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Breast Augmentation Surgery

INTRODUCTION

Breast Augmentation or Augmentation Mammoplasty has always been one of the most popular cosmetic surgery procedures. Its popularity is a testimony to this operations success rate and reflects the large number of women with a need to achieve a larger fuller breast. Some women undergo augmentation because their breasts have failed to develop normally. Others are seeking to restore their once well developed breasts that have lost volume due to pregnancies or weight loss. Although this operation is purely cosmetic in nature most breast augmentation patients will credit the surgery with also enhancing their self image and self confidence.

The Implants

The operation relies upon the insertion of a breast implant in a surgically created space located either between the breast tissue but over underlying chest muscle or beneath both breast tissue and muscle and resting on the rib cage.  Without the evolution of medically safe breast implants this operation would not be possible. The first implants that actually worked were developed in the early 1960's and were made out of the material known as Silicone.  To this day Silicone has remained the only viable substance out of which to construct a breast implant. The FDA has carefully studied these implants and has anointed them with its seal of approval. Patients can therefore be confident that having implants will not lead to any long term health risks.

There are two types of Silicone Implants. One type consists of an outer shell made of silicone that functions like a balloon and is filled with a salt water solution after insertion into the patient. This type is commonly referred to as the salt water or saline implant. The second type again has an outer Silicone shell but it comes already filled internally with Silicone in the form of a very thick gel. This implant version is known as the Silicone Gel Implant.

There are pros and cons to each implant but there is really no difference in how they look. Not that this would be done, but should a Saline be placed in one breast and a gel in the other visibly they would look the same. This is because the Gel and Saline implants have the same basic structural shape. The Gel generally requires a larger incision through which it is inserted and therefore on average results in a larger telltale scar after surgery.  On the other hand the Gel implant is felt to more closely mimic the consistency of normal breast tissue than dose the saline implant. This makes the Gel enhanced breast feel more natural, again on average, than the saline enhanced breast. A careful discussion of these implant differences with Chicago Plastic Suregon, Dr. David Ross will be necessary to determine which one is right for yourself.

Choosing Implant Size


The size of implant chosen is obviously critical to the operations outcome in many ways. Truly, only the patient herself knows what size she visualizes as best for herself and therefore hopes to arrive at from surgery.  During preoperative consultations, Chicago Plastic Surgeon, Dr. David Ross will come to an understanding of the size increase each patient desires and the size implant this increase requires. His goal is achieve this exact size.  However, it is not possible to predict before surgery the precise size of implant that will surgically fit in a given patient. Therefore it is not always possible to guarantee a specific implant size and a final cup size change prior to the operation. Chicago Plastic Surgeon, Dr. Ross' clinic stocks every implant size manufactured and every effort will be made to insert the implant of choice. However, if the preoperatively chosen implant is found during surgery not to fit properly then a size adjustment must be made to avoid an unnatural look to the breast.

The Operation


Breast Augmentation is an outpatient operation that is most commonly performed under a general anesthetic and requires approximately one hour of operating time. The surgery involves inserting the implant through one of three commonly use incisions, in the arm pit, around the areolar or in the fold under the breast. As noted, the implant is either placed above or below the muscle depending on the amount of breast tissue each patients possesses. In general, if the patient is at least a B cup they will have enough tissue to camouflage the implant thereby avoiding the appearance of ripples and wrinkles on the surface.  In fact, patients with a B cup or larger and a slight droop to the breast could have a distorted result if their implant is placed under the chest muscle.  For most patients with less than a B cup a submuscular placement becomes mandatory. At the conclusion of the surgery a tight compression bandage is applied and the patient sent to recovery for several hours prior to discharge.

Recovery


The patient returns the day after surgery to remove the bandages which are replaced with a supportive brazier. It is critical that the patient avoid vigorous arm movements particularly at the shoulder joint for the first three days. Such arm movements have been known to cause bleeding around the implant requiring surgery to evacuate this collection of blood.  Analgesics will generally be required for the first three to possibly five days.  One could return to a sedentary occupation usually by day three after surgery. By the end of the first week most patients are feeling quite comfortable and able to perform their normal daily routines. Vigorous athletic endeavors can resume at three weeks after surgery. .

Other Procedures Performed by Chicago Plastic Surgeon, Dr. David Ross:

Breast Augmentation above the muscle - In the "over" approach, the implant is sandwiched between breast tissue above and the underlying pec muscle.

