Breast Surgery Day – Breast Implant Exchange, Implant Rupture, & Breast Augmentation Explained

Megan Jack: Good morning. It's Dr. Megan Jack. I'm here at Inspire Aesthetics in Delray Beach, Florida, and it's breast day. This morning I have a couple of breast surgery cases, all cosmetic, and what we're doing first today is a breast implant exchange. 

It's a nice young lady who has perfectly good saline breast implants, but one of them has started to deflate, which can happen. It can either happen slowly where there's a little leak of saline from the valve, or it can happen really fast when all of a sudden, one implant is completely deflated and completely asymmetric. That's sort of what's happening with this patient, so we need to fix it pretty soon so she can back to feeling nice and natural and symmetric. 

We're going to take out the old implants today, put in some nice new ones and just get her back to baseline. That's a nice easy straightforward surgery that we're doing today, and make her nice and comfortable in surgery and then get going here pretty soon. 

And then a little later today we're doing a breast augmentation, so for that young lady we are doing a silicone submuscular primary breast augmentation which I'll go over really quickly with you here. She is unhappy with the size of the breasts. She's pretty symmetric. She's had one baby, doesn't have a lot of droop after her baby, but she was left with some deflated breasts, not a lot of volume. We're just going to restore her to a volume today that is not particularly big, but will be proportionate to her body and just help restore how she's feeling, her confidence, and how she looks and fits in clothing. 

What we're going to do today, I'll just draw it out for you. For the second case, the breast augmentation is, if these are her breasts ... so these are the breasts, these are the areolas or the nipples. She is getting a inframammary incision. Your inframammary fold or crease is this crease that's under the breast. Okay, we're going to make a short little incision here, right in that crease, which will be about 4 cm. 

So it's pretty short, not very big, and it heals beautifully in that location. It's my favorite incision to use for breast augmentation for a few reasons. One, the complication rates are a little lower through that approach, in my opinion, so lower rates of infection, lower rates of bleeding, and I'm pretty sure lower rates in things like changes in nipple sensation and breast feeding because you're not really cutting through as much breast tissue in this area. You're basically cutting from the skin, and in most women, you can go straight down to where the implant is going to go in without having to cut through breast tissue. Feasibly when that happens, you're not going to be affecting any nerves or milk ducts or anything like that, so I like this approach for that reason. 

The other thing that I like using this incision for is lower rates of capsular contracture which is the tightening of the little pocket or the scar that forms around the implant, because again, we're cutting through less breast tissue, less of a risk of bacterial contamination of an implant which can theoretically contribute to that complication. We want to avoid those, and that's why I like going through that approach. 

The incision is made there in this location on both sides, and then we basically will go down straight to the muscle which ... let me draw you side view so you can see that. If we go to the side view of the breast, there's the nipple. This is where your crease would be. What we see here is here we have our fat and our breast glandular tissue here. And then beneath that you have your pectoralis muscles. There's two. There's a major and a minor. And then below that you have your chest wall, so ribs and sternum, et cetera. The bones are back here. 

When we do the surgery, what we do is we make the same incision here. We make a little incision here in that crease and then you can see, we don't have to touch as much of this tissue because there's really not a lot there. We basically go in. We slide right up to where the muscle is underneath the breast tissue. We lift the muscle up a little bit. Now again, this is a submuscular breast augmentation. Okay, so we go there. We lift up this major muscle, the top one. The minor stays down. And then we slide our implant in between the two. So it's going to go right in this area here. And that's saline, silicone, doesn't matter. That's how we do that. 

The other option would be to do a subglandular augmentation where instead of lifting up the muscle, you slide the implant in here, so on top of the muscle. That would be where that one goes. Again, my preference is to go below the muscle for the same reason as I choose that incision, because the complication rates in my hands are a little lower with that approach, because I think there's less bleeding, there is less infection, and again, less risk of capsular contracture. 

That's what we're going to do today. I'm excited, and it's going to be a good day.