The risk of decreased nipple sensation with breast augmentation surgery is roughly 10%. This is unrelated to the incision chosen to insert the implant and more related to the creation of the pocket for the implant. Most patients have some temporary numbness which improves in a few weeks, however, there are some patients who may experience permanent loss of nipple sensation. Usually during the procedure, the nerves are not seen, and therefore not injured. But a certain percent of the population will have an unusual location of the sensory nerve, which places it in danger during the surgery.
Unfortunately, there is no way to correct decreased nipple sensation.
Liposuction is a procedure which removes excess fat through small metal cannulas inserted into the skin. A tummy tuck (abdominoplasty) is a procedure that involves a surgical incision across the lower abdomen to remove excess skin and fat. A good candidate for liposuction is someone who is relatively young (<40) with good skin tone and no stretch marks. A good candidate for a tummy tuck is someone with loose skin, stretch marks and a weakened abdominal wall- such as women after multiple pregnancies. Often times some liposuction of the love handle area is combined with a tummy tuck to enhance a patient’s overall contour.
By far the best way to insert a breast implant is under the chest (pectoral) muscle. This technique gives a more natural look and makes it easier to breast feed after surgery if a patient desires to do so. The risk of capsular contracture (scar tissue) is also lower when implants are placed under the muscle compared to over the muscle. The interpretation of mammograms is more difficult when implants are on top of the chest muscle, yet another reason to avoid this location.
As a plastic surgeon in Beverly Hills, I have the opportunity to see a wide range of patients throughout Southern California as well as outside of the state (and country). We see patients who travel great distances seeking second and third opinions on certain procedures since there are so many plastic surgeons in Beverly Hills. I enjoy meeting patients from all over the world (we even recently had a patient from New Zealand) and helping them with their plastic surgery concerns. I feel a responsibility to manage patient expectations more carefully since patients come to Beverly Hills seeking and expecting the best level of plastic surgery expertise.
There are four different incisions that can be used for breast augmentations. These incisions are 1. Inframammary 2. Periareolar 3. Transaxillary (armpit) 4. Transumbilical (belly button). The two most common approaches are the inframammary incision, which is in the breast crease and the periareolar, which is near the nipple. The breast implant incision associated with the lowest complication rate is the inframammary incision, as it has the lowest incidence of capsular contracture (scar tissue). This incision also allows for insertion of larger, cohesive gel implants (“gummy bear”). The selection of incision should be based on the patient’s anatomy as well as the surgeon’s experience. I prefer the inframammary appproach to breast augmentation because there is significant data in the plastic surgery literature to support this incision.
Excess male breast tissue, known as gynecomastia, affects about one third of the adult male population. The majority of cases do not have a known or defined cause. Some popular causes of gynecomastia are heavy marijuana use, steroids and certain medications. There are several ways to treat this problem depending on the degree of the gynecomastia. Mild cases can be treated with liposuction alone if there is good skin tone in the chest area without sagging skin. Moderated cases of gynecomastia are treated with a combination of liposuction and direct excision of breast tissue through an incision around the nipple/areola. Severe cases will require removal of breast tissue as well as removal of skin from the chest wall. A thorough history and physical exam by an experienced plastic surgeon is needed to determine the best treatment plan for men with gynecomastia.
The two basic ways to reshape or augment the buttock involve either a fat transfer (Brazilian buttock lift) or buttock implant. Fat transfer allows the use of a patient’s own fat to create a softer, more natural feel to the buttock compared to silicone buttock implants. The fat transfer technique also allows for more sculpting and reshaping of the surrounding areas of the buttock such as the hips and waist. Buttock implants are primarily indicated for very thin patients who are not eligible for a fat transfer procedure. These firm silicone implants tend to look and feel less natural and have higher complication rates compared to a fat transfer. During your consultation your specific anatomy will be evaluated to determine which procedure is best for you. In some cases, patients may have to gain weight prior to surgery to become better candidates for a fat transfer to the buttock.
A breast augmentation can reduce the chances of being able to breast feed in certain patients. There a few things you and your surgeon can do to maximize your ability to breast feed after breast implants. One would be choosing an incision away from the areola and placing the implant under the muscle (submuscular or subpectoral). I always advise patients however if breast feeding is a very high priority for them to consider holding off on breast augmentation until after their pregnancies. That is the only 100% effective way to ensure that you will be able to breast feed.
Many patients wonder whether they should have breast augmentation alone, or if they also need a breast lift at the same time. This is a very common yet complex procedure in plastic surgery. If a woman has no sagging skin with a good nipple position, then a breast augmentation with saline or silicone breast implants is usually sufficient to achieve a fuller look. If a woman has had multiple pregnancies and perhaps has breast fed, then an implant ( to restore volume) and a breast lift (to improve shape) combined may be the best choice. Some women are happy with their size but just want some improvement in their shape; in these cases a breast lift alone can achieve a better, perkier breast contour.
A thorough exam and consultation with a board certified plastic surgeon is the best way to determine which breast procedure(s) is best for your specific anatomy.
There are four incisions that can be used to insert a breast implant for breast augmentation and each has its pros and cons. One of the more popular incisions is located in the breast crease, under the breast, which is called an inframammary incision. This incision is about 4-5cm in length and can be used for both saline and silicone breast implants. This incision allows easy access to place the implants under the pectoral muscle without violating the breast tissue/milk ducts and therefore allows a very high percentage of patients to still breast feed after surgery. This incision also has perhaps the lowest rate of capsular contracture rate (which is hard scar tissue that forms around breast implants). Another common approach to breast implant insertion is the periareolar incision, near the nipple. This incision however does disrupt some of the milk ducts and can interfere with breast feeding. It is also associated with a higher capsular contracture rate as the bacteria in the milk ducts can come into contact with the implant and cause inflammation which may lead to hard scar tissue. A less common incision for breast augmentation is the transaxillary (armpit) incision. This incision is heals fairly well in the armpit skin however the implants have a tendency to look a bit off to the side, since they are inserted from a more lateral (side) approach. Creating the breast implant pocket is more difficult and less precise than the previously mentioned incisions. It is also very difficult to create any look of cleavage via the armpit incision. The final and least popular approach is the transumbilical (bellybutton) incison. Only saline implants can be placed through the bellybutton (not silicone). If the implants rupture or need revision, you can not exchange the implants through the bellybutton approach. The final decision as to which incision is best for a breast augmentation depends upon each patient’s anatomy and their specific desires. This should be addressed in detail during the consultation visit.