Augmentation

Breast Augmentation, also known as augmentation is a surgical procedure to enhance your breast contours, making them larger and fuller. This achieved by using “breast implants” or by “fat transfer” to the breasts.

I always tell my patients that the ultimate goal of the breast augmentation surgery should be. Natural and proportionate body contours, and not the quantity of implant. Breast augmentation is not just about increasing breast size. It is a procedure that needs to be artistically and meticulously balanced with your specific anatomy and desires.

Breast Augmentation is usually done as outpatient procedure, twilight anesthesia, and the patient can go back home the same day.

Breast Augmentation is a good option in the following cases:

● Underdeveloped breasts, also known as breast hypolapsia
● Breast deflation after pregnancy, or major weight loss
● Correction of natural breast asymmetries, where one breast is smaller than the other, or deformed
● Breast Implants, due to breast reconstruction after mastectomy

A breast enhancement surgery can add/ restore volume and fullness to the breast, and improve your confidence and self-image. But, it does not correct drooping or sagging breasts, which might require a breast lift surgery. That may combined with the breast augmentation if appropriate.

It is very essential for me that you are clear on why you are considering breast augmentation. So, even before your initial consultation, you should reflect on some questions:

● Are you clear about what is wrong with your breasts?
● Are you thinking of breast augmentation as a life-changing procedure?
● What are your goals and expectations from the surgery?
● Will you be comfortable and confident with the changes from the surgery?
● Do you understand that the correct size for you is specific to your body contours, and the goal is not about achieving any particular size?
● Do you accept that minor flaws are likely to remain?

I will be asking you these questions in my initial consultation, and your answers will help me to assess whether. You are a right candidate for breast implants.

If you are an adult woman, who is in generally good health, not currently pregnant or breast-feeding. Ideally a non-smoker, have a positive attitude, and have realistic expectations from the surgery. You are potentially a good candidate for breast enhancement.

To emphasize, if you are under 18 years of age. Then your breasts haven’t fully developed, and you should not consider breast augmentation until later.

I will be keenly assessing your suitability for breast implants through your answers in our initial consultation, and will. Proceed only if satisfied that you are a good candidate.

Breast augmentation can  done by transfer of fat from your other body parts to your breast, or by inserting implants in the breast.

When breast augmentation surgery is done via implants, there are 3 factors that affect the technique:

● Implants type
● Incisions type
● Implants placement method

We will review each of these in separate sections below.

As mentioned earlier, breast augmentation can  achieved even without inserting external implants – by using fat from. Your other body parts via liposuction, and injecting it in your breasts.

This option is more “natural” – as no external devices are implant but it works only for small increase. In breast size – just 1 cup size; or where volume required only in the upper breast. The drawback of this method is the possibility that the body reabsorbs the injected fat. It is also a more expensive technique.

The implants inserted in the breast to increase your breast size are essentially of two types:

● Silicone implants
● Saline implants

Silicone Implants

Silicone implants are breast implants that filled with silicone gel. They mimic the natural feel of breast tissue and are the most preferred type of breast implants. The newer and more cohesive “gummy bear silicone breast implants” have advantages over. The traditional silicone gel implants in that even if the implant ruptures, the gel does not leak. Modern, high quality, FDA approved implants today come with 15 years warranty. Provide excellent and long-lasting results, and deemed medically safe.

With silicone implants, you will need regular ultrasound or MRI screening to ensure the implants are working properly.

Saline Implants

Saline implants, as the name suggests, are fill with sterile saline (salt) water, within a silicone shell. Saline breast implants feel less like natural breasts compared to the silicone implants. The volume of saline water filled in the shell is adjustable and that determines. The size of the breast and affects its shape and feel. If the implant leaks, the body naturally expels the salt water.

Implant Shapes and Textures

Both silicone and saline implants come in different shapes (round/ tear-drop shaped) and textures (smooth/textured).

Typically though, saline and traditional silicone implants are generally round, while the gummy bear silicone implants can be round or shaped. A skilled breast surgeon can either implant look natural. Round implants provide fullness to the upper breast, while shaped implants provide a slightly tapered or sloped look, being wider at the base and tapered at the top.

Smooth breast implants provide a sleek and uniform surface to the breast and have lower chance of rippling. Textured breast implants designed to add more firmness to the implant and reduce. Their movement within the breast tissue, so that the breast shape, particularly in shaped breast implants, does not distort.

