Asymmetrical Breast Augmentation
 

Breasts are seldom perfectly even or symmetrical. The natural boundaries may differ with breast folds at different heights. Nipples and areola may be spaced unevenly on the chest wall and project in separate directions. Irregularities in the underlying rib cage will often be accentuated by the addition of implants. Perfect symmetry in these circumstances is difficult to achieve.

22 year old with minimal breast tissue , asymmetry, and lack of distinct breast folds. Transaxillary breast augmentation with no breast scars . 360cc Implants

Choosing an Implant size
 

Bras are measured in two dimensions - the cup size and the body circumference around the rib cage. It takes approximately 200 cc of implant volume to bring about a one full cup bra size increase. Because of differing bra styles and manufactures patterns the dimensions of a particular cup sizes are not necessarily uniform. Some women may prefer a tight and revealing cup while others desire loose and full cup coverage. Plastic surgeons are therefore reluctant to predict a particular cup size after augmentation.		28 year old 2 months after Breast Augmentation Mammoplasty with 400 cc Saline implants inserted via a Transaxillary incision. The slight residual redness in the axillary fold should spontaneously resolve.
In order to provide a fuller appreciation of each implant's potential effects, our office offers special implant sizers. When placed in soft loosely paneled sports bras which mimic the natural response of breast tissues and covered by a thin camisole top ,the sizer system allow a very popular visual clue to the anticipated results. Generally one should select a slightly larger implant for sub muscular placement to account for the flattening. tendency of the overlying muscle Over time normal atrophy breast tissues as well as compression by the implants may result in an apparent loss of size and a somewhat smaller outcome Saline Implants

Saline Implants are popular because they are considered safe. In the event of leakage the saltwater content will absorb naturally into the body. The change in volume will be immediately noticeable. These implants require only a small incision as the saltwater filling is added only after the implants are in position. The implant volume can be adjusted at the time of surgery to help balance any unevenness in the breasts.   Saline Implants have a tendency to form ripples from folding of the implant shell. Due to the fluid movement of saltwater they may feel less natural than silicone implants.		40 year old with asymmetrical and deflated breasts . Transaxillary Breast Enlargement with 400cc sub pectoral saline implants has restored her former breast shape.
Surgeons will typically position saline implants beneath the muscle to soften and conceal the implant outline . Mammography will be aided by the muscular plane of separation between the implant and gland. Visit the Mentor Web site "LookingYourBest.com" For more information. Sub muscular Implants   Placing implants behind the muscle (sub muscular) will provide the additional coverage to conceal and soften the outline of the underlying implants. This is essential in small breasted women with thin and minimal glandular tissue. The muscular coverage helps conceal the potential ripples and folds inherent in saline (saltwater) implants, however, strong pectoral muscle activation in athletic or muscular women can produce implant movement and contour changes. This can range from momentary contour distortions to eventual lateralization of the implants. Sub muscular placement beneath the pectoral muscles provides 29 year old athletic women with scant breast tissue and minimal breast folds to hide incision scars. Results of breast enhancement with 380 cc saline implants placed deep to the pectoral muscles and inserted via the Transaxillary approach.   only partial coverage as the muscle is not large enough to enclose the entire implant. The outer lower one third of the breast will have no muscle reinforcement. Breast Implant Profiles   Breast implants come in different shapes and contours. Low profile or moderate implants: These implants are typically under filled to achieve a softer more pliable contour. Medium Profile or moderate plus implants are designed to have greater height and firmness where increased projection is desired. High profile implants afford maximum projection and shape retention but may appear somewhat round and unnatural. Teardrop or Anatomically shaped implants are most commonly used in breast reconstruction following mastectomy.     38 year old with slight asymmetry and outward ptosis of the right breast. Results after Trans axillary breast enlargement utilizing 400 cc saline implants placed in a sub pectoral pocket. Deflated Breasts   Loose and deflated breasts with minimal sag or ptosis are ideal candidates for breast implants. Simply restoring the breast to their original volume will give immediate results . Whether from weight loss, breast feeding, pregnancy or the aging process , breast implants can provide a return of the natural shape, projection and fullness of the breasts These loose and pliable breasts tissues can readily accommodate higher profile implants for increased cleavage and projection.     29y/o four months result Transaxillary Augmentation Mammoplasty 425 cc implant in sub muscular pocket.   Breast Cleavage   Cleavage after breast augmentation depends on many factors including, the structure and shape of the chest wall , the relative position of the nipples , the thickness of the surrounding breast tissues as well as the type and size of implants used.   Women generally request maximum projection combined with the tight cleavage produced with push in bras. If your breasts are widely separated, either from a broad or prominent breastbone (sternum) or outwardly positioned nipples this type of cleavage will be difficult to achieve. 29 year old with limited breast tissues and lack of distinct breast folds or well defined cleavage. Results after augmentatiion mammoplasty with submuscular 375 cc saline implants.   Altering the normal breast boundaries by sliding the implant closer together under the thin skin of the sternum can result in both palpable or visible rippling at the cleavage line. The chest wall is not flat but cylindrically shaped with curved ribs and outwardly pointed breasts. A prominent breastbone (pigeon breast ) will accentuate this outward effect while a indented or sunken breastbone (pectus excavatum) will allow for deeper cleavage but with somewhat inwardly pointing breasts. Deviating from the natural contour lines of the breast by overly releasing the normal skin or muscle attachments at the midline can lead to less than desirable results. Implants must be centered under the nipple complex – positioning the implants closer to the center midline can result in outwardly pointing nipples. Overly thick breast and chest wall tissues will conceal the contour enhancements provided by implants, Thin skin and breast tissues will often require muscular coverage to pad and soften the breast outlines. Adding larger volume implants will not necessarily correct all cleavage issues . Periareolar Breast Augmentation

