Breast Augmentation is one of the most common procedures in plastic surgery. Dr. Cohen has extensive training and experience with this procedure, as well as keen insight knowing that women seek this procedure for different reasons. The most common reason for breast augmentation is to enhance the size and volume of the breasts in order to look more feminine, or to feel and look better. In some instances, a woman seeks this procedure because she is bothered by the natural asymmetry of her breasts, and correction of the asymmetry is just as important to her as volume enhancement. Other times, women seek improvement to the shape of her breasts, due to either a congenital way her breasts developed, or due to changes that have occurred as a result of having children, such as deflation and ptosis.
When a woman seeks breast augmentation, Dr. Cohen pays very close attention to what she is looking for besides volume enhancement, in order to come up with a surgical plan to achieve the best results. Dr. Cohen performs an extensive physical exam of the breasts’ anatomic dimensions and tissue quality, taking nearly a dozen anatomic breast measurements that allow him to make a thorough assessment of what operation and what type of implant will be ideal for each individual patient.
In order for breast augmentation with an implant to achieve an aesthetically pleasing outcome, several anatomic characteristics of the breast have to be brought into perfect harmony. The top two priorities are to make sure that the implant fits perfectly inside the breast skin, and that the ideal position of the nipple on the breast is restored. If the nipple cannot be raised to the ideal position with an implant alone, then a breast lift (mastopexy) is necessary. If the only way to fill the skin envelope of the breast is with a very large implant that is either unsafe for the patient’s tissues or aesthetically unacceptable due to the large volume, then the right operation becomes a mastopexy rather than an implant.
Other priorities in breast augmentation include maximizing breast symmetry. Almost all women have at least some degree of breast asymmetry, which is completely normal. There are over a dozen types of breast asymmetry in addition to the obvious asymmetry in size. These differences may be in breast base diameter (the width of the breast), position on the chest, nipple location, and breast volume, among others. It is crucial to recognize these preoperative asymmetries, because, similar to a magnifying lens, breast augmentation tends to augment any existing asymmetries.
During your consultation, Dr. Cohen evaluates, measures, and comes up with a surgical plan aimed at correcting all preoperative asymmetries, in order to avoid severe postoperative asymmetry caused by implants. While perfect symmetry cannot be guaranteed in any breast procedure, Dr. Cohen takes every measure to correct as much asymmetry as can be corrected surgically. This individualized assessment of each patient is crucial for developing the right surgical plan that will achieve an excellent, aesthetically pleasing result after breast augmentation.
Other considerations in breast augmentation include the implant type (silicone versus saline, round versus anatomic, smooth versus textured), different incision locations for implant placement (in the crease under the breast versus around the areola versus through the armpit), and different anatomic planes of implant placement (under the muscle versus over the muscle). During your consultation, Dr. Cohen will go over the pros and cons of each, and will address any of your concerns about the safety of silicone and the safety of textured implants.
Depending on the individual anatomy of the breast, it may be necessary to perform a mastopexy (a breast lift) along with breast augmentation, although in some patients Dr. Cohen will recommend that the two procedures are separated into two surgeries. This recommendation will be largely based on his thorough evaluation of each patient. In a properly selected patient, a mastopexy with simultaneous augmentation using the patient’s own fat from liposuction can be performed, and Dr. Cohen considers this procedure safe and effective in the right candidate.