There isn’t really one “best” implant type. The type of implant that will I will choose for you will be a personalized decision. That depends on your specific requirements, your anatomy, size change needed, scar and placement preferences, your maternity plans, and other relevant factors.

1. What are the different types of incisions for breast implants?

There are 4 different places where incisions can  made for implant placement:

● Below the breast crease – Inframammary / Sub-mammary incision – This leaves behind a thin scar that gets concealed within the breast crease. It allows for wider reach and therefore, larger implants can be place more precisely with this technique
● Around the areola – Peri-areolar incision – Incision  made along the outer edge of the areola, concealing the scar in the dark pigmentation of the areola. This technique is generally when a breast lift surgery is also being combing with the augmentation surgery
● In the armpits – Trans-axillary incision – Incision made in the armpits and the placement guided to the desired position using specialized equipment and camera

Above the belly button – Transumbilical incision – Single incision made just above the belly button through which the implant is guid up to the breasts.

There are 4 different places where incisions can made for implant placement:

● Below the breast crease – Inframammary / Sub-mammary incision – This leaves behind a thin scar that gets concealed within the breast crease. It allows for wider reach and therefore, larger implants can be place more precisely with this technique
● Around the areola – Peri-areolar incision – Incision  made along the outer edge of the areola, concealing the scar in the dark pigmentation of the areola. This technique is generally when a breast lift surgery is also being combing with the augmentation surgery
● In the armpits – Trans-axillary incision – Incision  made in the armpits and the placement guided to the desired position using specialized equipment and camera

Above the belly button – Transumbilical incision – Single incision made just above the belly button through which the implant is guid up to the breasts.

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Implants are usually placed either:

● Under the chest muscle – Sub-muscular placement – With this option, implant gets cover by the muscle, so it’s not easily felt
● Above the muscle, but under the breast glands – Sub-glandular placement – This option allows for faster recovery

I have attained specialization in a newer placement technique, called “dual pane breast implants”, wherein the implants inserted partially under the muscle and partially under the breast glands. I use this specialized technique only in select patients after an evaluation. Dual pane breast implants last longer without sagging.

Yes, it is possible for you to breastfeed successfully with breast implants, and so a breast augmentation surgery can be doing even. If you have maternity plans for later. Research has not shown any harmful effects on breast milk due to implants. Depending on your implant placement (under the chest) and the incision-type (under the breast, armpit or umbilical. You should be able to breastfeed without any concerns.

It is, however, possible that during surgery, milk ducts, nerves, or glands get damag affecting breast milk flow or production.

I will discuss your maternity plans during our consultation and determine. The right technique for you based on those discussions and other pertinent factors.

X-rays used during mammograms cannot go through saline or silicone implants to reveal the underlying breast tissue. So, it’s possible that a part of the breast is not visible in the mammogram making. It difficult to detect any abnormalities therein.

However, by going to an experienced radiologist and letting the radiologist know that you have breast implants. The radiologist can take the mammogram by displacing or moving. The implant out of the way to get a fuller look at the breast tissue. This is more easily achieved when the implant was place behind the muscle (sub-muscular placement) during surgery.

In rare cases, because of the pressure applied to the breasts in a mammogram, the implant can rupture. However, since the technician when informed of the implants lifts. The implants out of the way, the chances of the damage are minimal.

In those patients where it is difficult to move the implant to do the mammogram. The alternative is to do a breast ultrasound or MRI, both of which are effective in screening for breast cancer.

Breast augmentation done with modern, high quality breast implants by a skilled surgeon can last for 15 years or more. However, implants are medical devices that can damage or rupture due to time or accidents, or because they have reached the end of their prescribed useful life. In such cases, a re-operation will be need.

Your natural breasts itself, may still sag or lose volume due to ageing, breastfeeding or weight loss.

Where breast augmentation done via fat transfer, if the injected fat  reabsorbed by the body over time, you may need to redo the procedure.

At my clinic, I use the highest quality FDA approved implants which come with 15 years warranty. Additionally, in appropriate cases, where I do the breast augmentation surgery using the “dual pane non-sagging breast implants” specialty technique, the results obtained are very effective and long-lasting.

The surgery itself takes 1-3 hours, is usually an outpatient one, and you can go home the same day. Most women are able to resume work within 7-10 days, and might need just 1 week leave from work along with 2 weekends.

