Breast augmentation still remains one of the most in-demand and gratifying procedures Dr. Gallagher performs. Dr. Gallagher draws on her experience as a breast reconstructive and gender affirmation surgeon to deliver customized results to her patients. She prides herself on listening to, and carefully planning with patients to reach their goals.
Most patients will request a natural full result, which is Dr. Gallagher’s specialty. Dr. Gallagher’s technique uses the implant to push forward and showcase the natural breast so the “operated look” is avoided. The key to this is choosing the correct implant size for the patient’s body. In this way recovery is fast and the patient gets a long-lasting beautiful result with none of the telltale signs of a breast augmentation.
Implant Size
Dr. Gallagher will spend a lot of time deciding on size with a patient before surgery. While this is ultimately up to the patient, there is certainly a sweet spot when it comes to size. Every woman has enough space for a particular implant size- if a patient sticks to that size there will be many benefits. The result will be very natural, will last longer,and because no muscle cutting or stretching is required recovery will usually be much faster and easier.
Breast Augmentation Technique
Incision
There are three main routes through which a breast implant may be positioned. Incision choice is important, because when you have a lovely natural breast augmentation, often the only way to possibly tell a patient has had surgery, is the incision. Dr. Gallagher specializes in keeping that incision small, and placed in the best possible position for healing.
The three main options for incisions are:
- Through the infra-mammary fold. This is normally the choice of the majority of Dr. Gallagher’s patients. This is because the incision can be kept quite small depending on the size of the implant, and also because it heals extremely well, therefore in most patients it will be almost invisible. When we look at the chest, it is hidden from view in the fold, and the slight discoloration will fade to match the skin color of the fold in about a year. This incision preserves the ability to breast feed, and also preserves sensation to the nipple.
- Through the areola or the edge of the nipple itself.
- Through the armpit or trans-axillary approach. This can usually only be done after silicone implants for breast augmentation.
Implant Position
The next question to be considered is where to position the implants? Again there are a number of options for this, implants can go on top of, or underneath the muscle, or a combination of these, where the implant is half covered by the muscle and half covered by the breast.
Dr. Gallagher offers all three as part of her tailored approach for patients. Let’s start with the most common position patients choose, which is underneath the muscle.
Underneath the Muscle
Dr. Gallagher will most commonly choose this position, designing a pocket underneath the muscle, with minimal blood loss, so that the patient’s recovery is fast. This position is advantageous because, at the upper part of the breast there is a smooth transition, as the upper part of the implant is hidden underneath the muscle, thus avoiding the telltale rounded out appearance at the top of the implant. This is the choice of most girls who want beautiful results showcasing the natural breast. For most women underneath the muscle is best, because the rate of capsular contractures or hardening of the implant is lessened if it can be positioned here.
Underneath the breast itself
Alternatively, for some of our patients, particularly our transgender women, we may choose to put the implant underneath the gland itself, or underneath the breast itself. One instance, in which we would choose to do this, is in what we call a tuberous breast, where the shape of the breast is not very favorable to begin with, or when the fold is very high, and we don’t have a rounded out bottom to the breast. Often it is best in that situation to rely on the roundness of the implant itself to provide that, and so in order to make sure that roundness can be readily seen, we put the implant underneath the gland itself.
Dual Plane
Using a dual plane technique, Dr. Gallagher might position the top part of the implant under the muscle, and the bottom part under the breast. With this technique a little lift effect can be created. Dr. Gallagher will do some dissection up underneath between the implant and the breast tissue, allowing the breast to slide upwards, a little ,in order to get the illusion of a raised nipple or very subtle lift. This is useful in patients with some sagging.
Choosing an Implant for Breast Augmentation
Silicone Vs Saline.
Patients have a choice of two implant fillers either silicone or saline (salt water). Most patients opt for silicone as it usually feels softer and is less prone to rippling which can be seen underneath the skin. Saline, on the other hand, tends to be a little cheaper, and some patients, who are worried about having silicone in their bodies, may opt for this. The big questions are:
- How likely is it to rupture?
