When women in Frisco, Texas, come to Dr. Tabbal to discuss breast augmentation, he utilizes the same fundamental approach that is the cornerstone of his practice philosophy: providing patients with the knowledge and, therefore power, to make the right choices to achieve the results they want.
Ideal results are different for each woman. Some women strive to attain curves which they have never had; others desire to restore the shape and youthfulness that aging and childbearing took away. This is why a personal, tailored approach is so important.
Dr. Tabbal On the Importance of Your Consultation
Patients within this community – and in particular, those who come to my practice — seek to maintain the beauty and manner which is typical of the Southern woman. My patients take interest in their appearance and physical presence, which is based, in part, on a proportional physique. I understand that considering breast augmentation is a highly personal decision, and I approach each consultation with the thoughtfulness and personalized attention that both the patient and the surgery deserve.
Our relationship starts with your consultation and begins with a targeted history and physical assessment. It’s from this exam that I gather key information about the specific characteristics of your anatomy and tissues which enables me to reliably suggest the implant options which are best for your body.
It is during this discussion that the development of your goals for surgery begins. Having a clear mental “picture” of what you hope to achieve is only as powerful as the clarity with which your surgeon can envision this image. Therefore, I take great care to translate your subjective expectation into an objective reality.
This “two-way” sharing of information, from you to me and vice versa, culminates in an objective reference point from which your surgery is designed to fit your specific goals.
Your procedure will be uniquely yours, with a surgical plan tailored to fit your goals and your body.
Breast Implant Options
Dr. Tabbal’s practice provides you a wide array of implant choices for achieving your aesthetic goals. Technological advances have developed to the point where patients today have many more choices than just saline versus silicone. Dr. Tabbal offers both traditional “round” implants and shaped implants, including the highly-cohesive “gummy bear” silicone gel implants, from all the major breast implant manufacturers including Mentor®, Allergan, and Sientra®. All are FDA approved and rigorously tested.
Dr. Tabbal’s goal is to provide you with the information and knowledge to help guide your choice. Each breast implant affords a unique set of advantages and disadvantages which make some more favorable or better suited to your specific anatomy and to your desired expectations.
Dr. Tabbal’s goal is to provide you with the information and knowledge to help guide your choice.
Choosing Your Incision
Breast augmentation surgery begins with choosing where to place the incision, knowing that this is ultimately where the scar will be. As with so many other aspects of breast augmentation, a variety of factors play a role in determining which choice is best suited for you. Some particular factors include your breast anatomy and desired degree of enhancement, the style and size of the implant being used, and also your personal preference. Ultimately, Dr. Tabbal will share with you his recommendation, which is focused on placing the implant as precisely as possible while minimizing the risks of surgery and the visibility of your scar.
Dr. Tabbal on His Preferred Incision Type
Because of its proven safety and effectiveness, I most often utilize an incision within the inframammary fold (the crease “under the breast” where the breast meets the chest wall). This approach to implant placement is the most direct, allowing for the best access to the breast pocket and enabling precise surgical dissection that translates into precise implant placement.
Additionally, this “path” to the breast pocket helps minimize potential contamination of the implant with bacteria residing within the milk glands of the breasts or the sweat glands and hair follicles within the armpit. By minimizing the risk of infection, including “subclinical” infection, the potential for developing capsular contracture is reduced. Capsular contracture is a condition in which the scar tissue that surrounds the implant thickens and hardens, often distorting the shape of the breast. Another benefit of the inframammary incision is that, once healed, the scar is well hidden within the crease of the breast.
Having demonstrated the pros of choosing the inframammary incision, there are advantages for a subset of patients to consider other incision types. These include the endoscopic/transaxillary approach (armpit) and the periareolar incision.
In the case of the endoscopic approach, an incision within the armpit allows me to use an endoscope to place the implant from “above” as opposed to from “below.” Many argue that this technique is “scarless surgery,” since the scar is not visible while the arms are placed next to one’s body. Yet, on occasion, scars in this region can become unsightly when healed, becoming quite visible when wearing bathing suits, dresses, tanks tops and such. Other disadvantages to this approach exist, including (but not limited to) the increased risk for capsular contracture (because of the potential contamination of the implant with bacteria located within the hair follicles and sweat glands of the axillary tissues) and longer downtime and recovery after surgery.
The periareolar incision is located within the border of the lower half of the areola (the pigmented area of tissue surrounding the nipple) and the surrounding skin. In many cases, these scars can heal quite nicely and result in fairly imperceptible scars. More importantly, however, I favor this choice of technique when a patient’s anatomy requires adjustments to the height (or location) of the inframammary crease as in the case of women who have constricted or tuberous breast deformity. Downsides to this approach remain considerable and include the increased risk for capsular contracture, visibility of the scar, and damage to the nerves supplying sensation the nipple.
Placing the Implant
The next decision in performing breast augmentation is choosing the breast pocket or location of the implant. Three varieties of implant position exist, including subglandular (above the muscle), submuscular (behind the muscle) and “dual plane” which is a combination of both.
Dr. Tabbal on His Preferred Implant Placement
In the majority of women undergoing augmentation, I will favor a dual plane (mostly submuscular) approach because of its ability to combine the advantages of each technique while minimizing the inherent disadvantages of either.
These are 2 main reasons for my preferred approach:
- Your safety is the top priority. Studies suggest that implant placement behind the muscle decreases the risk for capsular contracture.
- You want a long-lasting result. Placing the implant behind the muscle gives the implant better coverage with existing breast tissue; this minimizes implant visibility, rippling, and palpability while producing a more natural, consistent result that stands the test of time.
On occasion, there are exceptions to this recommendation, including women who exercise their chest muscles heavily, such as bodybuilders. For women who regularly lift weights, breast implants under the muscle can look unnatural when the chest muscles contract. This is known as an “animation deformity.” In such cases, I will discuss opting for a subglandular implant position instead.
Your Rapid Recovery
Dr. Tabbal had the unique privilege of being trained by some of the world’s most experienced and notable surgeons, who helped refine the technique of breast augmentation so that patients could benefit from a rapid recovery. Minimized post-operative discomfort, downtime, and ultimate length of recovery are the result of appropriate implant selection, meticulous surgical dissection that minimizes stretching of the breast tissue, avoiding contact with ribs, and preventing bleeding before it begins.
These specific measures, and other thoughtful aspects to the post-operative regimen employed by Dr. Tabbal and his team, allow most of his patients to feel only mild pain after surgery, often requiring minimal medication, although experiences vary. While swelling is normal, it will typically subside within the first week or two following surgery. Generally, patients can return to normal, nonstrenuous, activities including work within 1 to 3 days following surgery. To minimize the potential for complications, aerobic exercise or other activities that raise your heart rate or make you strain should be avoided for three weeks. Heavy lifting can be resumed approximately 4 to 6 weeks following surgery.
The journey of knowing what’s best for you begins with your consultation with Dr. Tabbalconsultation with Dr. Tabbal. If you have interest in starting the discussion of breast augmentation, Dr. Tabbal is ready to help guide you.