I will prescribe what exercises will need to be doing to aid recovery, use of pressure garments, medication, etc. Heavy exercises should only be resume after my consent.

Every surgery carries some risks, but at this stage of my experience and expertise, the risks that my patients have are minimal. Standard risks include:

● Anesthesia risks
● Bleeding
● Infections of any kind
● Scars
● Need for corrective surgery
● Reduction/ loss of sensation in nipple or breast
● Damage to milk glands, nerves, ducts
● Implant risks – capsular contracture, implant rupture/ leakage, rippling

Risks are minimize in the hands of an expert surgeon, by doing the surgery in a good, licensed clinic or facility, following proper protocols; and by the patient carrying out all given instructions – both before and after surgery.

Breast augmentation cost varies based on the following factors:

● Type of implant, placement, and incision
● Whether the procedure is being doing under general or local anesthesia
● Whether it involves overnight stay
● Hospital/ Clinic used for the surgery
● Skill & expertise of the breast surgeon

When breast augmentation is done as a cosmetic procedure, insurance does not cover the cost. If, however, it done for medical reasons, such as, after a mastectomy, all or part of the cost may be cover by insurance. Please check with your insurance provider about your policy entitlement.

Another significant aspect to take into consideration, besides just the initial surgical costs, is your comfort factor with. The breast surgeon, and your faith in the surgeon’s expertise. Pay a bit more – but be sure, and be comfortable with your surgeon.

This is especially important, because if not done right the first time, you might need a revision surgery; so, consider that in your decision-making.

The choice of your breast surgeon is a decision to made with due care. While cost is a relevant consideration, there are other more important factors that should determine your decision:

● Qualifications and certification, specifically plastic surgery related certifications and memberships, such as membership of American Society of Plastic Surgeons (ASPS)
● Years of experience as a plastic surgeon, number of surgeries done
● Number of breast surgeries done
● Proof of work – before/ after images
● Patient testimonials
● Surgeon reputation
● Your comfort factor with the surgeon, his manners, his patience in answering your questions
● Surgeon’s philosophy regarding patient safety

You are planning a significant surgery, and one that requires very specialized training and even artistic flair, so it’s extremely important that you decide wisely. Pay more if needed, but choose a surgeon who has an extensive portfolio of successful breast surgeries. Make sure that you are fully comfortable with your surgeon.

The clinic or hospital for your breast enhancement surgery done should be carefully chosen. Ensure that the facility is license. A hospital is not necessary for a breast surgery, an accredited/ licensed clinic is just fine.

The clinic should have a licensed anesthetist on board, competent nursing and operations staff, and the surgical room should be clean and hygienic.

Ministry of Health (MOH), Dubai regularly conducts inspection of all medical and surgical facilities in Dubai and license. Is granted or renewed only if the prescribed conditions regarding hygiene, safety, etc. met.

My medical center – Cocoona Center for Aesthetic Transformation, Dubai is an MOH-licensed clinic, and. We permitted to perform surgeries under local anesthesia. We also have competent anesthesiolgists on board, and a full team of caring and professional nurses, patient counselors, and other support staff.

If your surgery needs to performed under general anesthesia, we can do it at another licensed facility of your choice, or where we have a tie-up.

● What aspects of your breast are bothering you the most?

This is a very specific question that helps me identify what is bothering. You and I can compare your concerns with actual physical findings. If it matches, I am confident of giving you a good result.

● What is your present cup size and what size are you expecting?

It is very important for me to understand your expectations. I will than analyze if they are realistic or unrealistic. I will explain to you what to expect, and whether I will be able to meet your expectations.

Many people are not aware of cup sizes. Read further to understand it.

● Measure your band size – Place a tape around your body just underneath your breasts and take the measurement in inches. Make sure the tape measure is horizontal and fairly snug. Bra band sizes are usually an even number. If this measurement is an odd number, then you should try out bras in both the size below your measurement and the size above. If you measured 31 inches, your band size could be 30 or 32.

