gel, immediately behind the breast or pectoralis major muscle.

This procedure has been done since the early 1950s. At the time of consultation, realistic goals are assessed as to the size of the implant required for the desired result and also whether some form of ptosis procedure (lifting the drooping breast) will be necessary for the optimal result.

Augmentation mammoplasty may be performed through several different incisions. The classic procedure utilizes an inframammary incision on the underside of the breast.. A peri-areolar incision (incision around the areola-skin interface) is an alternative to the inframammary scar. Dr. Dabb prefers the transaxillary(armpit) incision with saline implants. This allows for a hidden incision in the axilla, leaving no tell-tail incision on the breast itself.

In certain patients, gel implants may be utilized instead of saline. Gel implants may be preferable to saline implants when the clinical situation requires that the implant be placed on top of the pectoralis muscle. Gel implants do cost more than saline implants. When they fail, the failure may be difficult to detect, so the FDA suggests an MRI every three years.

At the time of consultation, the size of the implant is determined. Careful measurements of the breast are made, along with evaluation of the chest wall, especially the pectoralis major muscle. Care is made to choose an implant that properly fits in anatomic pocket behind the muscle.

This sometimes is in conflict with the patient's initial desires, especially if the patient desires to be dramatically larger.

If there is uncertainty as to the size of the desired implant by the patient or surgeon, an adjustable implant may be used. This implant is designed with a filling port that may be left underneath the skin. Saline may be injected into this port to enlarge, or withdrawn from this port to diminish the size of the implant. This system is especially valuable for patients who have significant breast asymmetry, allowing the surgeon to alter the size of one implant in reference to the other.

Surgery - The procedure is performed as an outpatient, under general anesthesia or I.V. sedation. The implant is placed with endoscopic assistance. This allows for maximal visualization of the pocket from behind the muscle, allowing for less postoperative complications, such as bleeding, and creating an exact anatomic dissection. Endoscopic placement causes minimal disruption of the pectoralis major muscle; the patient may return to normal activity immediately after the procedure without any restrictions or fear of disrupting the muscle. Dr. Dabb has performed endoscopic augments for over 10 years.

Recovery - After the surgery, the patient is placed in a brassiere and a strap across the top of the breast. The patient is allowed to shower 48 hours after the surgery. The patient is kept on antibiotics for approximately five days. There are no immediate postoperative restrictions. A pain pump mixed with local anesthetic and an antibiotic is utilized, minimizing the immediate post operative discomfort.

Return to Work - 48 hours

Full Activity - 7 to 10 days

Complications - Bleeding, infection (with associated loss of implant), loss of sensation of breast skin or nipple, asymmetry, traumatic rupture of the implant, leakage of the implant, capsular contracture (scar tissue forming around the implant), palpability of the implant, and visual rippling of the edge of the implant will be discussed.