Cosmetic Surgery Tips

Breast Augmentation For Symmetry

Breast augmentation is a surgical procedure that can help you achieve the shape, size and look you want. It can also help you feel more confident about yourself.

If you’re considering having breast augmentation, it’s important to know that there are many different techniques available to achieve your desired result. The type of surgery that’s best for you depends on your needs and desires, as well as your body type and the amount of natural breast tissue you have available for placement.

One of the most common techniques used for breast augmentation is saline implant placement. Saline implants are filled with sterile salt water before being inserted into the breast tissue. These implants are popular because they are easy to place and they provide immediate results without requiring an incision in the skin (which is why they are often called “no-touch” or “sub-muscular”). Saline implants have a low risk of complications such as capsular contracture (when scar tissue forms around the implant) and deflation (when an implant loses its shape over time). However, they do tend to be less durable than silicone gel implants so they may need replacement sooner than silicone gel implants

Breast Augmentation For Symmetry

Breast Symmetry

Breast symmetry is a complex goal in the wake of breast cancer and mastectomy. Yet MUSC Health’s expert plastic surgery team strives to achieve as much symmetry as possible between your breasts and, as a result, we are changing what’s possible in breast reconstruction.

If you are having a mastectomy on one side and intend to preserve your cancer-free breast, symmetry procedures may be done on the preserved breast during a secondary stage in the reconstruction process. Possible symmetry procedures include breast reduction, breast enlargement (for example, placement of implants) or a lift (mastopexy). The surgeon also may graft fat from one area of your body and use it to add volume or correct a contour problem. 

Symmetry procedures and techniques are typically covered by insurance and may be performed on the reconstructed breast to make adjustments.

Breast Symmetry Procedures

Breast Reduction

Breast reduction can be done on your cancer-free breast to help match it to your reconstructed breast. During the reduction procedure, excess breast tissue, fat and skin are removed allowing the breast to be re-shaped into a smaller, lighter, firmer breast that sits higher on your chest. Typically, the incision is made around the areola and a vertical line extends downward and follows the natural curve of the crease under the breast. Your nipple is not detached, but simply moved to a higher position so that most women retain nipple sensation and the ability to breastfeed.

This surgery typically takes around an hour when done during the second stage of breast reconstruction. General anesthesia is used, and you will have some swelling, bruising and numbness during recovery. Expect to return back to work in about two to three weeks and resume normal activities within six weeks. Risks include bleeding, infection, loss of sensation, loss of nipple, scarring and the need for additional procedures.

Breast Augmentation

Breast enlargement (augmentation) may be incorporated into the reconstruction process, whether you plan to add more volume at the outset or your surgeon suggests it as a tool to enhance the symmetry and appearance of your breasts.

While each situation is unique, you can talk with your plastic surgeon ahead of time to determine the most promising cosmetic options for enlargement. If you plan to have natural tissue reconstruction and you want a larger breast, you will discuss which transplant procedures will offer you the most tissue and fat. Procedures in which tissue is harvested from your abdomen, such as the DIEP flap procedure, might be the most promising. The “stacked” variation of DIEP involves taking two flaps of tissue from the abdomen and connecting them to form one breast when more fullness is desired.

Implants also offer opportunities to go up in cup size. There are two types of breast implants – silicone and saline (salt water). Saline implants do not sit like normal breasts and tend to have a rippling effect. Someone who undergoes a cosmetic breast augmentation has natural breast tissue that will cover saline implants and mask those problems. In contrast, breast cancer patients have little to no remaining breast tissue following a mastectomy. They can expect better cosmetic results with silicone gel implants, which hang more naturally and are more cohesive with less chance of rippling.

Well-known concerns about silicone implants resulted in them being taken off the market for several years, but the FDA thoroughly examined the evidence and declared them safe in 2006, allowing them to be used again. Currently, an average implant lasts for 13.5 years, and even though it will eventually rupture, it’s not dangerous. Because today’s silicone implants are made of a cohesive gel, the inner material does not “leak” and the capsule of scar tissue around the implant keeps it secure. Most people don’t notice that their silicone implant has ruptured. This usually has to be determined by an MRI. But when a saline implant ruptures, the saline leaks out and the implant goes noticeably flat.

