Breast Augmentation – FAQ

Breast Aug FAQ in Covington, LA

Most women do a lot of research about breast implant surgery before ever consulting with a plastic surgeon. There are countless websites, and almost everyone has friends who have had the procedure and have an opinion on how it should be done. The amount of information can be overwhelming and sometime difficult to understand. I have put together some of the most frequently asked questions about breast implant surgery to help you navigate through the process. I hope you find this information useful.
Elizabeth Kinsley, M.D.

Risks

The risks associated with breast implant surgery are the same as with any surgery. Bleeding and infection can occur but are exceedingly rare, and every precaution possible is taken to avoid these. There are also risks associated with anesthesia, but again, in a healthy woman, these risks are negligible.

The main risk that is particular to implant surgery is capsular contracture. The body will form a capsule around any foreign object, so capsular formation is a normal process. At times, for reasons mostly unknown, this capsule will thicken and distort the implant. At worst, it can result in the implant being misshapen or malpositioned. Fortunately, this occurs in a very small (1-2%) of patients. A medication may sometimes improve or resolve the tightening caused by a contracture, and sometimes surgery is required to release the tightened capsule.

The implant can also become malpositioned over time, even without a contracture. This is often seen with submuscular placement, where over time the implants are pushed downward and out to the side over time.

One of the main things that can be done to avoid complications is meticulous surgical technique. A bloodless field is very important, and the implant is never touched- the implant is taken from the sterile container and placed into a funnel (like a pastry bag) and into the pocket without touching it.

Bottom line: Capsular contracture can occur at any time but is treatable.

Above or Under the Muscle?

Before saline implants were introduced, most implants were placed above the muscle (subglandular). However, when saline implants were placed in the pocket behind the breasts it frequently resulted in visible rippling which was not acceptable. The move toward sub muscular placement of saline implants began in an effort to camouflage the ripples associated with saline.

Today we have a huge selection of silicon implants to choose from: textured, smooth, shaped and a variety of profiles. The fill volume of an implant, or how much looseness the implant has affects the appearance once placed, especially sub glandular. Many silicon implants can be placed sub glandular in selected patients with excellent results. The shortened downtime is a major plus to this method as well as the decreased revision rate.

Below the muscle is used in very thin patients or patients with inadequate tissue coverage for sub glandular placement as well as for all saline implants. The downside to sub muscular augmentation is the risk of muscle animation (having the breasts move when the pectoral muscle is flexed) and downward displacement of the implant over time. The recovery time is slightly longer than for sub glandular but is usually about one to two weeks.

I have done thousands of augmentations both sub muscular and sub glandular and the best advice I can give is discuss this with your surgeon.

Bottom line: Either Submuscular or Subglandular works- talk with your doctor to decide which is right for you!

Silicone Vs. Saline

As a surgeon, I generally prefer silicone implants. This is not to say that I do not occasionally use saline implants, I just think the look and feel as well as durability of silicone cant be matched by saline.

It is not uncommon to see a saline implant spontaneously “fail” after several years. When this happens the breast just goes flat, and the body absorbs the saline without any risk. Unfortunately, this usually occurs at bad times, like a week before vacation, and the patient has to have the implant(s) replaced.

The silicone implants available today are considerably different from the old silicone implants. The outer shells are very durable and difficult to damage. As a test, I gave some to my two young sons and let them play dodgeball, basketball, frisbee, you name it, and see what would happen. The implants did fine through all of this, and I was surprised, pleasantly, at how durable they were. One of the dogs did finally catch an implant and the home testing ended, but it impressed to see what kind of abuse the implants would handle. By the way, saline implants wouldn’t last a day in my house.

Silicone implants also come in an incredible variety of shapes, dimensions, and profiles that can be tailored to almost any breast shape or body type.

BOTTOM LINE: I prefer silicone but use saline if patient desires.

Implant Shape and Texture

Before the introduction of the modern silicone implant, most implants used were round. Anatomical, or teardrop shaped implants, are now becoming increasingly popular and are available in an incredible assortment of sizes and shapes to match any woman’s body.

Basically, we speak of implants in terms of “cc’s”, that is, the volume they hold. Round implants have the same height as width, but vary in projection. The projection is the measure of the implant from front to back- or how much it sticks out from your chest. Commonly used terms are moderate, moderate plus, high, and even ultra high implants. The selection of which implant to use can take more time than the surgery itself, but it is the most important step of the process.

Throw into this mix the newer shaped silicone implants. The come in almost every conceivable combination of height, width, and projection and are the ultimate “custom” implants. They come in every combination of width, height and projection, and are made of a more viscous gel that is referred to as “form stable”. That means that the implant will hold it’s form. These can give amazing results, but come at an increased cost. For some woman who have thin tissue or mild sagging, or those that want the most natural look, the increased cost is money well spent.

As you would expect, textured implants have a rough surface, and smooth implants have a smooth surface. Textured surface implants have a decreased incidence of contracture, especially when placed in front of the muscle.

Bottom line: There are a lot of choices. Don’t stress! It is my job to figure out which one will work best for you!

Incision Site

The implants can be placed through an incision in the breast crease- called inframammary, or through the nipple area- periareolar, or through the armpit- transaxillary. Any of these incisions are fine, and they all heal very nicely. If repeat surgery is ever needed or desired for any reason, however, it is very difficult to work through the armpit or nipple incision. For this reason, I generally use the inframammary incision.

Bottom line: The inframammary incision is the preferable.

SIZE!!!

This can be the most difficult part of the process. The first thing to realize is that implants don’t come in cup sizes, so you cant just order up a B or C cup and it will happen. Next, bra cup sizes are all over the place. You may be a 34C in one bra and a 36B in another. Even with the same manufacturer, you may wear different cup sizes. It is impossible for me to say what cup size you will be after surgery. With almost 20 years of experience doing this, and actually having shopped for bras myself, I have a good idea of what women mean when they say a B or C or D cup, The important thing to remember is that you are adding the implant to what you already have- so if your friend got a certain size implant and you loved how they looked, getting the same exact size may not give the same result if your breasts were different to begin with.

At the consultation, I ask the patient if they could pick a cup size what would it be, then work from there. Considering skin laxity, chest width, body shape, asymmetry, etc., together the patient and I will make a size selection. I think the approach of letting the patient try on implants, 3D imaging, and a thorough understanding of what the patient wants, the old recommendation of “going up a size” can be tossed out the window. The implants currently used are much more sophisticated than the implants of just a few years ago. So my tendency is to spend some time in the consultation and get it right the first time. I don’t believe that bigger is always better: I believe that right is always better.

Bottom line: This is the hard part. Understand that there may not be a “perfect” solution and that a number of implants may give a very pleasing result.