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Breast Augmentation

Breast augmentation adds volume to the breast with a breast implant to increase fullness and create better balance with the rest of your figure. Your clothing options will expand tremendously, and you’ll be comfortable wearing many types of clothing you might have been uncomfortable wearing before.

There are different types of breast implants available, and three different approaches for augmentation. The small incision can be placed under the breast, at the edge of the nipple-areola, or in a skin fold in the armpit. There is no single best type of implant and approach for every augmentation. Breasts are extremely different and Dr. Forley believes in customizing the surgery to the individual patient. He uses advanced dimensional analysis techniques to determine the ideal implant choice to achieve your goals. He uses precise dissection techniques to create a form fitting pocket in which the implant is placed to optimize the natural appearance of the breast.

During pregnancy, breast enlargement occurs that stretches the skin envelope of the breast. When pregnancy and nursing are over the tissue within the breast shrinks, usually to a size smaller than it was originally. The skin, however, remains slightly stretched, and the smaller tissue filling the breast falls to the bottom of the stretched skin envelope. The result is usually a breast with somewhat loose skin, breast tissue located primarily in the lower part of the breast, and an empty upper breast. In many cases, a breast implant can be used to restore the natural fullness and proportions of the breast.

24 year old female 6 months following submuscular saline breast augmentation via armpit incision *Results may vary.

Is This For Me?

You should consider a breast augmentation if:

  • You have smaller breasts and desire a fuller cup size.
  • You find yourself wearing push-up bras and not wanting to do so anymore.
  • Your breasts are asymmetrical and you are unhappy with the shape.
  • If you’ve lost breast fullness after pregnancy.

The Consultation

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39 year old female 8 months following sub muscular silicone gel breast augmentation via inframammary fold incision

During your consultation, Dr. Forley will first ask about your medical history and to describe what concerns you most about your appearance. He will discuss your preferences regarding breast size, incision location, and how you would like your breasts to look. After examining your breasts, he will recommend a range of options for implant type, size and incision location that will be best for your breast and will balance the rest of your figure. The incision for breast augmentation can be placed in the fold beneath the breast, around the areola, or in the hollow of the armpit, depending on the type and size of implant to be used and your preferences. In any of these locations, very meticulous closure of the incision minimizes the visibility of the scar and maximizes its quality.

In most cases, the implant is placed partially behind the pectoralis muscle on the chest wall. Dr. Forley will discuss the best option for you depending on your preferences and your specific breast type. New techniques and implant choices allow very precise customization of the procedure to match your desired outcome and to achieve the most natural appearing breast possible. For example, Dr. Forley can narrow the distance between the breasts and produce more fullness or cleavage, increase fullness in the upper breast, add more lateral contour to the breast, or all three, depending on your preferences. Options for improvement of any breast asymmetries will be discussed.

41 year old female 3 months following submuscular silicone gel breast augmentation via periareolar incision *Results may vary.

Preparation

Your pre-operative appointment will be scheduled 2 weeks prior to your surgery date. A complete review of the surgical plan as well as instructions for you to follow before and after surgery will be discussed. The final decision on implant selection will be made using sizers to assist in your visualization of the result. Routine blood tests and a mammogram will be obtained in preparation for your surgery. A program of vitamins and supplements to optimize your healing and recovery will be provided to you during your pre-op visit. Photographs will be taken and kept strictly confidential.

The Procedure

Dr. Forley will carefully mark the incision sites and answer any last minute questions. The anesthesiologist will then review with you the twilight/sedation technique that is utilized exclusively in the Joint Commission accredited office surgical suite. During the procedure, Dr. Forley will create a precise pocket for placement of the implant. He will carefully control any bleeding and use antibiotic irrigation to reduce the risk of infection. A specialized device called a Keller Funnel will be used to enable placement of the implant through the small incision that is used by Dr. Forley. After final implant placement and position is achieved, considerable time will be spent to precisely closing your incisions to achieve the best possible scar result.

46 year old female 2 months following submuscular silicone gel breast augmentation via periareolar incision *Results may vary.

What to Expect After Your Procedure

All of your incisions will be carefully closed with stitches placed beneath the skin that will dissolve. You’ll be able to shower or bathe within 2-3 days. None of the sutures will have to be removed. Following breast augmentation procedures, most patients have discomfort for the first 2-3 days which then rapidly diminishes. Pain medication is provided to make you comfortable during the initial stages of recovery.

Your breasts may feel tight to you at first but this sensation will gradually resolve over the next several days as the initial stage of swelling decreases. You may develop slight bruising around the breasts, which will usually resolve within about a week.

The Stages of Recovery

  • Day of surgery: Usually performed as an outpatient procedure in our accredited office surgery facility.
  • Bruising and swelling resolve: Initially over 3-10 days but continued softening occurs for up to 4 months
  • Return to work, social activity: 3-4 days
  • Aerobic or strenuous activity: 14 days

We encourage a return to normal activities very rapidly. Just don’t do any type of strenuous exercise that would push your pulse over 100 for about two or three weeks. Any aerobic activity that increases your pulse over 100 also increases your blood pressure, and could make you bleed.

Potential Risks and Complications

Risks common to all surgical procedures such as bleeding, infection, loss of sensation, and thickened scar tissue formation occur in a very small percentage of cases. The risks of deflation, capsular contracture, and surface rippling are specific to implants. We will give you more detailed information about these and other risks in our written information and encourage you to discuss any which concern you during your consultation.

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1. Everyone will know I have breast implants. A natural appearance is a realistic expectation when implant selection is customized to the dimensions of your breasts and the proportions of your body. An implant that is too large will appear unnatural, make you look heavier, and ultimately result in sagging of your breasts as you get older. 2. Implants must be replaced every 5-10 years. Although there was a study that showed a slightly increased risk of implant rupture annually after 10 years, there is no general consensus that implants should be routinely replaced if you are satisfied and not having any problems with them. Every surgical procedure has risks and replacing intact implants that are problem free in anticipation of a possible leak could potentially result in an issue that you otherwise wouldn’t have to experience. 3. I will have to change my lifestyle or activities. You will need to modify your activities during the first 2-3 weeks following surgery. You will be able to resume your normal lifestyle following this recovery period. 4. A large enough implant will correct droopy breasts. In some cases, adding volume to the breasts with an implant will create a lifting effect by essentially expanding and increasing the projection of the breasts. However, this effect is limited and if there is more significant sagging a mastopexy or breast lift will be needed. Newer techniques with shorter scars can often be used to achieve the desired effect. 5. Implants feel unnaturally firm. Implants by definition are not going to feel the same as natural breast tissue. However, silicone gel filled implants have a very soft, compressible feel and are a very good approximation of breast tissue. Saline implants feel a bit firmer and less compressible but still result in a soft breast. The unnatural firmness that can occur in some breasts is usually the result of a contracture of the capsule that forms around an implant over time.
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