Breast enlargement surgery is now safer and more natural


For the Mirror

By using a camera inserted through a small incision, plastic surgeons can now perform breast enlargement surgery with greater safety and less scarring than ever before.

The camera, or endoscope, requires an incision only two to three centimeters in length –– large enough for the surgeon to see the chest structures and even place implants later filled with saline. Use of the endoscope has contributed to new approaches to this popular type of breast surgery, producing some of the best results to date.

Generally, there are three main methods that use the endoscope for placing breast implants. In the transaxillary approach, a small incision is made in the underarm. A key advantage of this approach is avoiding any scarring on the breast itself. This technique also allows placement of the implant below the chest muscle, which can reduce the chance of scarring around the implant (called encapsulation). In some cases, encapsulation produces firm scar tissue that causes discomfort, and may require repeat surgery for removal.

Another implant placement technique involves making the incision under the breast, usually where the underwire of a bra would rest. With this method, called the inframammary approach, women avoid scarring in the underarm area, which may be visible in some clothing. Again, the implant is placed under the chest muscle with the aid of the endoscope. In addition to reducing the potential for internal scarring, under-muscle placement helps prevent implants from interfering with future manual breast exams and mammograms.

Women who are interested in the possibility of greater scar camouflage may be candidates for a third type of endoscopic breast enlargement. In the periareolar approach, the incision is made where the nipple and breast skin meet on the underside of the nipple, or areola. While this method causes more scarring in the breast tissue itself, it can be less visible depending on the woman’s anatomy and whether the incision is placed precisely on the breast-areola juncture.

The size of the areolas is another important factor in the periareolar approach, since small ones may prove too limiting for the endoscope.

Further risks to consider are an increased chance of implant infection due to cutting into breast ducts and tissue, possibly resulting in implant removal.

The modern, safer companion to the endoscope in breast augmentation is the saline implant. The controversial silicone breast implants are no longer approved for cosmetic breast augmentation, making saline implants the exclusive choice for this surgery.

There are two types of saline implants in use today; textured and smooth-walled. While textured implants are more likely to be felt through the skin (a problem encountered by women with minimal muscle mass) they may provide more projection for smaller women who desire a proportionately larger breast size. Textured implants are also known for producing less internal scarring, or encapsulation.

Smooth-walled implants tend to be less visible than their textured counterparts, and less likely to be felt by the patient or others. The goal for either type of implant is proper placement, especially in relation to the areola, to create the most natural shape possible.

For many women, having children or significant weight loss has resulted in a loss of breast shape, or breast sag. While mild cases of breast sag can be corrected with augmentation, some cases may require the addition of a procedure called mastopexy. A mastopexy, or “breast lift” involves the removal of extra breast tissue, followed by surgically repositioning the areola higher on the breast. Mastopexy can be performed at the same time as breast augmentation, but is a more invasive surgery with greater potential for scarring. Women should also be aware that repositioning the areola can cause permanent numbness in the area, as well as loss of the nipple’s erectile function.

A woman considering any type of breast augmentation surgery must carefully consider the risks. As with any surgery, there can be problems with healing or infection. Encapsulation –– when a capsule of scar tissue surrounds the implant –– can become painful and sometimes deform the breast. Any rupture or leakage of the saline implant, while harmless in itself, will require replacement of the implant and another surgery.

If an implant becomes infected, it may require surgery to remove the implant before antibiotics can be effective in treating the infection. Once the infection is healed the implant can be replaced, but the patient may be living without the implant for an extended period of time.

For thousands of women, the use of the endoscope in breast augmentation has resulted in surgeries that are less invasive, produce minimal scarring and achieve a natural look. Women considering the surgery should participate in a detailed consultation with a board-certified plastic surgeon who routinely operates with an endoscope. Identifying the right surgeon, becoming educated and weighing the benefits and risks will help ensure each woman makes the best decision for herself.

Keith Paige, MD, and Katherine Redmon, PA-C, practice at Virginia Mason Federal Way. Paige is the medical director of Virginia Mason’s department of plastic and reconstructive surgery. More information is available at 874-1604.

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