Providing Breast Augmentation (Enlargement) in New Hampshire, near Boston and Manchester
There are numerous breast augmentation websites, each containing dizzying numbers of preoperative and postoperative results.
What is most important for the patient to understand is what breast augmentation can do and what its imperfections are.
Breast augmentation provides both enlargement and lift to the breasts. At my New Hampshire practice, between Manchester and Boston, we can enlarge breasts that have never developed fully, or enlarge breasts that have lost volume after pregnancy or weight loss. In the later cases, some skin tightening (mastopexy or “breast lift”) may also be necessary.
Breast implants can be put behind the pectoralis muscle or in front of it; I use both methods, depending upon the patient’s activities, skin type, and breast contour.
Breast augmentation has the two most common potential complications of all surgical operations: infection or unusual bleeding (hematoma). In my experience, both are very rare. If infection is severe enough, the implant would have to be removed temporarily and then replaced some months later because the patient’s body cannot fight infection around a foreign material.
Hematoma occasionally occurs, and is largely an aggravation to the patient and surgeon, because it usually means a second trip to the operating room (for which there is no additional surgical fee) to remove any blood collections. Hematoma does not ordinarily change the likelihood of postoperative success and a good result.
Nipple sensation theoretically could change with any breast operation, but is relatively rare and minor following breast enlargement. I warn each patient before surgery that a partial or complete, temporary or permanent loss of sensation on one or both sides is possible after surgery. However, I have never heard of a total, permanent loss of sensation on both sides. Furthermore, if sensory change does routinely occur, it must be so slight that patients do not care because almost no patient ever mentions sensation to me postoperatively, even though each one has been informed before surgery that it could change.
The major aggravations with breast implantations are related to the fact that it is an artificial material. They are: so called “capsular contracture” and deflation.
Simultaneous Breast Augmentation and Breast Lift (Mastopexy)
Breast augmentation and breast lift have conflicting goals: the augmentation makes the breast larger and heavier, whereas the lift makes it higher. Therefore, while a breast implant lifts the breast, it will also tend to drag down the correction achieved by the mastopexy itself.
I therefore look at augmentation/mastopexy as a compromise operation. The augmentation improves breast shape while the lift improves breast position. However, if the implant is too large, it will invalidate the lift. Once again, the proper decision can only be made by a good consultation between patient and surgeon.
Secondary Revision after Breast Augmentation or Breast Lift (Mastopexy)
A variety of problems can occur after breast augmentation or lift: asymmetry, distorted or excessively hard results, unequal folds beneath the breasts, implants that are too large or too small, synmastia (the breasts touching in the midline), or rippling. We encourage patients to return to their plastic surgeons for revision. But, if for some reason any patients do not wish to do so, Dr. Constantian would be happy to see them in consultation because many of these problems can be improved.
Questions about Breast Enlargement
These are some of the frequently asked breast enlargement/augmentation questions we are asked at our New Hampshire practice, between Boston and Manchester.
- “What is capsular contracture and why does it occur?”
- Capsular contracture refers to a hardening in the feel of the augmented breast. This firmness is the result of thickening of the scar that the body normally forms around every prosthesis because it is a foreign material. In many woman, the scar stays thin and filmy so that the breast remains normally soft. In other patients, there are varying degrees of thickening and stiffening of the scar, so that the breast feels firmer than it should. The most honest percentages in the scientific literature from all breast enlargement surgeons are approximately 50% of patients with a soft breast; another 30% with a moderately soft breast; 10%-15% with a breast that is noticeably firmer to the patient but not hard; and less than 5% that will have a result that is hard or even occasionally deforming.
No one has yet identified a single cause of capsular contracture in all patients, and therefore there is no foolproof way to prevent it. I do all the preventive measures that seem logical and biologic, and have done so for many years. I try to minimize drainage, be extremely careful with the breast augmentation technique, minimize muscle spasm around the implant, minimize fluid collection around the implant, and in general minimize any factors that may cause extra inflammation and therefore scarring.
- “What are the deflation rates?”
- Every implant eventually deflates or “ruptures” whether it is gel or saline. Eventually the shell material fatigues and a crack appears. In saline implants, the saline is absorbed by the body in a perfectly harmless way, but the patient loses volume on that side. In silicone implants, the loss of integrity in the outer shell may not be as obvious, and sometimes it is not obvious at all and is only picked up by mammogram or MRI. Occasionally, the breast will become oddly shaped or distorted as a clue that the implant is no longer in perfect condition.
“Rupture” sounds horrible but it is not dangerous. In either case, the old implant is removed and a new one inserted.
- “How common is deflation?”
- The best information that we have about deflation rates is 1% chance per year. In other words, a patient who has a breast augmentation today will have had a 10% chance of deflation within 10 years, but a 90% chance that she will not have had a deflation. However, my guess is that real deflation rates are not that high. I have been practicing in the same office building for twenty-nine years, and have inserted so many breast implants during that time that I should have no time to do anything but replace implants at this point. While I do see perhaps one or two patients with deflations per year, it is still relatively uncommon. Many patients have implants without problems for a long time; but all patients should presume that they will need to have their implants changed one or more times during their lifetimes, depending upon their ages at the time of the initial operation.
- “Do you use gel or saline implants?”
- I use both saline and gel implants for breast enlargement surgery at my Nashua practice near Boston and Manchester.
I have used saline implants most often since the beginning of my practice and believe that they have several advantages, the chief one being a better mammogram can be obtained with a gel implant. However, gel implants do have the advantage that, when the surgical result is “perfect”, meaning no resulting firmness, the gel implant result feels slightly more natural than the saline implant result; and when the patient is extremely thin, the chance of visible rippling is lower.
Because of FDA rules, patients who have gel implants must agree to have periodic follow-up MRI exams.
For most patients, that difference is not significant and is largely a matter of patient or surgeon preference. Gel implants have their major advantages for reconstructive (post mastectomy) patients.
One Final Thought
For all of the potential imperfections of breast augmentation, and the fact that some patients will develop a firm result despite everything the surgeon and patient does, most breast augmentation patients are extremely happy. In fact, in twenty-nine years of practice I have never had a patient in whom I placed the original implants asked to have them removed, even when the result was not as perfect as I would have wished. Even with a result that is “good” but not “wonderful”, most women did not want to return to the way they were prior to the augmentation. It is that characteristic that makes breast augmentation, for all of its inherent imperfections, such a satisfying operation for patient and surgeon.
The consultation fee for Breast Augmentation surgery is $250.00. Dr. Constantian’s surgical fee for Breast Augmentation surgery is $4,565.00.
Because Dr. Constantian operates in a hospital setting, the hospital and anesthesia fees are not within his control and may change from time to time. If you would like more information regarding the hospital and anesthesia fees, please call our New Hampshire office.
Contact Our Practice
If you would like to schedule a consultation, or if you have additional questions about breast augmentation (enlargement) surgery, please contact our New Hampshire practice, convenient to both Boston and Manchester.
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