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Everything You Need to Know about Breast Augmentation

 

 

 

 

 

 

                                     Breast augmentation

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The Shape Of Your Breast

Fashion, 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.

Throughout the 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.

Breast surgery 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 here.

Breast 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. 

 

 

The first and most important is choosing a board certified plastic surgeon. 

 

 Other Breast Augmentation Choices: 

The decision 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. 

 

 

 

 

  • LOWERING THE CREASE OR INFRAMAMMORY FOLD

Lowering of 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. 

Patients 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 out".

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.

Four Important Facts about Breast Augmentation

 

 

                                                    breast augmentation and breast size             

                                                  Licensed image for CosmeticSurgeryForums.com

 

 

Breast Augmentation - Size Matters

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 size.

 

 

 

 

 

SILICONE OR SALINE BREAST IMPLANTS

All implants, 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 the body. 

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 ruptures on a saline implant and fluid leaks out, this will be visible quickly, because the implant will shrink. Ruptures 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.

 

 

                                                Saline Breast Implant

                                         Copyright 2010 Connall Cosmetic Surgery - Used with permission

                                                                 Photo of a Saline Filled Implant

 

 

 

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 has recommended. 

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 herself.

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 local anesthetic.

This implant is available in both smooth and textured surface, and also either round or anatomical shape

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. 

 

 

                                      Spectrum Adjustable Breast Implants

                                             Copyright 2010 Mentor Corporation - Used with permission

                                                   Spectrum Adjustable Breast Implants

 

 

 

 

Silicone implants 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:

  • come pre-filled with cohesive gel

  • have three layers of shell surrounding the silicone filler

  • firmer to 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. 

This 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.

Read more about Silicone Breast Implants and MRIs

 

                                                   Silicone Breast Implants

                                  Photo of Silicone Implants in various types of Cohesiveness and Profiles

 

 

 

 

 

NEWER COHESIVE GEL SILICONE IMPLANTS 

The 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 solid form.  

 

 

 

ADVANTAGES OF GUMMY BEAR ANATOMICAL IMPLANTS:

  • No Folds and or Rippling:

These 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.

 

 

 

  • No Leakage:

These 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.

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 less. 

 

 

  • Shape of the Implant:

The gummy 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:

Based 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 ANATOMICAL IMPLANTS:

  • Shape of Implant:

This 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:

Because 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:

Gummy Bear 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 own. 

The only 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 the augmentation.

The 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 pocket.

 

 

  • Incision Size:

Gummy Bear 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.

 

 

  • Gel Fracture

Because of 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 occurrence.

 

 

  • Cost of Gummy Bear Implants:

Gummy Bear implants cost considerably more than saline. Gummy Bear implants are also several hundred dollars more than traditional silicone.

 

Read more about the Anatomical Shape Implants

 

 

 

 

 

Breast implants are NOT 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.

 

 

 

 

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