Silicone Implants Silicone Implants have a more natural feel due to the viscous quality of the silicone Compared to the rapid rebound and movement of saline the thicker silicone offers a slower and more compliant feel which more accurately mimics normal breast tissue. Any leakage is similarly difficult to detect as silicone is not absorbed and the breast volume remains unchanged. An MRI may be needed to detect this silent leakage.		33 year old with bilateral breast sag and pseudo ptosis. Augmentation Mammoplasty with 350 cc silicone implants inserted via a nipple- areola incision with internal uplift . Incision site at the inferior margin of the areola.
Because they come pre filled with silicone they require a somewhat larger incision , Moderately sized silicone implants can be placed thru a specially designed axillary incision. Unlike saline implants, the volume or size of the silicone implant cannot be adjusted to accommodate breast asymmetries at the time of surgery Silicone implants come in a variety of shapes and profiles and shell texturing. Currently you must be at least 22 years old to receive these implants,

41 y/o with bilateral breast atrophy and glandular ptosis . She refused a formal Mastopexy procedure. Results after 425 cc implants inserted via a Periareolar approach and internal breast uplift Note the incision scar at the inferior border of the areola.

Breast Revision Implant Exchange Mammoplasty 
 

Capsule Contracture With all breast implants the body forms a capsule – a thin tissue layer which surrounds the implant. This capsule will typically remain soft and pliable When this capsule tightens and shrinks around the implant it is known as a contracture. As a result the breasts may feel firm , appear unnatural and cause discomfort. Self message and medications including anti-inflammatories , antibiotics		34 year old with spherical capsular contracture , distortion and flattening of the breast bilaterally . Breast revision with removal of the capsular contracture and implant replacement.
and vitamins are probably   more effective as preventative measures . While external ultrasound has shown some promise in softening the capsule , painful or disfiguring implants may require surgical release or removal of the constricting capsule. Replacing or changing the type of implant - silicone or saline and repositioning to a sub glandular or sub pectoral pocket are the most commonly recommended treatments. Other techniques include tissue expansion or incorporating a dermal lining .

Tubular Breast Augmentation
 

Tubular Breasts are so called due to their “tube Likie “ appearance. The brests have a narrow constricted base at the chest wall with a tight skin envelope and sagging overhanging areolar complex. The breast tissues appear to be pushed forward and protude into the niplle areolar complex As a result the areolar are often enlarged and asymmetic .		24 year old with narrow and constricted ( Tubular) breasts with associated asymmetrical ptosis, and protrusion of the nipple areola tissues. Correction with 350 cc saline implants positioned deep to the pectoral muscles.
The net effect is a drooping and limp barbell shaped breast a which sags and overhangs the natural breast folds with downward projecting nipples. Correction requires expansion of the narrow base , with isertion of an wide based implant,. Release of the prolapsed areolar breast tissue by internal scoring incisions will allow relaxation and redraping of the abnormal tissues. A periareolar or donut type mastopexy reduces the enlarged areola and allows for coorection of any assymmetry.

Breast Uplift Mastopexy
 

A Mastopexy procedure is used to lift , tighten and reposition the breast. The natural breast tissue will be preserved to afford fullness and projection. Where there is insufficient tissues an implant may be added to achieve the desired volume and cleavage. The sagging tissues a re treated by surgically reshaping and repositioning the breast gland and removing the excess skin around the areola. If there is minimal sag a crescent uplift with removal of the excess skin will elevate the nipple.		39 y/o with pendulous and sagging breasts. 3 months following mastopexuoxy procedure with preservation of breast tissues for maximum projection and fullness.
For greater degrees of f breast ptosis some combination of either a doughnut, vertical or horizontal incision technique will be required.   Following surgery the breast must be supported by a bra. With normal aging the breasts will eventually droop and loose their shape. Wearing a supportive bra in a regular fashion will help delay this process. See also: Breast Augmentation

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Breast Augmentation