Breast Augmentation in 2012

Breast Augmentation is one of the most talked about and popular cosmetic surgery procedures done worldwide. It is one procedure that women talk about openly and honestly and love to show off. Women from all age groups from young to old are getting their breasts augmented in every country, all the time. It does not matter what nationality, socio-economic status, or race, having beautiful breasts to most women makes them more confident, feel sexier, and boosts their self esteem.

Last year alone, over 400,000 breast procedures were performed in the U.S…with ¾ of that being augmentations and ¼ being revision surgery.

Because I work with some of the top breast augmentation doctors in the world, I’m going to focus on what I have learned in the past 16 years that I have been in the operating rooms with them.

Are you a candidate for Breast Augmentation?

1. Breast asymmetry
No two breasts are alike, and some women have a noticeable difference in the size of their breasts. Everyone has one breast that is a little bigger than the other, but some women have huge differences that can affect how their clothing fits and their self esteem.

2. Weight loss and gain
Large changes in weight can alter breast size and volume.

3. Pregnancy

Pregnancy and breast feeding can sometimes “deflate” the breasts.

4. Naturally small breasts. Breast to hip ratio does not match
Some women do not develop large breasts and want to look better in clothing, bikinis, etc. Augmentation can help clothing fit better and improve self-confidence, taking you from an A cup to a B, C, or D cup.

5. History of Breast Cancer and Congenital deformities…

Having a previous mastectomy or defect can lead to irregular breast shape and/or complete lack of breast tissue. Reconstruction augmentation can assist in regaining breast symmetry as well as improves self-esteem in patients.

How to find a Surgeon
Many people use word of mouth in finding a surgeon, and this is usually fine because this is such a common procedure, and there are many surgeons who are good at doing it. Still, it is always good to go online and do your research and look at before and after photos etc. It is also a good idea to go to the Medical Board website for your state and research your doctor on there as well. This will tell you if the surgeon has any legal issues going on with his medical license.  Since there are SO many physicians that are offering this procedure here are a few things to keep in mind:

Any bargain deal that is advertised on T.V., in a flyer, or in a local magazine can be a red flag. If it sounds too good to be true, it usually is. The last thing you want is to put yourself in danger when having surgery, and the credible, safe surgeons do NOT advertise. These are usually clinics that have many patients that come through, and sometimes you don’t even meet your surgeon until the day of the procedure.

Go to someone who specializes in breast augmentation and body work. Plastic Surgeons usually have a reputation for being good at specific surgery, so you want to pick someone who does a lot of breast work. Do a search under breast augmentation or if you already have implants, search under breast revision.

Here in Beverly Hills, I know who to refer to for breast surgery only because they are known for that specific procedure.

Interview and consult with 2 or 3 different surgeons. Ask them how many breast surgeries they do per month, and ask to see multiple photos. There are also many photos on the websites of the surgeons so you can check them out before you go in.

Make sure that you have a clear idea of what you want your breasts to look like. Pictures are a good reference in terms of size, but remember that everyone has different anatomy, so one size of implants will look different on every person. For example, many patients come in and already think that they want a 400cc implant because that’s what their friend has. The answer is that a 400cc implant can look very different on you depending on how much of your own breast tissue you have this size of your rib cage, depth of the chest wall and your height and weight. All of these things should be taken into consideration by your doctor and discussed with you.

Saline vs. Silicone:
I would say that in my area about 90 percent of women are choosing silicone implants. Patients say that silicone implants feel more natural than saline. The FDA has now concluded that silicone implants are safe to use…although if one were to rupture, it is not always detected right away. The FDA recommends that women have MRIs done every other year starting with the third year after having surgery to look for any ruptures. Saline implants are a little bit cheaper and may show a bit more rippling of the implant through the skin if the patient is thin; also if a saline implant ruptures, it will be noticeable as the saline will get absorbed by your body which is not dangerous. With any rupture, another surgery will be needed to replace the implant.

