Breast Enhancement-FAQ

Breast Augmentation – FAQ’s

What technical surgical details do you consider for me during my breast augmentation consultation?

There are 7 major things that I consider as a surgeon regarding your breast augmentation:

Type of Implant: silicon versus saline implants
Surface of Implant: smooth versus textured
Shape of Implant: round versus teardrop shape
Placement of implant: above or below the muscle
Type of incision
Size, including the width / diameter of implant
Thickness of implant (low profile, moderate profile, high profile)

Type of implant

In terms of the silicone versus saline implants, there is a difference.
Currently, silicone implants are only available through a special FDA
investigational study. I am involved in both of these studies, through
Mentor and Allergan/ Inamed.

Silicone implants are cohesive gel, and are very good implants in terms
of their overall characteristics. However, you do need to be involved
with an FDA-approved investigator, and also meet some criteria or
medical conditions to get them.

Please click here for more information about silicone implants, or contact my office to see if you are a candidate for silicone breast implants.

In terms of saline implants, any patient can get them without being
enrolled in a FDA investigational study. They are essentially empty in
the operating room, where I fill them with saline solution and adjust
the overall size and volume of the implants. These are the most popular
breast implants in the US.

Smooth versus textured implants

In terms of smooth versus textured surface, I generally prefer
smooth surfaced implants. Textured implants are geared towards people
who have had repeated problems with capsular contracture or excessive
scar tissue formation, and thus require a textured/rough, pebbly
surface over the breast implants that allows greater scar tissue
ingrowth into that area. Most of my patients who have not had previous
breast augmentation surgery would be a better candidate for smooth
implants.

Shape of Implant

One can either opt for the round or anatomic/tear drop shaped
implants. I usually prefer round implants for most of my aesthetic or
cosmetic breast augmentation patients. I feel that teardrop-shaped
implants do not achieve as aesthetic an overall result as round ones in
MOST of my patients.

However, I do feel differently if you have very little breast
tissue, or you have certain breast shapes. In those cases, I may
recommend an anatomic or teardrop-shaped implant.

Placement of Implant

The next consideration is placement of a breast implant above or
below the (pectoralis) muscle. In general, most patients who require a
breast implant need a fairly larger implant in proportion to their
breast tissue, and I place the implant UNDER the muscle.

This allows the skin, breast tissue, and muscle to mask or hide the
hardness and possible wrinkling of the actual implant. That is
determined based on your body type, and I cannot make a recommendation
until I physically examine you in my office.

I generally do not place saline implants above the muscle.
There are exceptions, based on your overall breast shape, the amount of
breast tissue you have, and other factors. Also, in female bodybuilders
or weightlifters, saline implants are usually placed ABOVE the muscle.

I usually recommend placing silicone implants ABOVE the muscle.
This is because they feel so soft and natural that they do not need to
have their surface masked by the pectoralis muscle. This generally
means substantially less pain for my patients, since the pectoralis
muscle is not stretched during surgery. Again, there may be exceptions,
depending on my examination at the time of your consultation.

Type of Incision

In terms of the incision, there are four choices, although I do have my preferences. Saline implants can be placed in:

Underarm Area / Axillary Incision
Around The Nipple / Areolar Incision
Breast Fold / Inframammary Fold Incision
Belly Button / Umbilicus

With regard, to the underarm/axillary incision, I believe this is a
good incision as long as you are very diligent with breast implant care
after surgery. I create a tunnel from your underarm incision to the
base of the breast and insert the implant through this incision. The
problem after surgery is that the implant tends to drift into this
tunnel toward the underarm incision. As long as you are aware of this,
and can devote a fair amount of time towards implant massage to keep
the implant closer towards the base of the breast, then I feel that
this incision is a good one.

If you are unable or unwilling to spend any time taking care of your
implant after surgery, then I would recommend a nipple/areolar incision
or breast fold/inframammary fold incision.

I would advise a nipple/areolar incision if you already have a normal,
slightly enlarged nipple areolar complex, especially after childbirth.
I do need at least 1 to 2 inch of diameter around the nipple to place a
saline or silicone implant. I can diagram this for you in the office,
but essentially, if you have a smaller than average nipple areolar
complex diameter, it would be difficult for me to put in the silicone
implant. A saline would certainly be possible, but again in some women,
especially in young women who have not had any children, this may be
hard to do.

An inframammary/breast fold incision is a very good incision,
as well. This is the most common incision used by me, as well as by
most plastic surgeons. Despite how little or how much breast tissue you
have before surgery, it is very difficult to see the surgical incision
once the implants have been placed.

The belly button or umbilicus incision is only a possibility if you
have no previous abdominal surgery. Since it does not give me as good
control of the pocket, it takes me longer to do this actual procedure.
I do charge a premium if you want to have breast implants through a
belly button incision.

In terms of healing, the nipple areolar incision has the
disadvantage of taking a little longer to heal. Specifically, the
numbness that you may feel in your nipple areolar area should fade over
time, but it may take several months. It may take up to 6 to 12 months
to fully resolve.

The ability to lactate or produce milk should be possible with any of the above incisions long-term after surgery.

Silicone implants can only be placed through a nipple/areolar incision, an inframammary incision, or an axillary incision.

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