Introduction
Endoscopic three - dimensional breast augmentation is a revolutionary procedure that combines the precision of endoscopic techniques with the visual benefits of three - dimensional imaging. In New York City, a hub of medical innovation and aesthetic excellence, this procedure has gained significant popularity. This article will take an in - depth look at the various aspects of endoscopic three - dimensional breast augmentation in NYC, including its overview, the best surgeons, implant options, and the latest technological advancements.
Understanding Endoscopic Breast Augmentation
Overview of Endoscopic - Assisted Breast Augmentation
Endoscopic - assisted breast augmentation is part of a growing trend in surgery, where the goal is to achieve the desired outcome with minimal incisional access. Plastic surgeons have long been focused on this approach to maximize cosmetic benefits by limiting and camouflaging scars. In breast augmentation, remote placement of access incisions, such as in the axilla or umbilicus, is a common strategy. This not only makes the scars less visible but also provides other advantages in terms of access to the surgical site.
Techniques and Their Advantages
Transaxillary Endoscopic Augmentation Mammaplasty
The transaxillary approach was first described in the 1970s. Initially, the blind technique had some limitations, such as a higher incidence of implant malposition. However, with the advent of endoscopic plastic surgery in the 1990s, the use of endoscopes in breast surgery revolutionized this approach. Endoscopic transaxillary augmentation mammaplasty allows for direct visualization of the dissection, reducing the risk of implant malposition. Howard demonstrated a significant decrease in the incidence of implant malposition from 8.6% to 2% when using the endoscope with the axillary approach. This technique is now widely used, but it has a significant learning curve, and more straightforward cases are recommended for initial experience. It also has limited application in secondary cases.
Transumbilical Endoscopic Augmentation Mammaplasty (TUBA)
The transumbilical approach was first implemented in 1991. It was initially criticized, mainly due to concerns about lack of control at the operative site, especially regarding bleeding and the plane of dissection. However, with improved instrumentation and better endoscopic skills, these criticisms have been proven invalid. Johnson's original study reported a lower complication rate with less bleeding compared to other methods. As plastic surgeons gain more expertise with this procedure, it has become increasingly popular.
Indications and Contraindications
Indications
Indications for endoscopic breast augmentation include the patient's desire for a remote incision and the absence of a well - developed inframammary crease to hide a crease incision below the horizontal visual axis. Patients who are concerned about visible scars are often good candidates for these endoscopic approaches.
Contraindications
There are several contraindications for endoscopic breast augmentation. A constricted lower pole with a short distance from the inframammary crease to the areola can be more difficult to address and may require radial scoring of the breast parenchyma. Tubular breast deformity is often better treated with a periareolar access incision due to the need for correction of the herniated areola and scoring of the constricted lower - pole parenchyma. In cases of ptosis, while endoscopic breast augmentation is possible in pseudoptosis and grade 1 ptosis, it requires careful consideration as there are concerns about over - or under - dissection of the inframammary crease, especially for inexperienced surgeons.
Three - Dimensional Imaging in Breast Augmentation
The Role of 3D Imaging in the Consultation Process
Three - dimensional imaging systems, such as the Vectra® 3 - D breast imaging system, have become an invaluable tool in breast augmentation consultations. These systems capture multiple pictures of a person's body and reconstruct a three - dimensional image that can be rotated on a computer screen. This allows patients to have a virtual augmented preview of their breasts using different sizes and types of implants. It helps patients visualize the expected results of the surgery, which is a frequently asked question. As a result, patients feel more informed and confident about their decision - making process. The Center for Cosmetic Surgery in Colorado has reported that this technology has made a remarkable difference in the educational process and that patients love being able to preview their post - surgery results before the actual procedure.
