Well-proportioned breasts are key elements of a beautiful, shapely body. The size and shape of a woman’s breasts can have a significant impact on her self-image and self-confidence. Some women may feel disproportionately small, while others may feel that their breasts are uncomfortably large. Still others may be troubled by the shape of their breasts or by asymmetry. Men who have developed an overgrowth of breast tissue often suffer shame and discomfort silently. For these men and women, breast surgery may be the answer.

Breast augmentation is one of the most frequently performed cosmetic surgery procedure in the United States. By placing either saline or silicone filled implants beneath the existing breast tissue or below the chest wall muscle, augmentation can give a woman the fuller and firmer breasts she desires, as well as a better-proportioned look. Women may elect to undergo breast augmentation for many different reasons: to balance breast size to compensate for reduced breast volume after pregnancy or surgery, or simply to change the size and appearance of the breasts. Breast augmentation surgery can be performed under general anesthesia or with local anesthesia in combination with sedation.

Although most patients who have breast augmentation surgery are pleased and satisfied with the results, every woman considering this surgery should be well aware of the following information about breast implants.

• Implant lifespan: Breast implants, like any other medical device, are not considered lifetime devices. In other words, an implant is not expected to last indefinitely and any woman who has implants placed should know that at some point in her life, she will most likely need additional surgery to replace the implants.
  
  
• Need for further surgery: Studies done by the Food and Drug Administration (FDA) suggest that most women with implants will most likely need to have further surgery at some point during their lives. This could occur for many reasons including implant rupture, capsular contracture (hardening of the implant), or a change in breast shape or volume.
  
  
• Mammography and MRI: Women who have had a breast augmentation need to have mammograms performed at centers that use special displacement techniques to visualize the breast tissue in women with implants. These techniques may require more views and possibly additional exposure to radiation. Mammography may not be as sensitive in women with implants, although women with implants do not have increased chances of getting breast cancer. When the FDA approved silicone implants for cosmetic breast augmentation in November 2006, they stated that women with silicone gel breast implants should have a breast MRI three years after getting silicone implants and every two years after that. The purpose of the MRIs is to determine if the silicone gel breast implants are ruptured or leaking, because often leaks and ruptures have no symptoms. It is important to remove silicone implants if they are ruptured, to avoid the silicone leaking into the breast or lymph nodes. Many insurance plans do not cover the cost of these MRI tests that can cost $2,000.00 or more.
  
  
• Insurance: Health insurance premiums may increase for women with breast implants, and treatment of complications related to breast implants may not be covered.

Additional information about breast implants is available on the FDA’s website.

Some women may wish to undergo breast augmentation without the use of a synthetic implant.  For such women, the use of perforator flaps may be an attractive option. Although much more commonly used for reconstruction, perforator flaps can be used to add volume to a woman’s breasts with her own body’s tissue. Furthermore, for women who are experiencing implant-related complications following breast augmentation, perforator flaps can potentially be used to replace synthetic breast implants with soft natural tissue. Similarly, these procedures may be an appealing option for women who no longer want to have breast implants, but who still wish to maintain their enlarged breast size.  

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:: Correction of Tubular Breasts

One of the most common abnormalities of breast shape is called a tuberous breast or tubular breast. Such breasts result from congenital variation in the development of the breast tissue. Although there is considerable variation, tubular breasts all share some common features.  Tubular breasts are usually elongated and narrow and have an areola (pigmented area around the nipple) that appears disproportionately large.  Often, the breast tissue behind the nipple and areola protrudes and makes the nipple look puffy. The location at which the underside of the breast joins the chest (known as the inframammary fold) tends to be relatively high on the chest, thus causing the breast to droop and look long and constricted. For this reason, tubular breasts are sometimes called constricted breasts. When only one breast is affected, significant asymmetry results. When both breasts are affected, the distance between the breasts will be widened, making the cleavage area appear unnaturally broad.

Surgery to correct tubular breasts is commonly performed and almost always involves augmenting the breast. In addition to adding volume to the breast, the base of the breast is widened to a normal size, the inframammary fold is restored to a more natural position and the areola is usually reduced in size. Breast implants have traditionally been used to provide the volume needed to correct a tuberous breast.  Although implants continue to be widely used, a perforator flap can be used as an alternative to a breast implant. By using a woman’s own tissue, complications unique to breast implants (e.g., implant leakage or rupture, rippling, capsular contracture) can be avoided.

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:: Correction of Chest and Breast Deformities in Poland’s Syndrome

Poland’s syndrome is characterized by variable underdevelopment of the breast, nipple, chest muscles and ribs on the side of the body affected by this condition. Both men and women can be affected. In milder cases, the involved breast is generally smaller than the uninvolved breast and it may not be shaped normally. In more severe cases, the breast, nipple/areola and even the pectoralis muscle (large muscle of the chest) may be completely absent. In the most severe cases, the skeletal structure of the chest (ribs and breast bone) may also be affected. 

Reconstructive surgery is commonly sought by both women and men affected with Poland’s Syndrome.  Many different techniques have been described to correct the associated chest and breast abnormalities. Historically implants and muscle flaps have been used frequently in the treatment of people with Poland’s Syndrome. Breast reconstruction using a perforator flap such as the DIEP flap, GAP flap or LAP flap can help restore the contour of the chest and breast without the use of an implant or muscle. These reconstructive procedures may be an attractive option when an implant is not desired or when an implant has previously been ineffective.