femininity and your figure have one element in common – the shape of
your breasts. Fashion choices cover the curves yet many are
designed to enhance them.
ages women have turned to bras, corsets, and now surgery to obtain a
more aesthetically pleasing bust-line. Breasts are one of the
most defining features on a woman’s body – and there is no doubt
that the size, shape, and appearance of the breasts can influence
how women feel about their bodies and in turn feel about themselves.
is a highly emotion and fulfilling experience for many women. With over 575,000 women who underwent breast augmentation and or
breast reduction in 2007, according to the American Society for
Aesthetic Plastic Surgery. In the last year,
2009 - breast augmentation was the #1 procedure done with over
311,957 actual surgeries performed. Despite the recession the
overall plastic surgery demand only went down less than 2 percent.
You can read the latest statistics
surgery is a very personal decision. Most women consult a
plastic surgeon after they have carefully thought about surgery and
come into their offices armed with a lot of research questions. Most plastic surgeons find it easier to discuss the pros and cons of
this procedure with this type of patient who has already done their
homework, however this should never take the place of complete
guidance of a qualified board certified plastic surgeon. You
can almost expect without reservation, that your loved ones will
also have something to say about this procedure and how they
perceive it. But remember the effects of surgery on your
breasts and body are yours and yours alone.
about incision and implant placement is best done after a physical
examination and conversation with your plastic surgeon. Your
body type will dictate the options appropriate for you.
CREASE OR INFRAMAMMORY FOLD
the crease has to be done when the patient wants to get larger
implants, this is to make sure the implant is centered directly
behind the areola with even sides all around.
who naturally have a short distance from the nipple/areola complex
to their inframammary fold (crease) sometimes wish to increase that
distance so that the breast will appear fuller in the lower pole.
Measurements are made to ensure as much symmetry as possible - along
with making sure that this will not result with the breast implant
complication of "bottoming
Lowering of the inframammary fold is
a very important operation in breast augmentation, and it is
accurate and predictable when surgeons use optimal measurements and
techniques. Many plastic surgeons will reinforce the new
lowered inframammary fold to help guard against the tissue
stretching in the future. Repositioning the inframammary fold
may be necessary for the best optimal aesthetic result.
Though many women
considering breast augmentation have an idea of how they want their
breasts to look, talking with the plastic surgeon will help
determine the best type of implants for a patient’s body, shape and
size, general health, lifestyle of goals. Having realistic
goals in mind with the size of the implant is a must. The
toughest decision in having this surgery done is choosing what size
is going to be appropriate for your own body stature. Doing
your homework with what size is going to be good for you requires a
lot of extra time with researching.
The #1 reason for revision
augmentations is the regret of not going big enough with the right
size implant the first time. All implants come in sizes of
cubic-centimeters of trying to determine what implant is going to
give a patient a “C” cup can be challenging. The first thing
is that we all must have faith in our plastic surgeons on what they
deem is going to be best for our body. Going too large can
create complications for some patients, so it is important to listen
to what the experienced plastic surgeon is suggesting.
Your end result
is predicated on what you start this
process out with. If the patient has a lot of pre-existing tissue,
then more than likely, they will of course achieve a much bigger
size out of one type of implant versus someone who is not starting
out with any tissue. Also overall stature is an important factor
with ribcage and chest wall, as a patient who has a wider ribcage
will be able to accommodate a much larger implant than someone who
has a narrow ribcage.
Breast width figures predominantly in both ribcage
and lateral (sideway from the body) protrusion. Exact body
measurements are needed because simply there is no standard of
breast cup size in the garment industry.
Dr. Rodriguez talks about moderate vs high profile implants
When a patient
describes her desires for a certain breast size – by using “cup
sizes”, her perception of the patient and the doctor could be
totally different. Most doctors will suggest implants based on
the overall relative proportion of a patient’s figure. Exact
body measurements to include proportion include the distance between
the nipple and the inframammary fold and the sternal notch (the
depression right below the throat) to the nipple. It’s all
about the proportion and shape - to match the chest.
Remembering that all patients have different body structure; torsos and chests are always going to differ,
along with bones that might be irregular. All patients are not
just small, large or sagging – they each have specific individual
characteristics. Patients need to realize that their body type and
tissue characteristics may dictate the appropriate implant, type and
silicone or saline are made with the same shell which is made of
silicone elastomer. This shell is a flexible envelope which appears
clear and translucent and contains the implant filler either
silicone or saline. With saline implants - this shell is
inflated to the size it will become with sterile saline, and with
silicone this implant comes to the plastic surgeon pre-filled with
silicone cohesive gel inside from the manufacturer. Most
plastic surgeons will agree that silicone implants tend to feel more
like natural breast tissue, however there are perceived drawbacks. The biggest concern is with
rupture of a silicone implant, that it
is harder to detect this versus a rupture with saline. The
advantage of saline is the saline (salt solution) is dissolved by
Saline implants are more likely however to show
ripples in the implant – and can tend to appear less natural in
women with little to no tissue starting out. Small ripples can
show through thin skin. If the shell
on a saline implant and fluid
leaks out, this will be visible quickly, because the implant will
with saline are a little more frequent with this type and sometimes
the women can feel the movement of the saline solution inside the
implant itself. The breast manufacturers suggest that saline
implants should be replaced somewhere between 12 - 15 years.