Case Studies on the Use of 3D Simulation
In a case study of a 33 - year - old woman with severe asymmetric pectus excavatum, 3D simulation was used to select the optimal implant for breast augmentation. The patient had residual breast asymmetry after chest wall correction using the Nuss procedure. A 3D image of her breasts was taken with the Vectra H1 handheld 3D imaging system, and the implant outcome was simulated using the Vectra breast sculptor software. Based on the simulation, a 140 - ml full - height, low - projection, anatomically shaped, cohesive silicone gel implant was selected. After the surgery, the breast asymmetry and anterior chest wall depression improved to a natural appearance. The patient rated the result as excellent, and the mean score rated by board - certified plastic surgeons was 4.67. This case demonstrates the advantage of 3D simulation in preoperatively selecting optimal implants, especially in cases with complex anatomical variations.
Top Plastic Surgeons for Endoscopic Three - Dimensional Breast Augmentation in NYC
Dr. Adam R. Kolker
Dr. Adam R. Kolker is a double - board - certified plastic surgeon in New York City. His education and training span some of the most prestigious medical institutions in the world, including Harvard Medical School, New York University, and the University of Melbourne in Australia. As an associate clinical professor of surgery at the Mount Sinai School of Medicine, he stays at the forefront of advancements in plastic surgery. He is highly respected for his skill, artistry, innovation, and experience. Dr. Kolker has been featured in New York Magazine's Best Doctors issues from 2008 - 2024, as one of America's Best Plastic Surgeons in 2021 - 2024, and in Castle Connolly's America's Top Doctors from 2016 - 2024. He specializes in breast augmentation and other cosmetic surgery procedures, and his approach focuses on achieving beautiful, natural, and proportional results.
Dr. Zuckerman
Dr. Zuckerman is an expert in the placement of breast implants. He trained in plastic surgery at elite institutions such as Brown University and NYU. He can guide patients through important decisions regarding breast implant size, material, profile, shape, texture, and manufacturer. His patients' most commonly selected breast implant volume is approximately 350 cc. He takes great care to understand each patient's desired breast size and makes meticulous breast measurements at the cosmetic consultation to ensure a precise recommendation of implant profile and base diameter. He uses a no - touch technique during surgery to avoid touching the implant during placement and is able to achieve high - quality augmentation outcomes with either silicone or saline breast implants.
Breast Implant Options in Endoscopic Three - Dimensional Breast Augmentation
Filling Types
Saline Implants
Saline implants are silicone breast implant shells filled with a sterile saline solution. They are FDA - approved for use in patients 18 and older. Advantages of saline implants include that rupture or leakage is easily absorbed by the body, they are slightly less expensive than silicone implants, and can be inserted via a smaller incision as they are inserted rolled and filled with saline by the plastic surgeon inside the breast pocket. However, they are typically more firm and have a less natural feel, there is a risk of visible wrinkles and rippling, and a higher risk of rupture or leakage compared to silicone implants due to inherent structural weakness around the fill port.
Silicone Gel Implants
Silicone gel implants are significantly more popular than saline implants nationwide. They are softer and have a more natural feel, are pre - filled by the manufacturer, reducing the risk of filling asymmetry or leakage during placement, and have a lower risk of implant wrinkles and rippling. They are FDA - approved for use in patients 22 and older. However, they are slightly more expensive than saline implants, and breast implant rupture or leakage must be detected via MRI. Leak or rupture of a silicone breast implant is a rare, non - toxic event.
Highly Cohesive Silicone “Gummy Bear” Implants
Since 2013, the FDA has approved more cohesive types of silicone gel breast implants, also known as form - stable breast implants. The major manufacturers offer varying cohesiveness options. The benefit of these implants is that upon a leak, the gel acts more like a solid and will remain in place. They also minimize subtle changes in implant shape and can help maintain upper pole breast fullness. However, more cohesive gels translate to firmer implants, which may not be suitable for all patients.
Shape and Texture
Round vs. Shaped (Anatomical) Implants
Round breast implants are used in the majority of augmentations. They typically achieve a fuller upper pole. Shaped or anatomical implants were introduced to avoid an overly augmented appearance. They have less volume at the top of the implant, which can be a good option for patients with little natural breast tissue. However, a natural - looking result is easily achievable with a round silicone implant in the hands of a skilled surgeon. Both types are FDA - approved.
