Breast Augmentation is the most common aesthetic surgical procedure performed in the United States, with over 300,000 surgeries annually. The goal of breast augmentation is to enhance the size of the breast and mainly provide fullness to the upper portion of the breast. Currently, there are two types of implant available: saline and silicone. The implant can be placed above or below the pectoralis muscle (by flexing the muscle one can make the breasts move up and down), and many factors will determine which approach is better. Generally, I prefer to place the implant under the muscle because of more protection, less palpability, and less interference with mammography in the future.
For breast augmentation surgery, majority of plastic surgeons perform it either through an incision around the areola or underneath the breast crease. The advantage of the inflammatory fold incision (at the breast crease), is that the scar is not visible unless the patient is lying down. Also, the dissection causes minimal injury to the breast tissue when the implant is placed under the muscle. The final result is independent of the type of incision used, and is dependent on the surgical skill of the surgeon.
My goals is to recommend an implant which is proportional to the patient’s body, and make the implant look, feel, and behave as naturally as possible. If the patient has loose skin in the lower portion of the breast and the nipple position is low relative to the center of the breast, a breast lift (mastopexy) is then required. This breast ptosis (sagging of breast tissue) becomes even more critical to correct with an augmentation. Remember, for the best result, the nipple must be positioned at the center (the highest point of the implant); otherwise the breast shape will look unnatural. Therefore, it is imperative to correct any ptosis present.
I perform three types of mastopexy, and each is chosen to give the best result for an individual patient. The first is a peri-areolar mastopexy (donut lift). In this procedure, a circle of skin is removed around the areola and the skin in closed in a circle. This results in the incision being around the areola. The second type is a vertical mastopexy. Not only is a donut lift performed, but some skin is removed in a vertical fashion from the breast as well. The final incision looks like a lollipop. There is an incision around the areola, and an incision going down from the areola towards the base of the breast. The most aggressive lift is used for patients who have a lot of loose skin and the nipple is at the lowest portion of the breast. The incision is a vertical mastopexy with the addition of an incision underneath the base of the breast. This type of mastopexy is also called an anchor lift, since the final incision looks like an anchor. In all cases, the size of the areola can be reduced, if needed.
My goal is to obtain the best result with the minimum amount of scarring. Patients are always afraid of the final shape of the scars. Fortunately, unsightly scars are rare. I have performed hundreds of breast augmentation and lift procedures, and the risk of noticeable scar formation is less than 1% in my experience.
I have attached before and after photos to illustrate the effectiveness of these procedures.
Dr. Jazayeri is a board certified plastic surgeon with over 10 years of experience. To schedule a complimentary consultation at our Santa Ana office, please call 714-834-0101.