Any time you have Breast implant surgery the chances of having another breast surgery at some point in your life are more than likely. Some people have pregnancies and breast feed and then need to have their breasts redone. Some patients are so happy that they want bigger implants. Some patients decide they want smaller implants. Some patients get what is called a capsular contracture and need to have surgery to address this. A capsular contracture happens when scar tissue around the implant becomes very thick and tight, which causes hardness of the breast, deformity, and sometimes pain. It is not always known what causes this over growth of scar tissue, and although some surgeons will put you on medication to prevent this, there is no guarantee that you won’t have this happen.

In 1992, Silicone implants were removed from the market and studied by the FDA for safety issues in women with silicone implants. It was thought that there was a correlation between women with silicone implants and auto-immune disease. In November 2006, the FDA found that there was no correlation based upon their studies, and silicone implants were once again allowed to be sold by Mentor and Allergan, the two biggest companies that make silicone implants.

The choice between saline and silicone is between you and your surgeon….do what is best for you and your body. Both types of implants give a great result.

Soybean Oil Trilucent implants:

Soybean oil implants were pulled from the market in 1999 due to complications associated with these implants. If you currently have these implants, consult with your doctor.

Incision site:
In each incisional approach, a pocket is created for the implant to reside in. The pocket should be big enough for the implant to move around in and not too small or tight. Your surgeon is responsible for creating the pocket size.

Periareolar: (around the nipple)

This is the most common that I see done. This approach makes it easy for the surgeon to place the implant and create the pocket for the implant. The scar is on the bottom of the areola and is barely visible when stitches come out.

Inframammary: (the fold below the breast)

This approach is a good choice if the patient already has a good inframammary fold. It is probably one of the more traditional approaches but looks fine when placed correctly.

Trans axillary: (in the arm pit)

Some patients choose this approach because it is essentially scarless unless the patient has a history of keloid scars. The implant is placed using a long instrument that creates a tunnel for the implant to travel through to the desired location by the surgeon.

Transumbilical: (through the belly button) or the scarless technique

This procedure is done with the incision inside the belly button so it is a scarless surgery. The implant is then placed using a long instrument that creates a tunnel for the implant to travel through to the desired location by the surgeon.

Types of implants

Round smooth:
This is the most common shape used. If the implant turns around inside the pocket that was created for it, it will not be noticeable.

Moderate Profile:
This implant is wider in diameter and does not project outward as far as high profile implants. Moderate profile is usually chosen when the patient wants a more conservative look and /or has a wider torso or chest.

High Profile:
This implant is narrower and projects outward or higher. This implant is good for patients who want more cleavage and/ or have a narrow chest and torso.

Textured implants:
I do not see a lot of textured implants used with the surgeons I work with. Textured implants are said to decrease the chance of capsular contracture…however they are firmer and have a thicker shell and rippling can sometimes be more noticeable.

Gummy Bear implants:
Very cute name…but these implants are not FDA approved yet. They are a thicker version of silicone implants called cohesive gel, so that like a gummy bear, if you cut through it, the contents stay intact and do not leak out. They called are form-stable. These implants also have a multi layered thick shell and are tear drop shaped. The concept is that the implant will hold its shape and have less rippling as its shell is textured. If the implant ruptures, its contents will not leak out. Although they have had success with these implants in Europe and other countries, they are not approved as of now in the U.S.

Tear Drop-Anatomical implants:
These were created for breast reconstruction and are tear drop or oval shaped. The major part of the volume is in the lower part of the implant. These implants have a textured surface to help prevent the implant from flipping around inside the pocket. There is no guarantee that the implant will not flip…if it does, you will need surgery to correct this. This implant is for those who want a very natural look and who do not want a lot of fullness in the top of the breast.

Current trends in Breast Augmentation:
More women are choosing a slimmer silhouette rather than years before when larger breasts were in demand. A 300 to 400 cc implant is a popular range in the United States.

Smooth, round silicone implants are the most popular choice of surgeons, and high or low profile implants are decided based on the patients anatomy.

A new surgical technique is the use of the Keller funnel. The Keller funnel was developed by a plastic surgeon to facilitate easier placement of silicone implants with minimal force. It is a cone shaped, nylon device that when used, causes less trauma to the breast tissue, and creates a shorter incision site.

Submuscular vs Subglandular:
The placement of the implants is something that should be discussed between you and your surgeon.