Smooth vs. Textured Implants
Textured breast implants have a rough surface, similar to sandpaper under magnification. It is thought that the textured surface helps anchor the implant in place and may lower the risk of capsular contracture. Textured implants are more commonly used in breast revision surgery. However, they are associated with a rare type of cancer known as anaplastic large - cell lymphoma (ALCL). Round implants are available in both smooth and textured forms, while shaped breast implants are all textured.
Procedure, Recovery, and Complications
Procedure Steps
Preoperative Consultation and Physical Examination
The preoperative consultation is crucial. Surgeons discuss the four possible access incisions (periareolar, inframammary crease, axillary, and umbilical) with the patient in a non - biased manner. They also discuss the potential complications of breast augmentation, especially those unique to the endoscopic approaches, such as implant malposition, axillary hematoma, and lymphadenopathy. A physical examination is performed, and the proposed incision is marked. The distance from the areola to the inframammary crease and the transverse diameter of the breast are assessed to select the appropriate implant size.
Transaxillary Procedure
The patient is positioned in the supine position with the arms on arm boards at approximately 80 degrees. A 1:10,000 epinephrine solution is used in the incision and at the position of partial myotomy. An incision is made through the axillary position, and the subcutaneous tissues are spread vertically until the pectoral fascia is reached. The endoscopic retractor and scope are inserted, and the pocket is gradually enlarged. The myotomy of the pectoralis muscle origin is performed, and care is taken to avoid over - or under - dissection. A deflated saline implant is inserted, and then inflated. The pocket is refined, and the implant position and volume requirements are verified with the patient in the sitting position. Finally, the fill tubes are removed, and the axillary incisions are closed.
Transumbilical Procedure
The midline from the sternal notch to the umbilicus is marked, and lines from the umbilicus tangent to the medial border of the areola are drawn bilaterally. The patient is positioned supine with arms extended to 90 degrees. An umbilical ring is elevated, and an incision is made large enough to allow passage of the index finger. The mammascope is inserted through the umbilical incision and advanced to the fascial plane beneath the breast. An evacuated and coiled implant is inserted through the mammascope, pushed into the breast, and then inflated. After over - filling and external manipulation, the excess volume is removed, and the fill tubes are removed. The mammascope is reinserted to visualize the implants, and then withdrawn, and the umbilical incision is closed.
Recovery
Breast augmentation is an outpatient procedure, typically performed under general anesthesia. Patients can expect to walk around a few hours after surgery and may leave the house within the next day or two. They may feel sore for the first week or so and need to limit strenuous exercise for about 2 - 4 weeks. Surgeons may ask patients to wear a supportive surgical bra or sports bra for a certain period. If the implants are placed partially beneath the pectoral muscle, the breasts may initially sit high on the chest, but they will settle into their optimal position over the next several weeks, with final results after a couple of months.
Complications
Complication rates for endoscopic breast augmentation are comparable to other breast augmentation techniques. Common complications include implant malposition, axillary banding (fibrous banding across the axillary incision), hematoma, deflation, and capsular contracture. In the transumbilical approach, inadvertent subpectoral implantation has been reported, which may require an inframammary incision for correction.
Conclusion
Endoscopic three - dimensional breast augmentation in New York City offers a combination of advanced surgical techniques and cutting - edge technology. With options for endoscopic access to minimize scarring and three - dimensional imaging to help patients visualize their results, it has become a popular choice for women seeking breast augmentation. There are several highly skilled plastic surgeons in NYC, such as Dr. Adam R. Kolker and Dr. Zuckerman, who can provide personalized care and achieve excellent results. The choice of breast implants, whether in terms of filling type, shape, or texture, allows for customization based on the patient's preferences and anatomy. However, like any surgical procedure, it is important to understand the indications, contraindications, procedure steps, recovery process, and potential complications. If you are considering endoscopic three - dimensional breast augmentation, schedule a consultation with a board - certified plastic surgeon to learn more and make an informed decision.
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