Breast Augmentation

Choosing the material is important as well, as both silicone and saline are available. 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 newest 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. Choosing silicone vs. saline is entirely up to you and Dr. Ferguson can help you decide if you need further guidance.

Another 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. There is a third placement option as well where 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 elevated. 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 relatively less discomfort than even traditional breast augmentations, and patients are back to normal activities within 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 mammograms 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, says of this option: “Which gets closer scrutiny, the armpit or the exposed breast?”