Breast Aug FAQ in Mandeville, 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 sometimes 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.
What Are the Risks of Getting Breast Implants?
The risks associated with breast implant surgery are the same as with any surgery. Bleeding and infection can occur but are exceedingly rare. Every precaution possible will be taken to avoid these issues. There are also risks associated with anesthesia, but, again, in a healthy woman, these risks are negligible.
The main risk that is particular to breast 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 that are 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 improve or resolve the tightening caused by contracture. 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, in which the implants are pushed downward and out to the side over time.
One of the best ways of avoiding complications is using meticulous surgical technique and hygiene. 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 being touched.
Bottom line: Capsular contracture can occur at any time, but it can be treated.
Should Breast Implants Be Placed Above or Under the Muscle?
Before saline implants were introduced, most implants were placed above the pectoral muscles (subglandular). However, when saline implants were placed in the pocket behind the breasts, it frequently resulted in visible rippling, which was not acceptable. To camouflage these ripples, surgeons began using submuscular (under the muscle) placement for saline implants.
For silicone implants, we now have a wide range of options for their size, shape, and profile. The fill volume of an implant, or how much looseness the implant has, affects its appearance once placed, especially when it’s above the muscle. Many silicone implants with subglandular placement have had excellent results. Two major benefits of this method are a shortened recovery time as well as a decreased rate of revision.
Silicone implants are only placed below the chest muscles when the patient is very thin or has inadequate breast tissue coverage for subglandular placement. The downside to submuscular 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 for submuscular implants but typically only lasts about one to two weeks.
I have performed thousands of augmentations using both submuscular and subglandular placement, and the best advice I can give you is to discuss this with your surgeon.
Bottom line: Either submuscular or subglandular works. Speak with your doctor to decide which one is right for you!
Silicone Implants Vs. Saline Implants: Which Is Better?
As a surgeon, I generally prefer silicone implants. This is not to say that I do not occasionally use saline implants; I just think that the look, feel, and durability of silicone can’t 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 a bad time, like a week before vacation, and the patient has to have the implant(s) replaced.
The silicone implants available today are considerably different from older 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, to see what would happen. The implants did fine through all of this, and I was pleasantly surprised by 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 could 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 the patient desires.
What’s the Best Shape and Texture for Breast Implants?
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 type.
Basically, we speak of implants in terms of the cc’s, or volume, they hold. Round implants have the same height and width but vary in profile. The profile is the measure of the implant from front to back, or how much it sticks out from your chest. Commonly used terms to describe an implant’s profile are moderate, moderate plus, high, and ultra high. Choosing which implant to use can take longer than the surgery itself, but this is the most important step of the process.
Patients also now have the option of choosing shaped silicone implants. They come in almost every conceivable combination of height, width, and projection to provide women with “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” to help implants hold their shape. These implants can provide amazing results, but they come at an increased cost. For women who have thin tissue, mild sagging, or want the most natural look, this is often money well spent.
As you would expect, textured implants have a rough surface, and smooth implants have a smooth surface. Textured 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!
Where Is the Incision Made for Breast Implants?
Implants can be placed into the body through an incision in the breast crease (inframammary), in the nipple area (periareolar), or in the armpit (transaxillary). All of these incision options are fine and heal well. However, if additional surgery is needed down the line, it is very difficult to work through an armpit or nipple incision. For this reason, I generally use the inframammary incision.
Bottom line: The inframammary incision is preferable.
How Do You Choose the Size of the Breast Implant?
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 can’t just order up a B or C cup. Plus, cup sizes for bras are all over the place. You might 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 your cup size will be after surgery. After almost 20 years of surgical experience (and shopping for my own bras), I have a good idea of what women mean when they talk about a B or C or D cup. The important thing to remember is that you are adding the implant to what you already have. If your friend got implants that are a certain size and you love how they look, getting implants that are the same size as hers may not give you the same result if your breasts are a different size or shape.
At the consultation, I ask my patients what their ideal cup size would be and work from there. Considering skin laxity, chest width, body shape, asymmetry, etc., the patient and I will make a size selection together. I think the best approach is letting the patient try on implants, using 3D imaging, and having a thorough understanding of what the patient wants. The old recommendation of “going up a size” can be tossed out the window. Today’s implants are highly sophisticated, even more so than those from just a few years ago. My tendency is to spend some extra 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. Please understand that there may not be a “perfect” solution and that a number of implants can give you a very pleasing result.