Breast Augmentation
A woman usually considers having a breast augmentation for very personal reasons. I have done more breast augmentations than any other single operative procedure over the past twenty-five years and found that most women seek this procedure to help improve their body self image.
There are a number of decisions a woman must make when considering a breast augmentation:
- Choosing a qualified plastic surgeon
- Is a silicone gel implant or a saline filled implant preferable?
- What is the Kellner Funnel??
- Should the implant be placed over or under the muscle?
- Do I also need a breast lift and, if so, are the additional scars worth it?
- Is a textured or teardrop shaped implant better than a smooth or round one?
- What incision is best?
- What size implant is appropriate?
- How long will the implants last?
Choosing Your Breast Augmentation Surgeon
The most important decision, I believe, is choosing a qualified plastic surgeon. The recommendation of a person or number of people who have had a good experience and great results is often a good way to begin the selection process. I review in great detail the credentials to look for in my section entitled Finding a Certified Plastic Surgeon.
Silicone and Saline Breast Implants
Since the re-introduction of silicone gel implants several years ago, I have found that a growing number of women prefer gel implants. “Feel” and contour of gel implants are superior to saline implants. Folds in gel implants are less likely to show through the skin. For these reasons, gel implants are preferable if the implant is to be placed over the muscle. It should be noted, however, that the FDA has restricted the use of gel implants to patient 22 years of age or older. The gel in current implants is more “cohesive” than the gel used in implants used in the 1980s. This means that the gel is less likely to find its way to other parts of the body when the elastic shell encasing it develops a hole. The shells should remain intact 10 to 15 years on average. Many may last longer. Nevertheless, the FDA recommends an MRI scan for all patients with gel implants three years after their initial surgery and biannually thereafter. Saline implants do not have this same recommendation. When the shell of a saline implant fails, a specific endpoint is noted: the breast mound deflates in a matter of hours. The implant then must be removed from the pocket and replaced. The endpoint for gel implants is less specific and often not usually evident. If an MRI reveals a failure of the shell, then removal of the implant is recommended by both the FDA and implant manufacturers. Gel implants cost almost twice what saline implants cost. Good results, however, can be obtained with either implant.
Kellner Funnel for Breast Augmentation Surgery
The Keller funnel, in addition to speeding up the actual process of placing the implant and reducing surgery time, also allows the implants to be inserted with less overall trauma to the outer implant shell. This technique makes it possible for me to make a smaller incision and, most importantly, allows the implant to avoid all contact with the skin. Avoiding contact with the skin is important because residual bacteria on the skin or in the tissue of the breast may increase the risk of capsular contracture (scar tissue forming around the implant, giving it a hardened feel). With the Keller Funnel, the risk of developing capsular contracture may be somewhat reduced because it allows the implant to be totally placed inside the breast pocket without touching the skin during placement. Plus, the Keller funnel allows me to put less stress on the implant during insertion, and minimize residual scarring because of the smaller incision required. Using the Keller Funnel is another way for me to employ state-of-the-art instruments and techniques in breast augmentation procedures, with the goal of giving you the best and most predictable results possible.
Implant Placement – Over or Under the Muscle?
Placement of the implant over or under the pectoral muscle depends on skin thickness and breast tissue development or shape. If the skin is very thin, then placement under the muscle is preferable. Implant shape and folds are less likely to show through the added thickness. Patients should recognize, however, that the bottom outer half of the implant will not be covered by muscle because of the anatomy of the muscle. This means that wrinkles and folds are more likely to be seen or felt in the bottom half of the breast mound. Implants placed under the muscle are more likely to migrate from ideal position and surgery is more painful because of trauma to the muscle. However, many patients and surgeons think sub-muscular implants look more natural. If skin and/or breast tissue needs to be stretched out, then placement over the muscle is preferable.
What’s it Like to Have Breast Surgery?
My sister had the procedure about 6 years ago. She was my inspiration. The confidence that she gained afterward was infectious. I have gained an enormous amount of confidence. I feel like I carry myself differently which others may notice. I am comfortable with my body now.Click Here for Patient’s Perspective on Breast Augmentation
Will I Need a Breast Lift?
If too much skin is present and the breast is droopy, then a lift is necessary to achieve a good contour. Whether the improved contour is worth the additional scars is something only the patient can judge. (See my description of breast lifts).
Implant Shapes
There are some surgeons who feel that a teardrop-shaped implant looks more natural, especially in thin patients. In order for the implant to maintain its orientation, the surface is textured, allowing tissue to grow into the shell and fix its position. Some investigators suggest that this also decreases the chance of hardening of the scar tissue around the implant. I do not believe that the textured implant decreases the chance of hardening but when tissue grows into the shell and fixes it, the shell has a tendency to fold on itself as arms and torso are moved and twisted. This causes the implant shell to rub on itself and decreases its longevity. The teardrop shape is maintained even when a patient lies on her back and I do not think that looks natural. For these and other reasons, I only use smooth, round implants and my patients are very happy with the results.
Incision Locations
Incision Located Under the Breast - 6 Months After Surgery
There are a number of small incisions offered for placement of breast implants. These include under the breast, around the areola, in the armpit and at the belly button. The incision under the breast is, by far, the one I use most commonly. It is only an inch and a half long and heals well. It gives me direct access to the pocket and allows me to easily see everything I need to. It is also far enough from the nipple and breast tissue to decrease the chance that bacteria in the breast ducts might find their way on to the surface of the implant. The incision around the areola is also popular and my choice for women who are seen publicly without tops. There may be an increased chance that bacteria will contaminate the surface of the implant. The scar around the areola usually heals well but is sometimes visible as a white line adjacent to the pigmented areolar tissue. The incision in the armpit is well hidden but hurts more and has a higher chance of resulting in implants that are out of position. I do not offer the incision around the bellybutton because that approach can only be used with saline implants and the results that I have seen presented by surgeons at national meetings are aesthetically inferior to the results using other incisions.
Selecting an Implant Size
The choice of implant size is primarily at the discretion of the patient because only she can decide what size gives here the proportions she wants. I ask each patient to put on a spandex top that we provide and then try on different sizers that we stock. When a patient sees what she likes, that is the size chosen. At the time of surgery I inflate a sizer to fill the pocket I have made. If the desired size is too large to comfortably fit into the pocket, I put in the largest size that does fit. It is rare for me to find that the size a patient wants is too large when reasonable choices are made prior to surgery.
I never felt pressured and I chose the size I was comfortable with even though I asked numerous times for advice, I was still told it was my decision to make. The best decision I made was choosing Dr. Silberblatt and getting so much more in return. You have given me back my self-esteem!
DA – Roanoke, VA
The typical sequence of visits for a breast augmentation procedure at my office is as follows:
- A free pre-consult with one of my staff, if desired
- The initial consultation and evaluation ($40)
- A second, free consultation to answer any questions that may have come up, if desired
- A history and physical exam no more than one week prior to surgery
- Surgery
- Wound check the day after surgery
- Suture removal one week after surgery
- Post-operative checks 3 weeks, 6 weeks and 3 months after surgery
Patients usually require one to two weeks off of work. Active exercise may be carefully begun at about 3 weeks after surgery and all restriction are usually lifted 6 weeks after surgery. Each patient is considered individually according to needs and desires. The relevant risks and benefits are discussed at the time of the initial consultation and information packets listing these are given. The vast majority of patients are thrilled with their results.
Breast Implant Warranty
Ever wonder about how long breast implants should last? The implants used at our practice come with an extensive warranty program designed to protect the patient. Visit our breast augmentation warranty page to learn more.