Regarding size information with saline implants - they are available
ranging from 120 cc to 960 cc in the United States.
Silicone implants are pre-filled and sealed off before they leave
the manufacturer. Saline implants however; come to the plastic
surgeon deflated (in which they will be placed into the pockets –
and then filled with saline afterwards through a port). Each
saline implant has an optimal fill level with which the manufacturer
For instance, a 250ccs; breast implant comes
with a recommended fill of + 25ccs. This is to ensure the
plastic surgeon that going to this amount over the implant fill
level that there will be less rippling in the implant. However, a
concern to think about is that with more fill over the implant size,
the implant will not necessarily become larger per se, it will just
become firmer to the touch. Rippling can also occur to those
implants that have been overfilled by a lot, by causing scalloping
along the edges of the implant. So there is a fine line where
the actual fill rate should begin and stop.
Most plastic surgeons will stay within the optimal levels of
fill/overfill, but sometimes they will go over the recommended
amount. Most plastic surgeons will agree that the
manufacturer’s recommended amount is too low, and in order for them
to get the best results in a certain patient sometimes they do go
beyond what is recommended. Overfilling is seen more
beneficial in the long run than under-filling, as with under-filling
the chances or rippling or wrinkles are greater. Overfilling an
implant will reduce the stress lines or rippling that happen from having an
implant filled too low, because it is these actual stress lines that
can cause an implant to eventually fail.
This adjustable saline filled implant
is exclusively available through Mentor. The adjustable
implant allows the plastic surgeon to adjust the size of the implant
up to six months post operatively from your breast augmentation.
Deciding your size is one of the most difficult decision with having
augmentation. This implant allows the patient some time to get
adjusted to the size and decide whether it is going to be right for
The Spectrum technology is an
innovative design that allows the surgeon to continue making
adjustments to the breast after your breast augmentation surgery. There is a small removable fill tube that is left temporarily
attached to the breast implant after surgery. The tube is
accessible to the surgeon by injection through the skin (the port is
located under the arm area). Once the desired size and shape
of the implant has been achieved, the fill tube is removed.
There is a self sealing valve that immediately closes and seals the
breast implant. The port doesn't stay in the patient's body
forever, it is removed after the final fill is completed under a
After surgery the breast area can be
very swollen for the first two months. After the swelling
dissipates, the patient can see if they are satisfied with their
size. The adjustable implant offers an alternative to complete
replacement of the implants with those of a different size.
is the other choice for breast augmentation patients. There is
all different levels of cohesiveness with silicone implants, with
the newer "gummy bear" having the highest level.
Silicone implants do provide a much more
natural feel in the different
implant placements, and also will not
have nearly as much rippling as saline implants. All the
studies that have attempted to link silicone to connective tissue
diseases and autoimmune diseases, have failed to show any
correlation. The FDA has approved silicone implants back on
the market to be used as augmentation devices after several years of
making sure the implants were safe for the general public.
The newer generation of silicone breast implants:
pre-filled with cohesive gel
layers of shell surrounding the silicone filler
the touch - however; are still very soft to the touch
Because of how
long silicone implants were off of the market it is very important
that you consult with a plastic surgeon that has used silicone
implants as an option for their patients. Because of the
situation with silicone implants being taken off of the market from
1992 to 2005, investigators involved in the clinical studies were
allowed to use silicone implants for reconstructive and revision
surgery. These investigators that were part of this study were
the only ones that were allowed to use silicone breast implants
during this time.
November 2006 the FDA finally lifted all
restrictions on these devices and approved the use of silicone
breast implants for their patients who were at least 22 years old.