Breast augmentation surgery lasts about 30 minutes per breast and can be done on an outpatient basis with general anesthesia. There will be temporary swelling, numbness and bruising during recovery. You may be able to return to work as early as five to seven days after surgery and resume normal activities in six weeks.

Risks include bleeding, scarring, infection, loss of sensation in breasts and nipples, hardening of the implant (capsular contraction) and the need for additional procedures.

Mastopexy (Breast Lift)

As breasts get older and go through pregnancy or weight loss, they may be prone to sagging (ptosis). Because your reconstructed breast will be “new,” you may need a breast lift (mastopexy) on your preserved breast for the sake of consistency and balance.

Mastopexy rejuvenates breasts by elevating and reshaping them. An incision is made around the areola and extends vertically beneath this toward the crease under the breast. The nipple is not removed – it will be moved to a new, higher position – but the excess skin above and below the nipple is removed, and the breast is reshaped. If you are happy with the size of your breasts, but they are sagging, then a breast lift may be an appropriate surgery for you.

Breast lift surgery can be done in one hour on an outpatient basis with general anesthesia. You may experience temporary swelling, numbness and bruising during recovery. Most women return back to work in one to two weeks and resume normal activities in six weeks. Risks include bleeding, scarring, infection, loss of sensation in breasts and nipples and the need for additional procedures.

Fat Grafting

Fat grafting is a technique often used in the second stage of breast reconstruction to fine-tune appearance. During this procedure, fat is harvested by liposuction from one area of your body and transferred to the breast to add volume or correct a contour problem. This helps to eliminate dimpling, indentations and inward curves and allows you to achieve improved symmetry.

This is an outpatient procedure that can be completed in under an hour with very minimal recovery time. More fat is transferred than necessary because, on average, 30-70 percent of the fat that is grafted does not take. As a result additional fat grafting may be required several months later. However, the fat that does take will stay with you for life.

Advantages of fat grafting include the fact that you are using your own tissue rather than a foreign body or substance to add volume. Plus, you enjoy the added benefit of liposuction to remove fat from an area where you don’t want it.

breast augmentation asymmetry issues

Risk of and Corrections for Breast Asymmetry

Asymmetry is a common risk for anyone undergoing breast augmentation. If you notice asymmetry, the first thing you should do is consult with your surgeon to figure out the cause of the issue. In most cases, asymmetry is only temporary, but in rare instances it may be the result of a post-surgical complication.

Temporary Causes of Breast Implant Asymmetry

Residual swelling can last for a month or longer following breast augmentation. Once swelling has subsided, your breast implants will begin to settle into a more natural position. They may, however, settle at different rates, resulting in a difference in appearance. Your breasts will gradually settle over the course of 3-4 months, but it may take up to 8 months before your final results are realized. Usually a surgeon will wait 6 months to a year to determine if a revision is necessary.

Revision Surgery to Correct Breast Asymmetry

In some cases, breast asymmetry may be the result of a doctor or patient error. An unskilled or under-qualified surgeon could use improper techniques or even insert a poor choice of size for implants for your body.

In cases where asymmetry persists, revision surgery may be necessary to correct asymmetry or improve implant placement. Breast revision surgery should always be performed by a highly specialized surgeon. Revision surgery requires a lot of experience and skill to maximize predictability.

If you feel asymmetry is the result of doctor error, you may want to seek out the advice of a different plastic surgeon. Remember to always choose a board-certified plastic surgeon for cosmetic or reconstructive surgery.

Post-Surgical Complications that May Result in Breast Asymmetry

While minor asymmetries are common, anything significant may signify a post-surgical complication and should be reported to your surgeon. Some of these causes of asymmetry include:

Seroma – A seroma is a pocket of watery, yellow-colored fluid collection that may appear after a breast augmentation procedure. Seromas are usually a minor complication – more of an annoyance than anything else. Small seromas will often resolve without intervention. Larger ones will need to be drained using a needle and syringe, under local anesthesia. The best way to reduce your risk of developing seromas is to carefully follow your surgeon’s post-surgical care instructions.

Hematoma – A hematoma is a pooling of blood that can accumulate around the breast implant after surgery. In some cases, hematomas resolve without any surgical intervention. Other times, they may require surgical drainage. The overall risk of developing a hematoma is lower than 2 %. To minimize your risk, avoid taking blooding thinning medications such as aspirin at least 2 weeks prior to breast augmentation. You should also avoid doing too much physical activity.

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