Breast Procedures

Incision Placement

A breast augmentation is usually performed under general anesthesia. In select patients with existing implants, implant exchange can be performed under local anesthesia with intravenous sedation. Dr. Lee places the breast implant incision in the inframammary fold, which is the crease below the breast, where the resulting scar is well concealed. Dr. Lee considers this incision placement to be the gold standard practice as it provides him with excellent visibility and control during the procedure. This precision ensures accurate implant positioning, whether placed above or below the chest muscle, leading to balanced, natural-looking results. Because the incision is placed away from the breast tissue and glands, there is a lower risk of complications. This technique also has less impact on breastfeeding compared to other incision methods.

Implant Pocket Creation

Next, the implant pocket is created. Dr. Lee will use either the submuscular, subglandular, or dual-plane implant pocket method:

• Submuscular: The implant is either completely (total submuscular or subpectoral pocket) or partially (partial submuscular or partial subpectoral pocket) covered by the chest wall muscles (i.e. pectoralis major muscle). This method reduces the risk of implant visibility, rippling capsular contracture, and the implant bottoming out. Submuscular placement also allows for easier interpretation of future mammograms (in comparison to a subglandular placed implant). However, this method can come with a longer recovery period and the risk of animation deformity, which occurs when the implant shifts with exertion of chest muscles.
• Subglandular: The implant is placed above the pectoralis major muscle and covered by the overlying breast gland. This method typically comes with less post-operative discomfort and a quicker post-operative recovery. It also takes less time for breasts to assume their final position and shape. However, subglandular placement can come with an increased risk of implant visibility/rippling, capsular contracture, and the implant bottoming out. It can also cause a more difficult interpretation of future mammograms.
• Dual-Plane: The upper portion of the implant is covered by the pectoralis major muscle while the breast gland is released (separated) from the chest wall muscles, and used to cover the lower portion of the implant. Dual-plane implant placement combines the advantages of both subglandular and submuscular implant placement. This can mean reduced implant visibility/rippling, lower risk of capsular contracture, and reduced animation deformity.

Implant Positioning

Dr. Lee uses several techniques to ensure that your implants are naturally positioned in the breast pocket, creating a smooth transition from natural breast tissue to implant. This includes performing an intraoperative assessment with implant sizers. Implant sizers are identical in terms of their shape, base diameter, and volume of your desired implant. Once the implant pocket has been created on both sides, implant sizers are inserted, and your surgical wounds are temporarily closed. The operating table is adjusted to bring you into a seated position so that Dr. Lee can properly assess the appearance and symmetry of your breasts with your desired implants in place. If necessary, minor adjustments are made to ensure that an optimal outcome is achieved. The implant sizer is then exchanged for permanent silicone breast implants.

Once satisfied with the volume of the implant, the fill tube is removed. The implant pocket is then closed, and the incision is closed with absorbable sutures.