Smaller than desired breasts. One breast is noticeably smaller than the other. Breasts have lost volume after weight changes or child bearing.
BLOG: Thinking about a Breast Augmentation by Dr. Salzman
Larger and more shapely breasts. A more confident and positive self-image. More proportional body shape.
There are many choices in breast enlargement and we believe it is important to be given all of the options at the time of consultation. There are saline and gel implants, as well as expandable implants and shaped implants. The gel implants come in different consistencies and with smooth or textured surfaces. The placement of the incision can also be in numerous locations. We take these considerations as well as the preoperative state of the breast, the size of the patient, her desires and activity levels and address all of these at each and every consult.
Using Vectra 3D computer imaging, we can usually show the result that we think will be pleasing to the patient and achievable surgically. This is truly a customized approach for each individual patient. Dr. Salzman’s surgery technique is likewise different than most. Having done thousands of breast enlargement procedures, he has been able to streamline these operations to allow an easier recovery for his patients. There is very little blunt tearing of tissues; all separating of tissues is done with an electric forceps. We find that under the muscle patients can get back to all but the most physical of activities in a just a few days. We don’t put a lot of restrictions on what our patients can and cannot do. We also don’t place large constrictive bandages. We only place a small Band-Aid type dressing that is waterproof and will allow for bathing right away. There are questions that seem to come up a lot during consultation for breast augmentation and we can address those here.
Types of Breast Implants
Today there are many types of breast implants. We will summarize each below:
The saline implant has a rubberized silicone shell and is filled in the operating room with the salt water fill. It has some advantages over the gel-filled devices. Because the implant comes with no volume in it, the amount of fill volume can be customized to the patient’s individual needs during the implant placement. Breasts that are different sizes can then be made more symmetric by adding different amounts of salt water to each implant. Saline implants, because they are filled with a water like substance, feel less breast-like than silicone, last less long and wrinkle more than their silicone counterparts. They cost less than silicone implants. They can be placed more easily through remote incision sites like the underarm or belly-button. Learn more about saline implants.
SILICONE GEL IMPLANTS:
The silicone breast implants are the most studied implantable medical devices on the planet. Multiple peer-reviewed journal articles have attested to their overall safety in not causing systemic diseases. The American Society of Plastic Surgeons provides this FDA data at the website breastimplantsafety.org. Silicone implants have the advantage of feeling more breast-like, wrinkle less severely, are longer lasting, and provide more upper-breast fill than a properly filled saline implant. The silicone breast implant comes pre-filled. No adjustments in the operating room can be made. However, using the precision analysis of the Vectra™3D computer imaging and the experience and keen eye of a skilled experienced plastic surgeon, good symmetry can usually be obtained. The silicone implant, when using larger sizes, may necessitate a slightly longer incision. Silicone implants have a higher cost than saline implants. Learn more about silicone breast implants.
GUMMY BEAR IMPLANTS:
This term is confusing to most people. Plastic surgeons refer to this implant as “form stable” meaning that even if the shell were stripped away from the implant fill, the shape of the silicone would remain. These are usually shaped implants. The shaped implants, rather than being round, have different height, width, and projection ratios. For instance, the implant can be moderate in height, moderate in width and extra projecting. Three different heights, widths, and projections are possible for the same volume of implant. Dr. Salzman was involved in the FDA trials of this implant (style 410 Inamed) and has used it extensively in his practice. It is not presently available for free and unrestricted use. All silicone gel implants today contain a “cohesive gel.” Unlike the gel implants of the 70’s and 80’s, these newer implants have a more thick and non-runny gel. These gels are not as stiff and are known as the “gummy bears.”
Textured implants imply that the shell of the implant feels rough. Several manufacturing methods are employed to create this surface texture. The thinking in using these textured implants is that they may be more resistant to capsular contracture or the hardening of the scar tissue that naturally occurs around a breast implant. With the older implants of the 70’s and 80’s, where the gel inside was more runny and could leak out of the implant, it was thought that this textured surface could resist the formation of a capsule better than a smooth surface implant. With the newer forms of gel implants, and with most implants placed below the muscle where there is natural movement of the implant, the textured surface is unnecessary. The textured implants feel more stiff and when filled with saline have a higher rupture rate than their smooth shelled counterparts.
The smooth implant shell is just that: smooth in feel. It feels better than the textured shells, wrinkles less and lasts longer particularly in saline filled devices.
FDA APPROVES THE USE OF SILICONE GEL IMPLANTS
Dr. Salzman has performed thousands of successful breast augmentations in his 20+ years of private practice. During the FDA moratorium on the use of silicone breast implants, Dr. Salzman was one of a few select plastic surgeons in the US to be authorized to use the new silicone gel implants. He was chosen by both Allergan and Silimed as a lead investigator for the pilot study of these new implants prior to their FDA approval. In November of 2006, the FDA reinstated the approval of silicone breast implants declaring that they are safe and effective for women age 22 and older. Silicone gel breast implants are a wonderful alternative to saline and offer a much more natural look and feel.
Breast enlargement is done under a general laryngeal mask with adjuvant local anesthesia in an outpatient setting. During the procedure, which takes less than an hour, an incision is made either on the breast or in the underarm and a breast implant is placed either below or on top of the pectoralis muscle. The separation of the space (pocket) is all done with electric cautery forceps to facilitate healing and make for a smoother recovery. We sit the patient up in the operating room after both implants are in place and make any adjustments necessary to achieve the best symmetry. The incisions are closed with absorbable sutures hidden under the skin. A small dressing is placed and the patient goes home.
Recuperation and Healing
Breast augmentation patients have a mild to moderate uncomfortable feeling that lasts several days. Pain is controlled with oral medications and muscle relaxers are given if the implant is placed below the muscle. We ask the patient either wear no bra, a jog bra or the bra that we will supply for the first few weeks. No under wire bra should be worn for 6 weeks. Under-the-muscle implants will appear high on the chest wall for a few weeks then drop into the proper location in the pocket to give a pleasing shape to the breast. Patients may shower the next day. Most patients with non-physical type jobs may return to work in a few days.
Another option if the breasts are droopy and in a low position on the chest wall is a breast lift (mastopexy). There are several different types of breast lifts that can be done with an implant placement at the same time.
Learn more about the different types of incision options for breast augmentation.
The specific risks and suitability of this procedure for a given patient can be determined only at a consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.