Cosmetic Surgery & Beauty #73

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feature The fine art of natural-looking breast augmentation Breast surgery is more customisable than ever before. Research spanning decades has helped formulate surgical and aesthetic techniques that have placed breast surgery at the forefront of today’s plastic and reconstructive arena. The expertise garnered through years of investigation from leading surgeons around the globe means breast surgery today offers more individualised results, with less scarring and reduced downtime following surgery. The implants used in breast augmentation have been improved and refined through both design and manufacturing. Features to reduce the risk of capsular contracture and prevent implant rotation, gel diffusion and implant rupture help achieve superior results with fewer incidences of complication. Surgical techniques have also changed. Different implant placement and incision sites afford breast augmentation patients more options in scar placement and aesthetic outcomes. Surgical advances in breast reduction have lead to improved results, with less downtime. And a greater understanding of breast anatomy and aesthetics has made correcting deformities, such as tuberous breasts and asymmetry, more effective than ever before. Factors that need to be assessed before undergoing a breast augmentation include the size of the existing breasts and the width of the base of the breasts. The width of the base determines the most suitable implant size and volume the patient can have to enable their new breasts to look proportionate to the rest of their body. When considering implant shape, texture and size in breast augmentation, a decision is made with reference to a woman’s individual body type and aesthetic goals. During the consultation process, measurements are taken to determine the anatomical limitations and allowances of the breasts, chest and soft tissue, and patients are able to express their motivations, concerns and expectations going into surgery. The choice of projection is a very personal one. A woman who is happy with her shape and has sufficient breast tissue may opt for a low profile implant that will simply increase the size of her breasts. Another patient may favour a high-profile implant to reduce sag and generate cleavage. 20 www.cosbeauty.com.au
feature Implant fill There are two types of implant filling – silicone gel and saline solution – and both are encased within an outer shall of silicone. Silicone gel implants are touted to have a more natural feel than their saline-filled counterparts, and the gel’s cohesive consistency helps retain implant shape following insertion. In comparison, saline-filled implants are firmer to touch, and have a greater chance of rippling after insertion. If implant rupture occurs with saline-filled implants, the saline solution will be absorbed into the body and the rupture will be immediately noticeable to the patient. When using silicone gel-filled implants, rupture is less noticeable and can remain undetected for longer periods of time, which is cause for concern to some doctors and patients. Implant shape Implants come in round, teardrop (anatomical) and conical shapes. The round and teardrop options are the most popular in modern-day breast surgery. Round implants come in smooth and textured shells, and will usually lend more upper pole fullness than anatomically shaped implants. When the patient is upright, a round implant can assume a defined, round shape or a teardroplike contour, depending on its fill. Anatomical (teardrop) implants have a fuller lower pole, and the shape more closely resembles that of the natural breast. Their design gives them greater projection in relation to the size of the base, making them particularly suitable for women with little breast tissue. A precise degree of accuracy is needed when positioning anatomical implants, because if they shift after surgery the shape of the breast may be noticeably distorted. To reduce this risk, anatomical implants will always have a textured surface to enable adherence to surrounding tissue. Implant texture The surface of breast implants can either be smooth or textured. Smooth-shelled implants are acclaimed for their natural movement and feel, they are relatively easy to insert during surgery and have a thinner shell than textured implants. There is a downside to smooth implants, however, as they have a greater chance of capsular contracture (hardening of the breast), which is a common reason for revision surgery. In comparison, textured implants – usually coated with polyurethane foam – exhibit greater adherence to surrounding tissue, meaning there is less friction between the implant and breast pocket. This reduces the change of capsular contracture and protects against implant movement following surgery. Implant placement Breast implants can be placed either above or below the pectoral muscle and, in some cases, a dual plane approach means the implant is partially placed in both fields. Subglandular placement is when the implant is positioned above the pectoral muscle, beneath the glandular breast tissue. This implant positioning is best suited to patients who have adequate existing breast tissue, as this tissue will cover the implant’s edges after insertion. Subglandular implant placement often causes a pronounced “roundness” to the breasts, and the implant moves relatively naturally in this position following surgery. In patients with less soft tissue in the breast area, implants placed underneath the pectoral muscle – called submuscular implant positioning – are often less conspicuous. This placement helps camouflage the implant edges and can create a more natural-looking contour at the top of the breasts. In dual plane placement, the implant is placed partially beneath the pectoral muscle in the upper pole, while the lower half of the implant falls in the subglandular plane. This placement will camouflage upper implant edges and provide full projection in the lower pole, suited to women with a high degree of sag or an accentuated breast fold. It will reduce the defined ‘roundness’ usually associated with subglandular implants and will offer a natural breast contour. The incision site The incision site will determine the visibility of scars and is generally decided based upon the personal preferences of the patient and surgeon. There are surgical advantages and drawbacks for each site. The inframammary incision is the most common incision site for breast implant placement and it is made in the inframammary fold, or the crease under the breast. The periareolar incision is made on the border of the areolar - the area of darker skin surrounding the nipple. A transaxillary incision is made in the armpit fold, and a channel is created to deliver the implant to the breast pocket. And, finally the transumbilical incision, which not so commonly used, is made on the rim of the navel and an endoscope is used to tunnel to the breast. Ultimately, a thorough understanding of the implants, their shapes, fills and placement will help ensure a satisfactory outcome. csbm www.cosbeauty.com.au 21
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