Breast Augmentation Specialist
Known as a breast augmentation innovator, Dr. Jerome Lamb was the first Kansas City Breast Augmentation Plastic Surgeon to insert breast implants endoscopically using the transaxillary approach. This technique involves making a short incision at the lower edge of the armpit and utilizing a small endoscope/video camera to ensure proper placement of the breast implant. Dr. Lamb has developed special instrumentation to ease and improve the transaxillary breast augmentation process. Dr. Lamb was also the first Kansas City Plastic Surgeon to implement the dual plane breast augmentation, a procedure resulting in dynamic lifting of the sagging, deflated breast.
Many approaches to breast augmentation have been developed. The inframammary breast augmentation method relies on an incision on the lower part of the breast while the periareolar technique involves an incision at the areola, or the dark pink tissue around the nipple.
In the nulliparus breast, the transaxillary approach produces superb breast augmentation results. One key benefit is that, unlike other kinds of augmentation procedures, the transaxillary technique results in scars that are virtually invisible. The operation is performed in a way which minimizes the potential for nipple sensation disruption as well.
Breast Augmentation Consultation
Women interested in Kansas City breast augmentation begin the process with a comprehensive screening and personal consultation. Dr. Lamb considers a range of factors, including personal and family history of breast disease, as well as pregnancies, breast-feeding and any previous history of breast surgeries. In addition, measurements are taken to determine a range of workable implant sizes. The shape, volume and symmetry of the native breasts will influence both the size selection and outcome of your breast augmentation procedure. By the use of diagrams and sizers, your proposed procedure will be explained and your result will be simulated within a bra.
Breast Implant Placement
One key decision that you and Dr. Lamb must make is the placement of the breast implant. This is determined by the width of the chest wall, the relationship between the implants and the pectoralis muscles, and the particular size and look you seek to achieve. Dr. Lamb will review each of these options listed below with you during your consultation.
Breast Implants Primarily Under the Muscle:
Placing the implant under the pectoralis muscle provides long-term, internal support by essentially creating an internal bra that can prevent implant downward migration, or bottoming-out. Other advantages include ease of placement, no implant visibility, natural breast shape, minimal rippling of implant surface and minimal mammography interference. In addition, because the muscle acts as a separating barrier to the breast ducts which contain normal bacterial flora, capsular contracture due to that cause is markedly reduced. Drawbacks include postsurgical muscular discomfort and a short period of time necessary for the implants to settle into position as muscle stretches to a new dimension.Another approach involves partial submuscular implant placement, also known as dual plane breast augmentation. This technique also provides a more natural appearance with a smoother transition from the flat upper chest wall to the rounded implant. It likewise allows for unobstructed mammography, produces less visible and less tactile implant edges and minimal skin rippling, and reduces the risk of capsule contracture.
Breast Implants over the Muscle:
Although some surgeons choose the over-the-muscle approach to correct ptosis, or drooping, of the breast, this technique often proves to be counterproductive over time. Dissection of the subglandular pocket destroys the supporting ligamentous structure and allows the breast tissue to slide downward on the chest. Though selecting the subglandular approach in combination with a mastopexy (breast lift) may produce a flattering early appearance, the benefits generally are fleeting and the breast tends to bottom out. The subglandular dissection also reduces the blood supply to the central breast, limiting future options.
Type of Implant: Saline vs. Silicone
Another decision which will be discussed thoroughly with you during your consultation with Dr. Lamb is the type of implant (saline or silicone) which would be right for you.Implant technology has evolved dramatically since the 1970s, when silicone leakage and hardening caused significant medical problems for a large number of women. Today’s devices are manufactured with thicker, vulcanized, silicone elastomer and filled with saline, or salt water, after the implant is placed in the body, thus allowing for a very small incision. Form stable cohesive silicone-gel implants are now available for patients age 22 and older.Determining which type of implant will best meet the patient’s needs is part of Dr. Lamb’s consultative process. The desired size and shape of the augmented breasts, as well as the woman’s physical characteristics, all play a role in selecting the appropriate implant.
Your Breast Augmentation Procedure
In candidates with minimal or no breast sag, a transaxillary, endoscopic-assisted approach with a saline filled implant will be discussed. The transaxillary approach is relatively quick and the dissection is nearly bloodless. In addition, the inframammary fold ligaments are preserved, providing the most natural look. The surgical scar is minimally perceptible, and the entire procedure typically takes about one hour. Incisions are closed with sutures located beneath the skin surface to produce an imperceptible scar. In patients with thin overlying breast tissue, an infra-mammary approach with a cohesive gel implant may be recommended as an alternative. The infra-mammary approach may prove superior when a tight high infra-mammary crease needs to be adjusted downward to adjust proportion between upper and lower breast.Most patients opt for the On-Q Postoperative Pain Relief System. This system utilizes a small pump to provide a continuous infusion of a non-narcotic agent in the xylocaine family that will numb and relax the pectoralis muscle. This approach offers superior postoperative comfort, although patients will also be prescribed an oral narcotic and muscle relaxant for residual postoperative discomfort. Medications for minimizing nausea are administered with the anesthetic. The discomfort generally subsides within three days and mild analgesics, such as Tylenol, are adequate for controlling any subsequent pain. Some swelling and minimal bruising of the breasts will occur but will gradually disappear. Patients typically are up and around a day after surgery, but are advised to follow an easy regime and avoid overhead lifting. The postoperative regimen will likely include implant displacement massage. This will begin at your follow-up visit on the first day after surgery. The incision scar typically fades and becomes minimally perceptible within a month. Most patients have a natural settling that occurs within a few weeks, although very subtle maturing will continue for four to six months.In the mild-to-moderately saggy breast, a different procedure is selected. Performed through an inframammary approach, dual plane breast augmentation consists of a small sub glandular dissection of the lower one-and-a-half inches of the pocket, followed by a releasing incision in the bottom sweep of the pectoralis muscle and then dissection of a sub muscular pocket. By separating the lower portion of the posterior surface of the breast from the underlying muscle and then incising the muscle, the upper breast and nipple is dynamically lifted, while leaving the lower pole of the breast full. Often the nipple rises as much as one inch following this surgical maneuver. Because the dissection is more extensive, there is an increased risk of nipple sensory loss. The advantage, however, often means that the additional scars of a mastopexy are unnecessary. The appropriateness of these and other surgical techniques will be discussed at your consultation.Whatever approach is taken, during your consultation, the risks of problems such as capsular contracture, post-operative bleeding, nipple sensation loss, infection and scars will be discussed. Leukotriene inhibitor usage to reduce the incidence and severity of capsular contracture as an off-label modality as well as therapeutic ultrasound will be discussed.
The New You
Breast augmentation surgery offers you an opportunity to enhance your natural endowment in a way that is both safe and readily perceptible, both to yourself and others. For many women, breast augmentation creates a stronger self-image and improved self-confidence. This, in turn, can lead to a new and more positive outlook on life.To schedule a breast augmentation consultation with Dr. Lamb, either fill out the form on the right or call (816) 795-5262.