Breast Augmentation

This procedure is appropriate for women with small or asymmetrical breasts.

Appropriate candidates for this procedure are women who want larger, more shapely breasts, and women who are seeking to balance the size of their breasts.

Patients considering this procedure are seen by Dr. Casso in consultation. Their goals are carefully considered. Patients are questioned about previous pregnancies and possible substantial weight loss or gain.

Patients are shown a database of photos of Dr. Casso’s breast augmentation patients who are categorized according to height and breast size. By viewing pictures of patients of a height and frame size comparable to them, patients are able to obtain useful information about how a given implant size may look inside their body. Patients are also allowed to inspect a variety of implant sizers, and place them inside their bra, in order to visualize what an implant might look like on their body.

Breast Augmentation Techniques

For most patients, an incision within the crease under the breast is recommended. This incision is typically well hidden and often nearly invisible after scar fading occurs. Other incision sites (peri-areolar, axillary, umbilical) are preferred by some physicians, but have disadvantages as compared to the inframammary incision (in the crease under the breast), which is typically recommended by Dr. Casso.

Generally, a pocket under the breast and pectoralis major muscle is recommended by Dr. Casso. By placing the implant under the muscle, the implant is camouflaged not only by breast tissue, but also by muscle. This helps the breast look and feel more natural. Also, formation of significant scar tissue (capsular contracture) is less with this technique.

Breast Implant Options

Patients have an option for a saline implant or a silicone gel implant. In the opinion of Dr. Casso, both devices are good products and have a strong record of safety. There are pros and cons, however, associated with each device.

Patients who are particularly thin, and who have very scant breast tissue often do best with silicone gel implants. In these patients, despite the fact that the implant may be placed under breast tissue and pectoralis major muscle, there are some areas (particularly the lower outer aspect of the breast), where there is no significant muscle available for implant concealment. In these thin patients, particularly when the tissues are particularly tight, some visible rippling, or waviness may be apparent if saline implants are used. While it is possible that this may also occur with silicone gel implants, the tendency for this is less.

On the other hand, in patients with a more normal body weight, or with at least a moderate amount of breast tissue, particularly in the lower outer aspect of the breast, visible wrinkling with a saline implant is uncommon.

There are some advantages of saline implants for patients. First of all, the saline implant is packaged filled with air. During surgery, the air is removed, the implant is inserted into the breast pocket created for it, and then it is filled with saline. As a result, the implant can be inserted into a small incision, which is typically about an inch long, in Dr. Casso’s practice. In contrast, the silicone implant is filled with silicone in the manufacturing process, so a larger incision must be made to allow for implant insertion.

Secondly, after the saline implant is inserted and filled, small adjustments in the volume of the implant can be made. This is particularly helpful for women who have breasts which are slightly asymmetrical in size.

Thirdly, breast implant manufacturers and the FDA recommend an MRI of the breast three years after breast augmentation with silicone gel implants, and every two years thereafter to rule out the possibility of rupture. This is not required of patients with saline implants, as a rupture is readily apparent when the body absorbs the harmless saline (salt water) within a couple of days. A surgical procedure is required in the event of such an implant leak to replace the ruptured device.

Fourth, the cost of silicone gel implants is slightly higher than the cost of saline implants.

Breast Augmentation Procedure

The breast enlargement procedure (augmentation mammaplasty) is performed by Dr. Casso under general anesthesia at Houston Methodist St. John Hospital. While this procedure is sometimes performed under local anesthesia in outpatient facilities and doctors’ offices, Dr. Casso recommends general anesthesia at Houston Methodist St. John Hospital, which provides the patient with a comfortable surgical experience, and close, expert nursing attention, treatment of postoperative nausea, if present, and immediate medical attention in the event of any unforeseen emergency. The option for surgery in a full-service, state-of-the-art facility such as Houston Methodist St. John provides patients with a measure of safety and security which is unmatched.

Dr. Casso sees the patient in the morning before surgery and confirms the surgical plan. The patient is then taken to the operating room, where general anesthesia is induced by the anesthesiologist. A small incision is made within the fold under the breast. A space, or pocket, is created under the breast tissue and pectoral muscle, and a saline or silicone implant is inserted. The wounds are carefully sutured and small bandages are applied.

This procedure is sometimes performed in conjunction with a mastopexy, or breast lift procedure in women who desire lifting of the breasts in addition to enlargement (mastopexy-augmentation).

Patients generally go home in the afternoon after surgery.

Breast Augmentation Recovery

Patients are typically seen in Dr. Casso’s office the day after surgery, if possible. Daily showering is resumed and a light cami bra provided to the patient may be worn. Initial discomfort is controlled with oral medication and muscle relaxers. After about a week, the patient is instructed in massage of the implants, which enhances relaxation of tissues, and promotes a natural breast appearance. The sutures are removed seven to 10 days after surgery. Light activity may be resumed within a few days and aerobic activity can be started in about three to five weeks. Upper extremity exercise may be resumed gradually beginning six weeks after the procedure.

The breasts are generally tight and round initially, but over time assume a soft and natural appearance.

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