Dr Goldberg on Breast Augmentation
Written By: Mytien Goldberg
307 views . 8 months ago
As a physician and surgeon, one of my main responsibilities is to honestly guide, educate, advise and protect my patients. I have been asked to discuss my own particular technique for breast augmentation and to give my opinions regarding implant types, implant plane placement, incision locations, and size. One of my primary goals for breast augmentation is to understand the patient's expectations from the surgery. I often ask my patients how long she has been thinking about breast augmentation. I want to make sure my patient's decision is not impulsive or under the influence of others, i.e. partners, parents, or friends. I also inquire about the patient's desire on size and breast shape. The most satisfied patient is a well-informed woman who is happy with her improved size, shape, and overall confidence. Presently in the United States, breast augmentation is still the most popular cosmetic surgery. In 2010 alone, there were 296,000 primary breast augmentations up 2% from 2009. Interestingly, it is also the top cosmetic procedure in women in the age group of 30-45 years old. Unfortunately, it has the highest revision rate of all cosmetic surgery. Studies have shown a woman with primary breast augmentation will have a revision rate of 15 to 20% in the first 3 years after the surgery. There are several factors that lead to revision breast surgery; they are due to poor results, implant failure, unsatisfactory size or shape, capsular contracture, and infection. Breast augmentation is more difficult than most patients and even many naïve surgeons realize to consistently get a beautiful result. There are many reasons for this as we will start to see. I feel it is extremely important to "get it right" the first time. Every aspect of this procedure from clear honest communication with the patient, to complete evaluation, to meticulous technique should be directed toward an excellent and lasting result. For me, one of the key factors in preventing revisions in breast augmentation is pre-operative planning. Preoperative planning includes a thorough evaluation and understanding of the patient's chest and breast tissue. As a surgeon, I must detect any underlying asymmetries in the chest wall and breasts and see if these asymmetries will be improved with the surgery or not. Not all asymmetries will be corrected with breast augmentation alone. Some asymmetries can be made worst with surgery if they are not addressed. By educating the patients ahead of surgery, I will meet the patient's expectations for the surgery. After a thorough pre-operative planning, I will determine which breast implant types, size, and location of placement to meet the patient's desire shape and size. Meticulous surgical technique is as important as pre-operative planning. You may hear some surgeons boast that it only takes them 30 minutes for a breast job. For me, the first breast augmentation requires a meticulous pocket dissection without violation of key structures, bloodless surgery, and no touch technique to deliver an excellent result. Breast augmentation is not a race to see who will deliver the fastest result but rather who will deliver the best and aesthetic pleasing results that would stand the test time. What size implant is best for me? There are a lot of discussions on what implant type is the best. I think there is plus and minuses for both saline and cohesive gel implant.