Breast Augmentation Maryland
Surgery of the Breast
Plastic surgery of the breast involves:
|a. Surgery to enlarge size
||= Breast Augmentation
|b. Surgery to enlarge & shape
||= Breast Augmentation + Mastopexy
|c. Surgery to reduce size
||= Breast Reduction
|d. Surgery to shape
||= Breast Mastopexy ( lift)
|e. Surgery to create
||= Breast Reconstruction
Breast augmentation is the most popular of all breast procedures and, in fact, the most popular cosmetic operation in the United States. In 2008, 355,671 breast augmentations were performed. Contrary to popular belief, the typical breast augmentation patient is a happily married woman between 30-40 with two children. She has decided not to have more children and has the time and economic means to begin to think about herself, in addition to her family.
In my experience, there are generally three body types who request breast augmentation:
Type I - Very thin, somewhat muscular women with very little fat and very small boy-like breasts.
Type II – Well proportioned women with small, but shapely breasts
Type III – Women with adequate size breasts desiring larger breasts to balance their body size.
Among these types, there are numerous shapes of breasts which make the operation challenging in some cases. As a patient, the more attractive your breasts are prior to surgery independent of their size, the more attractive they will be after surgery. In addition, it is far more common to have two breasts of different size and shape than to have two perfectly symmetric breasts. For this reason, I will frequently use implants of different size, shape, projection and volume.
I employ the technique of submuscular augmentation in 95% of the cases. The implant, saline or silicone is placed beneath the pectoralis muscle of the chest . This placement allows a greater ease of palpating a breast mass, easier mammagrams, a better cosmetic appearance compared to placing the implant on top of the muscle, and the muscle and skin supports the weight of the implant, thereby slowing down the sagging of the breast over time.
Breast Augmentation with Breast Lift ( Mastopexy)
There is a large group of women who have either lost considerable weight or who have experienced breast volume loss because of pregnancy and nursing. The result is often small sagging breasts which can not be reshaped into attractive breasts with augmentation alone, but require a breast lift( Mastopexy). If the patient exhibits only a small amount of sagging, a modest augmentation may be adequate to both enlarge and lift the breast. Depending on the amount of breast sagging will determine the techniques used to lift the breast. Mastopexy with or without breast augmentation is a “trade-off” operation, that is, improved breast shape versus the potential for scars, some of which can be unsatisfactory.
The type of operation is dependent upon the extent of breast sagging (mammary ptosis), with or without breast augmentation. Another way to explain breast ptosis, is to ask the question, “How far must the nipple-areolar complex (NAC) be moved to place it at the apex of the breast mound.” When a mastopexy is performed without breast augmentation, there is an apparent decrease in the size( volume) of the breast even though only skin is removed.
1. Concentric, Doughnut, Purse-String or Benelli type Mastopexy
If the distance that the NAC must be moved is short ,this type of procedure can be used, frequently together with a breast augmentation. Incisions are entirely around the areola . While the scarring is generally very good, the procedure must be performed by an experienced plastic surgeon, otherwise the risks of stretching the nipple-areolar complex to a larger diameter and flattening the shape of the breast is possible.
2. Short scar or Vertical scar Mastopexy
Patients having considerably greater sagging require not only a lifting of the nipple/areolar complex (NAC) but also significant tightening of the loose breast in a horizontal direction. The vertical or short scar mastopexy procedure achieves this without requiring a long scar below the breast.This is Dr. Fontana’s preferred technique. It is done with or without breast augmentation. The vertical or short scar mastopexy eliminates the scars in the fold of the breast. The shape of the breast is less dependent on the tightness of the skin and the scars are significantly better.
Anchor Scar Mastopexy
If you have the opportunity of viewing either breast reduction scars or mastopexy scars, you may have come upon the term “anchor scar”. This technique produces scars around the areola, a vertical scar down the front of the breast and a long scar extending along the fold of the breast from the breast bone to the underarms. In the majority of patients, the scar is unsightly and unnecessary. The long term aesthetic results are not consistently good. This technique should NOT be used.
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