Submuscular means that the implant is placed below the pectoralis muscle. The pectoralis muscle runs across the top part if your breasts. Essentially, the top of the implant is covered by the muscle. This can help decrease rippling and the implant will have a smoother, more natural looking slope when viewed from the side, and less of a round, “headlight” look.

Subglandular means that the implant is placed below the glandular breast tissue but over the muscle. This placement is useful when the patient has adequate own breast tissue that will cover the implant. This is not advised for very thin patients with little or no breast tissue as the result will show a very round and rippled implant. Sometimes the recovery time is less because there is no cutting of the pectoralis muscle.

Risks:
As with any surgery, elective or not, there are always risks involved.

Infection:
Although the infection rate is very low with breast implants, it can be a devastating experience resulting in removal of the implant for several months if antibiotic treatment is not effective. It is very important to follow all of your post operative instructions given to you by your surgeon. Some of the most important ones are:

• Finish all of your prescribed antibiotics.

• Do not soak in a bath tub or Jacuzzi.

• No swimming.

• Do not touch your incisions.

• If your incision is under your arm (axilla) do not use deodorant or anything else until cleared by your surgeon.

Capsular Contracture:
This can happen at any time with your implants, although it happens frequently in the first months after surgery. This happens when the scar tissue that normally forms around the implant begins to get thicker and harder, resulting in deformity, pain, and hardness. There are different 4 grades called Baker’s Grades of capsular contracture, with 1 being the mildest and 4 being the worst. Usually a capsulectomy is needed which requires surgery, and possibly a new implant. This can sometimes re- occur several times in patients and the cause can be contributed to previous hematoma, seroma, injury, or smoking. Your surgeon may put you on medication to help prevent this; but it is not guaranteed that it will prevent this from occurring.

Hematoma:
This is a collection of blood inside the pocket and around the implant. During surgery, many small blood vessels are affected to make a place for your implants to reside. It is why after surgery it is important not to do any strenuous activity and to rest.  It is also important to stop all inflammatory medications such as Advil, etc two weeks before the surgery. Your surgeon should provide you with a long list of things to avoid 2 weeks prior to your surgery. Hematomas are painful and the breast can become much larger than the other one. Usually surgery is required for large hematomas to drain the blood, with drain placement for several days. If it is a small hematoma sometimes your body will reabsorb it on its own.

Seroma:
A seroma is a collection of clear fluid around the implant. This usually occurs right after surgery and can be drained in the office by your surgeon if it is a large amount. Smaller amounts will usually be reabsorbed by your body. Seromas and hematomas increase the risk of capsular contracture.

Deflation and rupture of the implant:
Saline implants can sometimes spontaneously deflate, either being a slow leak or a fast leak. In either case, the patient will notice it and the implant will need to be replaced. Silicone implants can rupture without the patient’s knowledge. Because the gel is encased in an outer shell, there is no risk of silicone fluid floating around in your body. Some patients will just notice that the implant feel different and some will develop a capsular contracture. The implant will need to be replaced.

Other less than desirable results can occur such as:

• Numbness
• Asymmetry
• Sagging
• Synmastia
• Bottoming out
• Riding too high
• Interference with Mammography
• Mal placement
• Extrusion
• Hypertrophic scarring
• Double bubble
• Rippling
• Decreased nipple sensation

All of the above should be discussed with you by your surgeon as they are possible risks and complications that can and do occur.

Recovery:
The most important thing that I cannot stress the most after seeing hundreds of breast augmentation patients is do NOT exercise or do anything strenuous which means elevating your heart rate or blood pressure for the first four weeks! Yoga, weight lifting and contact sports should be avoided for at least two months. The most complications that I have seen were from patients who did too much too soon. Even driving a car in the first week can be detremental. Any time you move your arms; you move the entire breast pocket and implant area. So it is really important to rest and follow instructions. Wearing a supportive bra is also important. The bra should provide compression, support, and stability.

As always, do your research before choosing a surgeon. There is a ton of information on this topic, and this is a guide to help you and steer you in the right direction while you are deciding on having breast augmentation surgery.