Breast Augmentation – Toronto Breast Implants

The design of breast augmentation procedures is almost entirely determined by three variables:

• the selection of incision location
• the pocket plane for implant placement (either sub-pectoral or completely subglandular)
• the appropriate breast implant Toronto

Breast 
Implant-related variables include size, shape, shell texture, filler substance, and final breast implant fill volume in the case of saline breast implants. There is no incontrovertible evidence that supports the superiority of one combination of choices over another. However, certain anatomic configurations in primary cases as well as certain problems presented in secondary cases are best treated with a specific combination of options that may differ from a usual preferred approach.

Position asymmetry of the areola is common preoperatively, and the placement of breast implants Toronto often magnifies any preexisting discrepancy following augmentation. The breast implants should always be placed symmetrically, even though the areolar position may be different on each side. Most patients tolerate naturally occurring asymmetry without concern so that correction, with its attendant scars, should not be advocated unless the degree of asymmetry is expected to be considerable. It is possible to raise the areolar position slightly with a vertically eccentric skin excision design, although it becomes more challenging to precisely control areolar shape as the perpendicular diameters of the skin excision design increasingly differ. More significant areolar position issues such as ptosis may require concurrent mastopexy.

Postoperatively, it has proved useful in cases of submuscular augmentation to have the patient wear an adjustable strap across the upper pole of the breasts for as long as 6 weeks. This prevents upward migration of the implants and ensures that the lowered inframammary crease remains at the desired height. This practice is most helpful in the case of transaxillary augmentation and should be used with caution when an inframammary incision has been used.

Periareolar incisions allow central access to the implant pocket and are compatible with either muscle plane and all types of Toronto breast implants. They are the best choice when it is necessary to lower the inframammary crease considerably. They are a logical choice when concurrent mastopexy may be required but is not certain preoperatively.

Inframammary crease incisions an ideal choice in patients who have significant breast volume preoperatively and exhibit either postpartum atrophy or just glandular ptosis. These patients usually have a breast base of appropriate diameter so that the incision will not end up displaced from the inframammary crease following implant placement. In most cases, the final scar is well concealed in a deep crease below a slightly ptotic breast. This incision is usually a secondary choice when the inframammary crease is either high or nonexistent. It is also not indicated in tubular breast hypomastia unless the areolar deformity is minimal and it proves necessary to add a skin flap to widen the breast base at the inframammary crease. The inframammary crease incision is not as good as a periareolar incision in secondary cases requiring capsulectomy or closing down the superior portion of the pocket because it is at the periphery of the pocket as opposed to its center. In addition, wound closure is more precarious in terms of either breast implant puncture during closure or exposure postoperatively given that the weight of the breast implant presses against it and the soft-tissue covering at the incision may be minimal. The inframammary incision is also not the best choice for patients undergoing unilateral augmentation as a symmetry procedure in breast reconstruction. In these cases, it increases the overall scar burden on the chest and may compromise lower skin-flap circulation should a mastectomy be required on the augmented side in the future.

The axillary incision is applicable to most cases of hypomastia that do not have more than grade I ptosis. Its obvious appeal is that there is no scar on the breast. This approach does not require endoscopy, although there is evidence to suggest that the procedure is more accurate when it is used. Whereas many patients require reassurance that the axillary scar will not be visible and will be of good quality, this routinely occurs. It is an ideal choice in patients having a low preoperative volume and high breast position on the chest wall, those with small diameter areolae, and those with no inframammary crease. Like the inframammary crease incision option, an axillary incision is an excellent choice for women with high preoperative breast volume who only require a small Toronto breast implant primarily to improve the upper breast contour. Secondary procedures in breast augmentation are usually a contraindication to an axillary incision approach. A simple exchange of implants through the original axillary incision requires endoscopy and can be challenging because multiple capsulotomies are often required. A second incision, such as a periareolar type, is well tolerated as an alternative by patients because it still constitutes the first scar on the breast.

The periumbilical approach has been developed recently with its chief advantage being a single inconspicuous scar located at a distance from the breasts. This method has many disadvantages, which include poor access to the breast implant pocket, inability to create a subpectoral pocket, inability to use a silicone gel prosthesis, inability to use a shaped prosthesis, and the need for a second incision for revision or breast implant Toronto replacement. It is not applicable to more complex conditions such as tubular breast hypomastia or other situations requiring alteration of nipple-areola complex position or shape. Its true value in breast augmentation remains to be established.