatient basis and patients are followed closely in the office after surgery. Postoperative swelling is normal. As the swelling disappears, the implants will look smaller. They are not. It is simply the swelling improving. The body is not symmetrical. Swelling postoperatively is not symmetrical as well. Most of the swelling is gone by 4-6 weeks after the surgery, and the implants "settle" into their final position after a couple of months. Most women are able to resume regular work 5-7 days after the procedure although they can work from home after 1-2 days. No strenuous activity or heavy lifting is permitted for 4 weeks.
Selecting an Implant Size
Selecting an implant can be an exciting experience. Dr Friedlander has sizers that will help you to visualize what your breasts will look like after the surgery. The concepts involved can be confusing because they are not standardized.
Most women want to be proportional after the surgery. Proportion is a perception. It is not a concrete object. For some women, proportion is a B cup, for others it is a full C cup, bordering on a D cup. This problem arises for 2 reasons. First, there is no consistency between bra manufacturers. That is to say, a B cup in a 32 bra has a different cup size than a B cup in a 34 bra, and a 34B bra in one manufacturer will fit differently than a 34B cup by another manufacturer. Secondly, proportion is determined by height weight and body dimensions, and not necessarily cup size. Often times, women who are naturally large and wear a D cup, will look proportioned. This can all be very confusing. Communicating your concept of proportion to your surgeon is important during this selection process.
You will be asked what your desired cup size is, but this useful as a guide only. If you wish to be large, do not hesitate to say so. Your surgeon cannot read your mind. Implants are sized by volume and by dimension. As the volume increases, so does the diameter and projection of the implant. Women with a petite frame, or who are very thin, may not be well suited for very large implants. Adjustments in implant dimensions may need to be made to accommodate your chest size or your desired result.
The best advice that can be given during the implant selection process is to be open minded. Select an implant that looks good on you, that you are comfortable with, without committing to an arbitrary cup size beforehand. Frequently, the selection can be narrowed down to one or two implants. If you are having a hard time at that point, remember, the implants will look slightly smaller once the surgery has been completed. Also, the difference between implants is typically 25 CC-30 CC or less than 2 tablespoons. This is barely noticeable and typically results in a slight difference in fullness.
Selecting an Implant Shape - the Evolution of Breast Implants
Gel breast implants were introduced in the 1960's, followed by saline implants several years later. The gel devices have evolved extensively over the years. They are significantly different from the early devices in the 60's and the later devices that were taken off the US market in 1992. Currently three manufacturers are FDA approved to market gel implants in the US. All 3 have a "form stable " implant. The term" form stable" relates to increased "cross linking" of the silicone gel imparting an additional degree of stability to the implant. Unlike the earlier gel implants and the saline implants, these newer implants containing the "more cohesive silicone gels" are more likely to maintain their shape allowing the surgeon to "sculpt" and "shape" the breast rather than just "fill" it.
The round version of "cohesive gel", "form stable" implants is most frequently used and produces excellent results. A small set of augmentation patients, however, benefit from shaped implants that can create greater fullness in the lower pole of the breast. This shaped implant has been available in Europe for many years and is now available in the US to satisfy a variety of patient needs.
The implants of all three manufacturers have been extensively reviewed by the FDA. FDA approval of the shaped Allergan and Mentor implants which are still involved in ongoing clinical trials is expected. Sientra received FDA approval in March 2012 to market its shaped implant. Surgeons now have greater flexibility to create an attractive breast shape or to correct a preexisting deformity.
Some revisions are inevitable. Some can be prevented by preoperative discussion and planning.
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