Breast Augmentation below the muscle - With this approach, the implants lie beneath both the breast and the muscle and are directly on top of the rib cage.

Axillary Breast Augmentation - The axillary approach to breast augmentation involves making an incision in the armpit through which the implant can be placed either above or below the muscle. The advantage of this procedure is that the resulting scar is hidden in the armpit.

Periareola Breast Augmentation - Periareolar Breast Augmentation has been a popular breast augmentation procedure for many years due to the fact that the scars can be camouflaged by placing them at the junction of the pigmented areolar skin and the non-pigmented skin of the breast. Access for placement of breast implants either above or below the chest muscle is excellent.

Breast Augmentation with Cohesive Gel Implants - What distinguishes cohesive implants is that the silicone gel is firmer, essentially a soft solid. If a cohesive implant is cut in half, there is no gross movement of gel, and the implant maintains its shape. This eliminates the concern of gel migration should the implant break.

Breast Augmentation with Textured Implants - Textured breast implants differ from smooth breast implants because of their fine sand paper like surface. Theoretically, the texturing reduces the complication rate of capsular contracture.

Breast Augmentation with High Profile Implants - High profile implants provide a result with more outward projection.

Breast Augmentation with Tear Drop Shape Implants - Teardrop breast implants which mimic the natural shape of a woman's breast would be a logical choice for breast augmentation. However, because of their capacity to rotate, they may create un-natural superior pull fullness. 

Breast Augmentation with Gummy Bear Implants - Gummy Bear implant is another name for a cohesive gel implant.

Breast Implant Replacement - A Breast implant can be easily exchanged for one of larger or smaller size or from saline to silicon depending on patients’ desires.

Capsular Contracture - Capsular contracture is a complication that results from a natural production of scar tissue that develops and completely encircles the breast implant within a few months of implantation. This scar tissue contracts around the implant causing the breast to feel firmer and sometimes even distorting the breast appearance. Statistically, this complication happens 5-10% of the time.

TUBA Breast Augmentation - TUBA stands for Transumbilical Breast Augmentation whereby a saline implant is tunneled through an incision in the patient’s navel up into the breast.

Uneven Breasts/Asymmetrical Breasts/Problem Breast Surgery - For women who have more than a normal breast asymmetry (such as a cup size difference between the two it is possible to correct this. Depending on the exact nature of the difference, a breast reduction, lift or augmentation may solve the problem.

Type of Implants used:

Saline Implants - Saline implant consists of an outer shell of silicon elastomer that is filled with a solution of salt water called normal saline. The shell is filled with this salt water through a fill tube inserted through a self-sealing valve in the implant after it has been placed in the patient.

Silicon Implants - Silicon gel implants consist of an outer shell of solid silicon elastomer filled with a silicon gel.

Cohesive Gel Implants - Cohesive gel implants consist of an outer shell of solid silicon elastomer that contains semi solid silicon gel also known as Gummy Bear Implants.

Textured Implants - Textured implants refer to either a silicon gel or saline implant with an outer shell that has a fine sand paper surface.

High Profile Implants - High Profile implants have a greater projection to base diameter ratio.

Tear Drop Shape Implants - ear Drop Shape implants are designed to mimic the natural shape of a woman's breast with an upper slope that leads into a fuller lower portion of the breast.

Gummy Bear Implants - Gummy Bear Implant is another term for the Cohesive Gel Implant.

Pec Implants - Male pectoral implants are a implant made out of a semi solid silicon that mimics the consistency and shape of the pectoral muscles commonly called pecs. The implant is commonly inserted through an incision in the armpit and beneath the existing pectoral muscle. It creates a look similar to that achieved through weight training.

RISKS AND POTENTIAL COMPLICATIONS


Post-op bleeding and infection are rare.  Approximately5-10% of patients will suffer a scar tissue contracture around the implant resulting in a firmer feeling breast.

DISCLAIMER


Though the above description of breast augmentation is accurate, it is also incomplete. The best way to determine whether you are a candidate for breast augmentation surgery/breast implants surgery, form of breast augmentation surgery/breast implants surgery and the breast augmentation cost/breast implants cost is to schedule a personal consultation with Board Certified Chicago Plastic Surgeon, Dr. David A. Ross of the Liposuction and Cosmetic Surgery Institute located in Chicago, Oak Brook, Naperville, or Arlington Heights, Illinois. That way, your specific anatomical requirements and aesthetic desires can be discussed. A plan can then be made of how to improve your breast appearance by Dr. David A. Ross.