Breasts are made of glandular tissue (which produces milk after pregnancy), ducts that connect the glandular tissue to the nipple, fat, and connective tissue. Breasts sit above the pectoralis muscles and the muscular fascia (the strong thin covering of the pectoralis muscles). Aging makes the connective tissue looser and stretched. Over time, gravity takes its toll, pulling the tissue down and making breasts sag.
What do you want to change?
If you are very sensitive about your breast size, breast shape, or the difference in size between your breasts, surgery may be the option for you.
Most women who want breast augmentation just want to be larger and look better in and out of clothing. For some, increasing breast size may mean that clothes are easier to buy because their upper body size and lower body size will be standardized.
Some women face other issues, including anatomical issues that can be only partially corrected or modified by augmentation surgery. Examples include breasts that are different in size, breasts that are tubular shaped (not conical), and breasts with unusual placement of nipples.
For patients with asymmetrical breasts where the difference between breasts is not great placing a larger implant on the smaller side may completely eliminate the difference. If the asymmetry is significant, the smaller breast may not have enough skin, so augmentation alone is not the appropriate procedure.
If the patient has tubular breasts (breasts that are narrower and perhaps somewhat longer or more pointed than normal), breast augmentation surgery may help to a limited degree. Tubular breasts are difficult to make identical but a skilled, experienced surgeon can come very close.
Saggy breasts can occur because of congenital reasons, childbirth, breast feeding, or aging. Breast augmentation can fill the extra skin, increase fullness in the upper part of the breast and generally make breasts larger. However, augmentation will not lift the nipple height or fill the extra skin above drooping breasts. If the amount of sagginess is too great, a breast lift may also be needed.
Breast augmentation surgery provides for the insertion of saline or silicone implants into the breast. Most implants are positioned behind the pectoral muscles. This results in more accurate mammograms and may reduce infection and capsular contracture (hardening of the tissue around the implants), so the implants will stay softer. Other choices are available for positioning, and will be discussed at the consultation.
Silicone implants are usually inserted through an incision made in the crease of the lower part of the breast, in the axilla (the armpit), or in the lower edge of the areola (the pigmented skin around the nipple).
Cohesive silicone gel or saline
Concerns about the safety of silicone gel implants became a major issue in the early 1990s. Since then, the medical community has new information and no longer is concerned about the safety issues of silicone.
Today's cohesive silicone gel implants have stronger and less permeable shells. They feel very natural when inserted in the chest. Instances of capsule formation and breast deformity have decreased significantly.
Saline implants are somewhat less soft and feel less natural than silicone gel implants. They feel like a plastic sandwich bag filled with water. After insertion, a saline implant can usually be felt at the bottom or along the lower sides of a woman's breast as an edge or as slight wrinkles.
For the first 48 hours the patient will be given pain medication and wrapped in a light dressing. For 2 weeks the breasts will be sore and bruised, and swollen for several months. Compression bandages may be worn for several days. Immediately after surgery, the implants sometimes sit too high on the chest wall, but they usually drop into a normal position over the next day or weeks.
The patient can return to work in 2 weeks. The patient should wait 2-3 months before resuming strenuous exercise.
Dr. Chartchai's surgical techniques are intended to minimize the likelihood of any complication. These complications or side effects include but are not limited to asymmetry (uneven breasts or nipples), hematomas (a collection of blood around the implant), poor scarring, changes in nipple sensation (it may decrease, disappear altogether, or even intensify), capsular contracture (a tightening of the scar tissue that naturally forms around the implant), and deflation of saline implants. If the milk ducts are cut, breast feeding may not be possible.
Please discuss these complications and your other concerns with Dr. Chartchai at the time of your in-person consultation.