The new cohesive
silicone gel implant is so much safer because of how much thicker
the consistency the gel is even when cut, nothing will leak out of
the implant shell, leaving the implant shape intact. There is also less palpable rippling and less potential for visible
rippling with silicone implants. Because of the
re-introduction of the silicone implant – the Food and Drug
Administration recommends a
magnetic resonance imaging (MRI) scan at
3 years after surgery using silicone gel implants, to check for
possible silent ruptures. This is a listed on the information
for all silicone implants, but only as a warning.
suggestion for a MRI should come directly from your own plastic
surgeon to tell you whether or not it really is necessary. Personally in having silicone implants for over 25 years, I have
never needed an MRI for evaluation, and I have never suffered a
rupture or a leak with four breast augmentations all done with
silicone implants. This issue with having an MRI every three
years should really be advised by your own plastic surgeon on what
he deems is correct for you.
newer cohesive gel implants are so much thicker in it’s consistency
that if a rupture should occur, that the silicone could not leak
outside the capsule that the implant is sitting in. The
molecules are simply too big to bypass the membrane. With the
newer style “gummy bear” implants, these implants can literally be
cut in half and will not go anywhere. The Gummy Bear implants are
made of silicone gel pieces, designed to prevent leakage and keep
implants are filled with a cohesive silicone that does not move from one area of
the implant shell to another. Because of this, the shell of the implant will
not collapse or fold.
implants are designed with a highest level cohesive gel. If a leak or a rupture
should occur, this cohesive silicone gel is designed not to be able to migrate
outside of the implant. These implants can be cut in half with no effort, and
the silicone stays intact. However, there is a layer of the implant shell that
decreases silicone diffusion but even with this intact there can be some
microscopic diffusion of silicone through the shell.
like all other implants can be physically susceptible to breakage. The
advantage with a gummy bear implant is since there are no folds that can occur
in the implant shell because of the fill viscosity; the chance of a rupture is
Shape of the Implant:
bear cohesive gel implants can and does maintain their shape since the filler
viscosity doesn’t move around like standard saline or silicone.
Less Chance of Capsular Contracture:
on the implant’s track record, there has been some studies correlating that
capsular contracture might occur less with these implants. There are varying
opinions on why this might occur with this implant – including the fact the
implants come standard in a
textured surface (which some plastic surgeons
believe does reduce the occurrence of capsular contracture) and or the fact that
the actual viscosity of the filler helps with the occurrence.
DISADVANTAGES OF GUMMY BEAR
Shape of Implant:
implant since it comes only as an
anatomical (tear drop shape); the patient is
going to be getting a more “natural” outcome with their breast augmentation
versus having a round implant. Anatomical implants have less upper pole
fullness than rounds. The patient who wants that definition at the top with
more fullness will not be happy with this shape of an implant.
Feel of Implant:
these Gummy Bear Implants are much firmer than the standard cohesive gel
implant, some patients have reported that the Gummy Bear implant feels “Not as
Soft” as a regular cohesive silicone implant. Some surgeon’s say that the
larger a patient goes with these implants, the firmer these implants will feel.
Rotation of Implant:
Implants only come in one shape –
Anatomical or Teardrop shape. These implants project more
from the bottom than they do on the top. Because of the design of these
implants, it is possible that the implant could rotate in the body. This will
cause distortion of the breast. Most plastic surgeons will take great care when
it comes to the pocket dissection (not to make the pocket too big), to help
minimize this from occurring. However, by the laws of nature; the pocket that
is made for the implant to sit in will eventually stretch out some on their
way to fix this complication is to have the implant removed and replace the
anatomical gummy bear implants for a round silicone implants. Patients are at a
higher risk for this to happen if they have a lot of pre-existing tissue before
anatomical (teardrop) shaped implants only come in a textured surface. It is this textured surface that increases friction and helps the implant from
rotation. The anatomical shaped implant is different at the bottom than the
top; and it imperative that the implant maintains the proper position in the
implants are not able to be “deformable” due to the viscosity of the filler. These implants cannot be squeezed into smaller incision. Most of the incisions
have a length of 4.5 – 5.5 cm. Using the
peri-areolar incision is not possible with the Gummy Bear
implants. Trans-axillary incision might be possible,
but can be difficult. Most plastic surgeons only use the inframammary
incision (crease incision) for placement of these implants.
the viscosity of the filler being almost solid in the Gummy Bear implants, this
can cause a gel fracture or a crack. Excessive manipulation seems to contribute
to this occurring. It is rare, and more conclusive data is needed for this
Cost of Gummy Bear Implants:
Bear implants cost considerably more than saline. Gummy Bear implants are also
several hundred dollars more than traditional silicone.
lifetime devices. They all have the potential to leak or rupture and they do not
change as a woman’s body ages over time. There is no telling
how long your implants will maintain their function and appearance,
which is why it is imperative to maintain an ongoing professional
relationship with your plastic surgeon.
It is important for
you to follow up on your first anniversary of your implant
placement, even if you have no concerns. Thereafter, you
should have your breasts annually evaluated by your plastic surgeon
or the doctor who performs your routine yearly breast exams and
mammogram screenings. There are many options should your
implants need to be replaced, or if you chose to replace them.