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Four Important Considerations Before Breast Augmentation
A breast augmentation can do wonders for a woman's self esteem. It is not a surgery to be taken lightly and there are many decisions to be considered before going under the knife.
For most women who decide to undergo breast augmentation surgery, the most important factor is that their new breasts look and feel natural and realistic. Several important factors can affect the appearance of augmented breasts, and each of these decisions should be made with the guidance of an experienced plastic surgeon. Saline or Silicone
The first important decision is whether saline or silicone implants should be used. There are advantages and disadvantages to both that you should consider before making the choice between saline and silicone. Silicone implants tend to have a softer, more natural feel. They also tend to be smoother, and it is less likely that rippling or scalloping will occur. However, silicone implants also have some downsides. The implants are pre-filled, which means that you must be confident what size implants you want before surgery. Because they are pre-filled, a larger incision is required to insert the implant so the scarring may be more significant. The implants also tend to interfere with mammograms; an MRI is required every two years, and this test is typically not covered by insurance. Finally, there is a history of silicone implants leaking into the body and causing medical complications. Silicone implants are approved by the FDA. Saline implants, on the other hand, can be inserted through a smaller surgical incision as they are not pre-filled. Once inserted, the implants are injected with the saline solution. The smaller incision results in less noticeable scarring. Saline implants also carry less of a risk of capsular contractions, and any saline leaks can be absorbed into the body without causing harm. Finally, saline solutions do not cause as much interference with routine mammograms.The downsides to saline implants include a less natural, harder feeling breast, and an increased potential for rippling or scalloping. Rippling and scalloping refer to a wavy appearance of the skin of the breast. This potential side effect is more likely in women who have a smaller amount of breast tissue to support the saline implant. 
The Shape of the Implant
Most implants are either tear shaped, which seems to more closely mimic a natural breast, or round. According to Walter Tom, MD, a California cosmetic surgeon who specializes in breast augmentation, while tear shaped implants seem to be best for patients desiring a natural look, they can rotate out of position and require surgical revision. This is the primary reason why many plastic surgeons use traditional round implants. Size is Also a Factor
Dr. Tom states that “the larger the implant, the less natural the shape of the upper pole of the augmented breast.” Larger implants are also more likely to ripple, and the risk of capsular contraction is increased. Location of the Implant
Implants can be placed either over or under the muscle and the different results can greatly affect the augmentation's outcome. Under-the-muscle placement is most commonly recommended, but the trend is shifting towards over the muscle placement because it results in a more natural, sloping breast as opposed to a rounded breast.
Breast implants placed over the muscle can result in a greater appearance of cleavage, and there is less trauma so the patient recovers more quickly. However, placing the implants over the muscle increases the risk of capsular contraction, and makes mammograms more difficult to interpret. Finally, women who have a smaller amount of breast tissue may be unable to have the implant inserted over the muscle because they will not have enough breast tissue to cover and support the implant.Location and Visibility of the Scarring
Even if an implant looks natural, noticeable scarring can be aesthetically unpleasant and destroy the illusion of a natural bust line. The location of the incision is thus a critical factor, because this determines where the scarring will occur. Breast implants can be inserted through an incision in the armpit, in the belly button, around the edge of the nipple (called a periareolar incision) or in the intermammary crease under the breast. There are benefits and detriments to each incision location. The intermammary incision under the breast is very direct, and allows the surgeon visualization when inserting the implant.
An incision in the belly button is the easiest to hide, but only a saline implant can be used.
An incision under the armpit is easy to hide, but it is more difficult for the doctor to create a pocket for the implant due to the lack of direct access.
The periareolar incision is very popular as it also allows the doctor easy visualization of the results. The main drawback here is the possibility of difficulty breastfeeding in the future.Each of these decisions can have a dramatic impact on your satisfaction with your breast augmentation procedure. The decisions should be carefully discussed with your plastic surgeon so you can achieve the desired results.
Related Topics: Breast Augmentation | Breast Implants | Saline Implants | Silicone Implants | Dr. Walter Tom
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