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Breast Augmentation

Breast augmentation or enhancement is one of the most popular cosmetic procedures in the United States as well as in Franklin County. There are many reasons women come to see Dr. Ledinh to discuss breast surgery – a desire to have larger breasts and cleavage, to return to their pre-pregnancy shape, or to achieve a more balanced and youthful body shape. For many of these women, breast size and shape is an important factor in feeling healthy, confident, and attractive.

Saline vs Silicone Implants

The two types of breast implants currently used in the United States consist of a silicone shell with either a saline (salt water) or silicone fill. Both implant types are safe and have their respective advantages. It is important to discuss with Dr. Ledinh what your cosmetic goals are, as they may affect the choice of implant used.

The main advantages of silicone are that it tends to produce less rippling and has a more natural look and feel than saline. Having said that, saline implants used in the correct patient and situation can achieve a result essentially indistinguishable from that of a silicone implant.

There are pros and cons of each type of implant. Patients should take into consideration that saline implants are generally less expensive and require a slightly smaller incision as compared to silicone implants. Saline implant leaks are also easier to detect, as the body will absorb the fluid and lead to noticeable implant deflation.

On the other hand, silicone implant leaks are much less noticeable – therefore, the FDA recommends an MRI 3 years after silicone breast augmentation and then every 2 years thereafter for surveillance. The main side effect of an implant leak is capsular contracture (a hardening of the scar tissue surrounding any implant or foreign body, which can lead to pain or distortion and may require implant removal or revision).

Under vs Over the Muscle

Breast implants can be placed above (subglandular) or below (subpectoral) the chest’s pectoralis muscle. The pectoralis is the large muscle seen in body builders, on top of which sits the breast tissue. In general, Dr. Ledinh will place the implants below the muscle, as he feels that this provides for a more natural look than when the implant is placed only beneath the breast tissue.

Other advantages to subpectoral implant placement include decreased risk of capsular contracture and less interference with mammograms. A possible disadvantage of subpectoral placement is increased pain in the immediate post-operative period due to the stretching and cutting of muscle required to position the implant. Subglandular breast implant placement is typically reserved for those women with a moderate amount of existing breast tissue and female body-builders. During your consultation, Dr. Ledinh will help you to decide which option is best suited in your situation.

Incision Location

The available locations for incision placement are: in the lower breast fold (inframammary), along the outer edge of the areola (periareolar), in the arm pit (transaxillary), and through the belly button (transumbilical). 
The inframmamary incision is by far the most common approach used. It is hidden in the fold underneath the breast, not being visible in the sitting or standing position, and offers ideal visibility for the procedure.
A periareolar approach is ideal for patients who have a medium to large-sized areolar diameter. The scar is usually difficult to detect as it is concealed by the color and texture difference between the areola and surrounding breast skin.

The transaxillary and transumbilical approaches are less seldom used in breast augmentation. These incisions are smaller and located away from the breast tissue. As a result, there are more difficulties in creating a more precisely defined pocket for the breast implant, which may lead to a less natural and less than ideal result. Furthermore, these two approaches are generally limited to the use of saline breast implants.

Implant Size

Many women come to Dr. Ledinh seeking a change in their breast to a specific cup size. The problem is that cup size is not standardized in the clothing industry – one company’s cup size is usually not the same as that of another company. Cup size also changes depending on the chest or band size (for example, the volume in a 32C is smaller than the volume in a 40C bra).

Dr. Ledinh will work with you to decide what implant size will best help you to achieve your desired look. This will depend on a variety of factors, including the amount of existing breast tissue, your body frame, any difference between the two breasts, and breast droop. Dr. Ledinh finds that the most accurate way to choose implant size is to try on sizing implants during your consultation. We recommend that you bring in a form-fitting top as well as a sports bra to try on with the sizers.

