BREAST ENLARGEMENT – AN INTRODUCTION TO YOUR FIRST CONSULTATION
Consultation and History of Breast Enlargement
In my view the initial consultation for breast augmentation should begin with open-ended questions about the patient’s goals and expectations for the procedure. Patients today have often spent some time researching the procedure either through friends or through the internet. The surgeon should be able to form an impression of the person as a well-informed, psychiatrically stable person with appropriately realistic expectations for the procedure. Any concerns about the patient’s level of understanding, unrealistic expectations, or self-esteem issues should be fully explored prior to proceeding with surgery. A careful medical history and physical examination is essential for the assessment of risk factors and candidacy for this surgery.
The ideal size and shape of the female breast is inherently subjective and relates to both personal preference and to cultural norms. However, most surgeons will agree that there are certain shared characteristics which represent the aesthetic ideal of the female breast form. These characteristics include a profile with a sloping or full upper pole and a gently curved lower pole with the nipple-areola complex at the point of maximal projection. The breast structure itself may be thought of as the breast parenchyma resting on the anterior chest wall surrounded by a soft tissue envelope made up of skin and subcutaneous fat. Clearly, the resulting form of the breast after augmentation mammaplasty will be determined by the dynamic interaction of the breast implants, the parenchyma, and the soft tissue envelope.
What to expect and look for during a breast enlargement examination
A thorough physical examination begins with observation and careful documentation of any signs of chest wall deformity or spinal curvature. It is imperative to document and draw attention to any asymmetry of breast size, nipple position, or inframammary fold (IMF) position. Careful palpation of all quadrants of the breast and axilla is required to rule out any dominant masses or suspicious lymph nodes. While palpating the breast, the surgeon should carefully assess the quantity and compliance of the parenchyma and soft tissue envelope. The soft tissue pinch test is a useful method of assessment in which the superior pole of the breast is gathered between the examiner’s thumb and index finger and measuring the thickness of the intervening tissue. In general, a pinch test result of <2 cm will often indicate a need for subpectoral, placement of the implant. It is also important to characterize the amount, quality and distribution of the breast parenchyma as it may be necessary to reshape or redistribute the parenchyma to achieve the desired shape of the breast mound. The elasticity of the skin should also be characterized by observing its resistance to deflection and noting any signs of skin redundancy or stretch marks. Both manufacturers have developed a preoperative planning system to facilitate patient assessment and implant selection.
Although implants come different volumes and dimensions the art of breast enlargement surgery is around picking the right implant, shape, volume and size for the right breast and chest wall type. This is based on the basic framework of breast dimensions, especially the width and height, as well as the amount of parenchyma. Trialing of different sizes with a sports bra remains an invaluable tool in arriving at the final range of implants.
Further Information Regarding Breast Implants and Enhancements
In my practice, we offer a provision of standard information pack for all surgeries. This includes detailed information on the augmentation surgery, postoperative recovery and scar management. Follow-up appointments or correspondence may be necessary to clarify any questions. It’s my standard practice to offer as many follow-up appointments as needed until the patient arrives at a well-informed decision regarding surgery.
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