- What happens if my implant ruptures?
The implant industry and the quality of implants are improving all the time, we believe the current generation of implants to be very safe. However ruptures certainly still happen and can be expected eventually in almost all implants.
It is interesting to note that the two different types of implant behave very differently when they rupture. With saline implants there is absolutely no doubt because the implant goes flat.
Silicone, on the other hand, is designed to be a cohesive gel and so when it ruptures it doesn’t go anywhere, it just stays in the same spot. Therefore often there won’t be any obvious changes while looking at the breast, and even ultra sound can’t always pick up whether the implant is ruptured or not, so an MRI is needed. Silicone implants were taken off the market initially, because of concerns about what happens when they rupture, and concerns about whether or not they cause other diseases. When they were reintroduced onto the market there were two FDA warnings. 1. They were deemed unsuitable for girls under twenty two years old. 2. Patients getting silicone implants are technically signing up to a lifetime of checking up on these implants. This is done via MRI and it is recommended that a patient have her first check up three years after the implant, and subsequently every two years, because this is the only way to know whether or not the implant has ruptured.
Textured v Smooth Implants
Two choices here again, one is smooth round and the other one is textured. Why do we have a difference? The textured implants were designed to help with a problem called capsular contracture. This basically means if a foreign body is placed inside your body, it will form a wall round that foreign body.
That is not a problem in itself, however for some unknown reason, in certain cases, that capsule or wall begins to contract around the implant, and this is what is called capsular contracture. The breast implants become hardened, and as it progresses they become deformed and in extreme cases even painful. There are lots of different ways to treat this, and one of the ways that is thought to avoid it, is by putting a textured coat on the outside of the implants. With modern techniques, Dr. Gallagher finds capsular contracture is pretty rare and usually recommends smooth implants.
Shape Round Vs Teardrop.
The next question is whether to use a shaped implant such as a teardrop implant, or a round implant. The vast majority of patients end up choosing a round shape. There are a few good reasons for this. First of all when Dr Gallagher places an implant, she aims to push forward the patient’s natural tissue that is already there, using the implant to create a platform for the natural breast, so the shape of the implant is not crucial. Secondly the shaped implants are much stiffer and require a much larger incision to position. Finally when a teardrop implant is inserted it is possible for that implant to flip, requiring a surgery to put it back in its right position
Breast Augmentation Surgery and Recovery
Once a patient has decided what size implant to get, what incision to use, and which type implant to place, it is time for surgery. Dr. Gallagher performs breast augmentation under general anesthesia because it ensures a pain-free procedure for the patient. General anesthesia is very safe and we only work in accredited centers with trained anesthesiologists. This way Dr. Gallagher focuses on your surgery while your anesthesiologist is free to focus on your comfort and safety. Dr. Gallagher does not do any drainage tubes for breast augmentation and rarely do we need any special dressings. We use skin glue on that small incision that the implant has gone through. All stitches are dissolvable. Most patients we will put on our rapid recovery protocol. Once the patient is fully awake they can get something to eat. Indeed some of our patients are ready to go out for a walk that afternoon! Straightaway most of our patients can move their arms without any difficulty. We do place a surgical bra at the time of surgery, but there is very little restriction of movement and the patient is able to shower the next day.
Settling
There will however be some swelling in the upper part of the breast (where the muscle is). This may last for a few weeks afterwards and you may not see your final results until this subsides. Most patients will note their breasts to be “riding high” somewhat in the early days and weeks after the procedure because of this swelling.
Recovery after Breast Augmentation
Each patient’s recovery is very personal, however most leave the hospital two or three hours after the procedure. The majority of patients are easing their way back into normal activities over the next seven days. Most patients take a week off work to recover. This of course depends on what the patient’s job is, if it involves a lot of strenuous activity longer may be needed. Usually around week four after the surgery our patients tend to be hitting the gym again.
