Breast Augmentation

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Breast augmentationis consistently rated one of the most satisfying cosmetic procedures by patients and cosmetic surgeons alike.  With proper training and experience, the procedure is straightforward. Patients will oftentimes undergo a noticeable emotional change along with their physical one. A shy, reserved woman may become outgoing and self-assured almost overnight. It is no wonder that breast augmentation is also one the most often performed cosmetic procedures.

The overall goal of breast augmentation is to increase the volume of the breasts regardless of whether the primary concern is breast size, congenital deformity, loss of volume after pregnancy, or asymmetry. Fortunately, implant size, shape and placement can be customized to fulfill individual patients' desires. At the initial consultation a careful examination by Dr. Ferguson allows him to evaluate body shape, breast shape and skin texture as well as volume. Subsequently, a plan is made together by the doctor and patient.

Breast ImplantsThe first decision is what type of implant to use. Size and shape are discussed. Most patients already have a cup size in mind, but they are encouraged to find a bra in their desired size, put it on, and fill the cups with rice inside hosiery. Wearing this around all day will give an accurate idea of what it will be like after surgery. Obviously, the question of silicone vs. saline will come up. This is entirely the patient's decision after discussing the advantages and disadvantages of each. Saline breast implants contain an outer shell of silicone within which the saline solution is placed. The new and improved silicone gel implants have the same outer silicone shell within which is a new cohesive silicone gel. Unlike the old silicone implants, which were more like a liquid, the new cohesive gel implants act more like a solid than a liquid and hold together uniformly while still retaining the natural give and feel of natural breast tissue. This gelatin - like cohesive silicone gel is much less likely to leak, rupture or tear as compared to the older traditional silicone implants, and the implant does not leak even when cut in half. Dr. Ferguson is certified by Mentor and Allergan to use their new silicone implants. These new cohesive silicone gel implants have a more natural feel and are less likely to produce rippling than saline breast implants. The cohesive gel implant requires a slightly larger incision to allow placement.

Boob PlaneThe second most important consideration is the placement of the implant. The breast implant can be placed either partially under the pectoralis major muscle (submuscular) or on top of the muscle and under the breast glands (subglandular) depending on the thickness of your breast tissue and its ability to adequately cover the breast implant. The submuscular placement may make surgery last longer, may make recovery longer, may be more painful, and may make it more difficult to have some reoperation procedures than the subglandular placement. The possible benefits of this placement are that it may result in less palpable implants, less capsular contracture, and easier imaging of the breast with mammography. The subglandular placement may make surgery and recovery shorter, may be less painful, and may be easier to access for reoperation than the submuscular placement. However, this placement may result in more palpable implants, more capsular contracture, and more difficult imaging of the breast with mammography. 

In the third option a thick layer of tissue called fascia overlies the pectoralis muscle. Using this subfascial plane often combines the advantages of both traditional planes. It is extremely rare for Dr. Ferguson to place implants in a subglandular fashion.

For patients with much of their own breast tissue or have moderate drooping of the breast tissue with most of the bottom have of the breast facing the chest the usual treatment is to combine placement of an implant and a breast reduction/lift. However, there is an alternative technique that Dr. Ferguson has mastered, the dual-plane approach. Through a small incision just above the lower crease of the breast, the lower half of the breast that is facing the chest wall is disarticulated off the pectoralis muscle before the muscle is elaveted. This allows the implant to support and expose the lower half of the breast with upper half of the implant below the muscle filling in the often depleted upper pole of the breast. The back of the implant is against the chest wall, so once the breast heals there is no long-term inferior displacement of the implant, the breast gets a nice lift, and it is all done through a small incision. This approach has reletively less discomfort than even traditional breast augmentations, and patients are back to normal activities with in one week.

The final decision concerns the placement of the incision and, therefore, the scar. There are pros and cons to each option. At The Ferguson Clinic this decoction is left to the patient after discussing each with Dr. Ferguson and the staff. Dr. Ferguson is well-trained and experienced in each approach.

The inframammary approach has been around the longest and is still the preferred approach by many surgeons, as it allows excellent visibility and minimal disruption of the glandular tissue of the breast. This is the preferred route for re-operation.  

Currently, the most popular incision among surgeons is the peri-areolar incision. This allows easy access to the appropriate planes, and the scar is usually well-camouflaged in the nipple-areola complex. There are two disadvantages to this route since it traverses the milk-producing glands of the breast. There is an increased incidence of infection (the glands harbor bacteria) and nursing problems. A new disadvantage is being seen recently. The scarring that occurs in the breast tissue may calcify over time and lead to false positive mamograms in the future.

Transumbilical breast augmentation, or TUBA, involves making an incision within the navel and using specialized instruments to place the implants. The limiting factor involves the technical demands placed on the surgeon. Dr. Ferguson is well-experienced in this approach and will use it in the patient with favorable anatomy.

The final incision, transaxillary, has also seen limited utilization due to its technical demands. This is Dr. Ferguson's preferred approach. Endoscopes allow complete visualization of the area, and the incision is away from the breast. Its primary complaint among surgeons is that the incision is not covered by bikini or sleeveless tops. With proper placement, closure, and postoperative care the incision is as well camouflaged as any of the other approaches. Under close inspection all scars are visible. Dr. Ferguson, again: "Which gets closer scrutiny, the armpit or the exposed breast?"
One to two weeks before the procedure you will have a preoperative visit where we will go over the plan with you one more time, give you your prescriptions, make sure no new issues have arisen, and discuss what to do and what to expect before, during, and after your procedure. You will be given a Valium to take before you come to the office the day of your procedure. There are two things we do not believe in at The Ferguson Clinic: pain and anxiety. We want to you to have a good experience.

Then, on the morning of your operation, Dr Ferguson will then meet with you and the responsible person who will be taking care of your postoperatively. Dr. Ferguson will make a few marks on you, then it is off to the procedure room. You will be given a mild sedative followed by local anesthetics. The procedure usually takes about an hour to an hour and a half. The incisions are closed with absorbable, dissolving sutures and drains are rarely used. A support garment is placed, and you will be discharged to the responsible adult within one to two hours. Within an hour most patients are ready to go home.

There is usually little pain the first few days, mostly just a mild to moderate aches. We will see you the next day in the office and remove your support garment. Bring a sports bra to wear home. At that point you can go home and shower, but you will need to avoid raising your arms above your shoulders for two (2) weeks. Other than that, you can resume most other activities the day after the procedure. You will then return 7- 14 days later depending on the approach used, and the small tape that covers the incisions is removed. You will usually be instructed in breast massage. The timing of the next visit varies from patient to patient, but is usually within a month.

For more information about having breast augmentation in Honolulu Hawaii contact Dr Ferguson today.


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