Other Considerations

Breast implants not only come in a variety of sizes, but also shapes, textures, and projection profiles. There are many decisions to make during the breast augmentation process and this can be overwhelming. Dr. Ledinh will educate you and help you to understand how each of these decisions can affect the surgical result. Working together, the best implant and technique will be chosen to help you achieve the desired look to enhance your attractiveness and confidence.


Breast augmentation surgery is usually done under general anesthesia and takes about 2 hours from the start of anesthesia to entering the recovery room. Although every patient is different, it is advisable to take at least 1 week off before returning to work and to refrain from strenuous exercise for 4-6 weeks. Patients need to consider the risks of the procedure prior to undergoing such an operation. Some considerations are discussed here:

General Surgical Risks

Every surgery carries risks of bleeding, infection, and complications of anesthesia. Although these risks are relatively low in breast augmentation surgery, they are important to consider. Bleeding can require return to the operating room or blood transfusion. A superficial infection may be treatable with antibiotics, but deeper infections closer to the implant itself may require implant removal. Infections have even been reported to occur years after breast augmentation surgery. As with any surgical case involving anesthesia, patients are more susceptible to pneumonia, heart attacks, blood clots, and other problems in the recovery period.

Implant Leak

Breast implants have come a long way from when they were first introduced in the 1960s. The latest generation of implants carries roughly a 1% risk of leak per year. Leak of saline implants will be immediately noticeable, whereas the leak of silicone implants is more inconspicuous. Implant leak may possibly lead to the development of capsular contracture.

Capsular Contracture

A film of scar tissue will form around any foreign body or implant in the human body. Capsular contracture occurs when this film of scar tissue thickens and hardens, which in the case of breast augmentation can lead to pain, implant distortion, and firmness of the breasts. The exact cause of capsular contracture is unknown, but is thought to be related to bacterial contamination, implant leakage, or bleeding around the implant. Depending on the severity of the capsular contracture, the answer to the problem may require implant removal or surgical revision of the breast augmentation.

Cosmetic Issues

According to a study published in the May 2013 issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, 98% of women undergoing breast augmentation surgery reported that the results met or exceeded their expectations. Breast augmentation is a long-lasting result whose cosmetic outcome depends partly on the size, shape, and contour of the breasts before surgery. It is important to remember that no two breasts are alike and that there is no way to fully counteract gravity and the natural aging process. Dr. Ledinh will discuss the realistic expectations and goals of breast augmentation with you during your consultation.

Nipple Sensitivity

Changes in sensation of the nipple are not uncommon after breast surgery. Most women will report increased sensitivity that resolves or improves after several weeks. Permanent numbness or decreased sensation, although rare, has also been reported.

Breast Feeding after Breast Augmentation

In general, breast feeding after breast augmentation is unaffected. However, there have been some reports of decreased milk production or inability to lactate (usually associated with decreased nipple sensitivity). It is important to note that there is an increased chance of eventually requiring a breast lift or breast augmentation revision in those women who have significant enlargement of their breasts during pregnancy and lactation.

Mammography after Breast Augmentation

Studies have shown that mammography can be more difficult to read in patients who have breast implants. Special views are required and these women are more likely to require a subsequent study such as an ultrasound or MRI.

Breast Reconstruction

Cancer patients who have undergone a mastectomy or lumpectomy may benefit from Breast Reconstruction. Depending on the patient’s preferences and cancer treatment, there are several options for reconstruction, such as using their own natural tissue or using implants.

Your care team members – including a dedicated breast surgeon, a breast health patient navigator, a plastic surgeon, oncology, and radiation oncology – will work closely with the patient’s family doctor or radiologist reading mammogram results to develop a plan of treatment.

For more information on WellSpan Breast Care Services, please call (717) 709-6599.

Breast Reduction

Breast Reductions may relieve some women of neck pain, back pain, or other physical symptoms caused by large breasts. The procedure involves removing excess skin, tissue, and fat to reduce the size of the breast. Men with certain conditions (such as gynecomastia) may also benefit from the procedure.