Smaller than desired breasts. One breast is noticeably smaller than the other. Breasts have lost volume after weight changes or childbearing.
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.
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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 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.
BLOG: Breast Ultrasound
Using Vectra 3D computer imaging, we can show the result that will be both pleasing to the patient and achievable surgically. This is a truly 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 since all separating of tissues is done with an electric forceps. We find that under-the-muscle patients can get back to regular activities in 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 sterile salt water. 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 saline to each implant. Saline implants, because they are filled with salt water, feel less breast-like than silicone, are shorter lasting 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:
Silicone breast implants are the most studied implantable medical devices on the planet. Multiple peer-reviewed journal articles have attested to their overall safety and lack of correlation in causing systemic diseases. The American Society of Plastic Surgeons provides this FDA data on the website breastimplantsafety.org. Silicone implants have the advantage of feeling more breast-like, being less prone to wrinkling, lasting longer, and providing 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, as well as the experience and keen eye of a skilled and experienced plastic surgeon, good symmetry can usually be obtained. Silicone implants, 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 silicone filling, the shape of the silicone filling 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 the 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 ’70s and ’80s, these newer implants have a thicker gel and are sometimes known as “gummy bear” implants.
Textured implants mean that the shell of the implant feels rough. Several manufacturing methods are used to create this surface texture. The reasoning behind using these textured implants is that they may be more resistant to capsular contracture, or hardening of the scar tissue that naturally occurs around a breast implant. With the older implants of the ’70s and ’80s, where the gel inside was runnier 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. Textured implants feel stiffer 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 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 aged 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 performed in an outpatient setting under a general laryngeal mask with adjuvant local anesthesia. 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 completed 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 can have mild to moderate discomfort 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 that the patient either wear no bra, an athletic bra, or the bra that we will supply for the first few weeks. No underwire bra should be worn for 6 weeks. Under-the-muscle implants will appear high on the chest wall for a few weeks before they drop into the proper location in the pocket. Patients may shower the next day. Most patients with non-physical jobs may return to work in a few days.
Another option if the breasts are droopy and low 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.