● Determine your cup size – Your cup size is not an absolute measure — it is measured in proportion to your band size. Bend over so that your chest is parallel to the ground. Measure around your chest with the tape over the most prominent part of the breasts. Now to calculate your cup size, you will need to subtract your band measurement from the cup measurement you just took. The difference between the two numbers determines your cup size:
● Less than 1 inch = AA
● 1 inch = A
● 2 inches = B
● 3 inches = C
● 4 inches = D
● 5 inches = DD
● 6 inches = DDD (E in UK sizing)
● 7 inches = DDDD/F (F in UK sizing)
● 8 inches = G/H (FF in UK sizing)
● 9 inches = I/J (G in UK sizing)
● 10 inches = J (GG in UK sizing)

Some people prefer minimal changes that will not be hugely obvious, others prefer radical changes. Some patients ask for natural results, which I am happy and skilled to provide. I am not comfortable with unnatural looks.

At the end of the day, your breasts need to not only look full, they also need to be proportionate to your anatomy and look realistically aesthetic.

● What is your medical history?

I will inquire about any past surgeries, pregnancies, medical illnesses, allergies, ongoing medications, motherhood plans, etc., to gauge your suitability for surgery, and which technique of surgery will be best for you.

After I’m through with my initial questions to you, and upon getting an idea of your expectations from the surgery, I will do a breast examination. I will evaluate the following:

● Breast proportions – size, symmetry, nipple height and position
● Breast footprint
● Volume and quality of breast tissue
● Skin elasticity

I use computer morphing to display and discuss the final post-procedure possibilities. That gives a visual idea of the possible outcome. I discourage extensive computer morphing, as it can be unrealistic and causes misunderstanding between patient and doctor.

Based on my findings from the examination and our earlier discussion, I will determine which method of breast surgery would be most suited for your specific case.

The basic breast augmentation process involves making incisions based on specific circumstances, either under the breast crease, or around the areola, or in the armpit, or above the belly button; inserting the implant, or injecting the fat through the incision; and then closing the incisions.

Your surgery will be done either at an accredited day care surgical facility such as my medical center in Dubai – Cocoona or a hospital, depending upon your choice, and anesthesia considerations.

Understanding the process involves knowing about anesthesia, basic surgery steps, post-procedure recovery, return to normalcy, risks involved, and expected results.

● What anesthesia is used?

The procedure involves some form of anesthesia. Depending on the type of placement, the surgery can be done under local anesthesia with sedation, though it is usually done under general anesthesia.

● What type of breast augmentation will be done for you?

The type of breast augmentation, including decisions on type of implant, placement of implant, and type of incision – will be a decision that I will arrive at based on the extent of changes that are needed to achieve your desired shape, your cosmetic expectations from the surgery, and your motherhood plans.

There isn’t one best approach and technique – I will customize your surgery plan exclusively for you.

● How is a natural looking shape attained?

The key to performing a natural looking breast augmentation surgery is to understand the proportions of the breast in relation to the rest of the anatomy – which is both a science and an art, correct the aesthetics, have minimal visible scarring, use high quality implants, and ensure that the implants retain their shape.

It’s also important to understand that a breast size or height that looks beautiful and natural in another person, might look out-of-place in your body, as each person’s natural anatomy is differently proportioned.

You should also note that it is not possible to have an extreme cup size increase – like going from a size A to size D in one surgery.

At this stage, you are likely to have few more questions for me to clarify. Some such questions covered herein. I will be glad to answer these and any other concerns you have.

● What is the recovery phase immediately after the procedure?

After the surgery, you will be up and about in a few hours, and be able to go back home the same day.

Following the surgery, your breasts will be bandaged and you will given support bras to reduce the swelling and hold your new shape.

There will be bruising, swelling and soreness for about a week to 10 days, which will gradually disappear. Your new breast shape will be visible immediately after the swelling has subsided. You will prescribed ointments, pain medication and antibiotics to help recovery.

Most of my patients return to work in 1 week to 10 days. Intensive exercise should undertaken only after 2-4 weeks, and with my consent.

● What should be doing post-surgery to improve the results?

Strictly follow the recommended post-surgery plan for faster recovery – including taking your medications, and keeping your follow-up appointments schedule.

Using support garments will also help to keep the initial bruising and swelling under control.

Keep a generally healthy lifestyle to retain your results. Do regular breast mammogram or ultrasound to check your implant/ breast health and condition.

● When will the results be visible?

Once your initial swelling subsides within 1 to 2 weeks, your enhanced breast contours will be clearly apparent, though you will be immediately able to see the increased size after surgery.