BREAST AUGMENTATION...
Your outcome is primarily dependent on your
choice of surgeon. Breast enlargement enhances the size and shape of the
breast through the surgical insertion of saline or silicone implants. No exercises, devices,
pills or medications advertised have any effect on the size of the breast. BREAST AUGMENTATION is the only way
to enhance the size and shape of your breast.
You also must have realistic expectations. You must realize that breast
augmentation enlarges only what you already have and therefore pre-existing
asymmetries will not be corrected ( example: if your nipples point out, they
will still do that after but your breast will be bigger).
If you have small, underdeveloped breasts or breasts that
have shrunk or atrophied after child bearing or have minimal sagging, breast augmentation can
help.
There are three common techniques and they differ only in
where the incisions are placed:
1) the inframammary at the breast fold (where the lower
part of the breast attaches to the chest): it is the preferred choice
especially in the woman who may desire a future pregnancy since it best
preserves the ability to breastfeed.
2) the periareolar or nipple (the incision is placed
around the dark colored area surrounding the nipple at the junction with the skin):
it is associated with additional scarring in the lower breast and the areola
region and a higher risk of loss of nipple sensation.
3) the axillary in the armpit (the
endoscopic Breast Augmentation is performed through this incision): has a
higher risk of redo-surgery because of higher chance of asymmetry and often
the scar appears irritated or darker because of the sweat glands.
In many cases the choice of the incision is the patients
but remember also that your choice may not be necessarily the best for you..
After creating the incision, the surgeon lifts the breast
tissue to create a pocket either directly under the breast tissue or underneath the muscle
depending on the surgeon's judgment and the patient's physique.
Since the FDA (the US Agency tasked to
approve drugs and devices) has approved Silicone implants for cosmetic breast
augmentation, you are now offered two choices of implants:
SALINE IMPLANTS
These implants are made with a rubberized
silicone shell which is filled with saline after implant insertion. In case of
implant failure, deflation occurs and the leakage of saline is absorbed in
your body ( your body is made of 70% saline and therefore there is no harm to
you). You will notice deflation almost immediately and the manufactures
offer a 10 year warranty covering your cost should this event occur. There are two styles
of saline implants (round and anatomic, which are rarely used today) and two types of saline implants that can be placed in the
pocket, smooth and textured. There are also different choices of smooth round
implants: low profile ( they are flat and I never use them), moderate
profile (most commonly used) and high profile ( they offer the most projection and are useful in
flat breast with little volume).
SILICONE IMPLANTS
Silicones are a family of chemicals naturally occurring in sand and
rocks. They are very biocompatible, reliable and flexible making them an
ideal choice for implantable medical devices. Silicones are used in a
wide variety of everyday products; examples are hairsprays, moisturizing
creams, suntan lotions, etc. as well as medical devices such as artificial
joints, catheters, facial implants and breast implants. Silicone-filled
Breast Implants are indicated for women at least 22 years of age and the
advantage is that they may feel more natural (but it depends on how much
breast tissue you have) when compared to saline implants. Like the saline
implants they come in a variety of sizes and shapes. Drawbacks are that the
incision is longer, the cost higher and lifetime follow-up is required
with an MRI (a specialized X-ray study) to detect silent ruptures,
which can add significantly to the initial cost. The risk of having
complications such as capsular contraction and failure or rupture of the
implant is much higher compared to saline or gummy bear implants and
this will also translate in higher costs in the future.
COHESIVE GEL/FORM STABLE ( GUMMY BEAR ) IMPLANTS
The cohesive gel implants are nicknamed gummy bear implants because they
are semi-solid. If you cut them with a knife it's the same as cutting a
gummy bear; in other words if you cut them in half you will have two intact
pieces. They have generated a lot of publicity because of their
advantages: (1) if ruptured they do not leak like the silicone or
the saline implants and have less complications; (2) they maintain their
shape and because of their consistency there is less rippling; (3) they
may better shape the breast in some cases. The
good news is that FDA may approve them later this year despite the fact that
they have been in use in Europe for almost a decade with great success. One of the
disadvantages is that they will require a longer scar but I see them
replacing the silicone implants.
In 80% of the cases I place the implant partially
underneath the pectoralis major muscle as reports suggest it may decrease capsule
formation (capsular contraction), a
form of scarring that can develop around the implant. However there are advantages and
disadvantages for each choice of placing the implant above the muscle or
underneath it and a detailed discussion with Dr. Herve` Gentile will
maximize your chance of obtaining the desired result.
It is the quality of your skin envelope, the soft tissues of your
breast and your anatomy including your frame and height, as well as, the shape
of your breast that determine where to position the implant underneath the
muscle or beneath the breast. Often plastic surgeons do not offer women
choices and this frequently dictates the result. Many patients are not
willing to accept a higher risk of scar formation in the future and therefore choose
placement of the implants underneath the muscle. An additional advantage is that it offers
greater breast visibility on mammograms, a concern if you have a family history of breast
cancer. The anatomical style implant which is sloped and shaped as a tear drop
may be the
natural choice for the woman who does not desire fullness in the upper pole of her
breast while a higher profile implant is best for the woman that already had her breast enhanced
but now desires slightly larger
implants. The high
profile round smooth implant is also reserved for the woman who has thin skin with
little or no breast tissue or has high placed nipples close to the chest.
Generally, for most women, a medium profile round smooth saline or silicone implant is chosen,
which may lessen the rippling effect or the folds which occur with all
implants.
During the consultation you will have, in addition to a
review of your medical history, a personal evaluation of what is appropriate for you, your
body size and frame as well as your breast size and sag if any. In the latter case the
implant is better placed above the muscle to increase breast projection.
Since
breast implants enhance the breast you should not view them as a substitute
for breast tissue and also like any mechanical device you should not think of
them as permanent. However, I do not recommend a specific time for
replacement. Very large implants will result in early sagging and are
associated with a much higher risk of scar formation, bottoming out, thinning
of the tissues and rippling. All of these problems, needless to say, will
result in additional surgery, which sometimes can also prove to be
unsatisfactory. The key determining factor is the type and quality of your
skin envelope and your outcome is primarily dependent on your choice of
surgeon more so than other procedures. You will also need to decide whether a
saline or a silicone implant is best for you and understand that no surgical
options are perfect and without a tradeoff.
The procedure takes about 1 - 1 1/2 hours, and after
surgery you are taken to the recovery room and monitored and kept there until you are
ready to be discharged. Recovery is variable and depends from
person to person but usually medication can control any pain or discomfort which should
subside in 2-3 days. Swelling and any bruising of the breast will disappear gradually.
Although you will be up and about a day or two after surgery, you should take it easy and
avoid any lifting or elevating your arms over your head and shoulders for 3-4 weeks.
Most patients can return to work at the 3rd or 4th day with some
restrictions but you will receive
detailed instructions from Dr. Herve` Gentile on what activities you can do.
Since Dr. Herve` Gentile uses a unique and bloodless technique do do your
breast augmentation
you do not need to wear a bra for the first few days and consequently this will cause less
pain and permit your implants to descend quicker. You will be
seen in the office at 1-2 and 4-6 weeks post-operatively and less frequently thereafter depending
on your progress. The scars usually fade with time and are barely noticeable.
At this time
your newly acquired figure should be able to better fill out clothes but remember that
although breast augmentation can improve your look and make you feel good, it is not a
guarantee for happiness.
COST
Most augmentations cost between $ 4,900 and
$ 7,000. Prices vary depending on the type of anesthesia used, who
provides the anesthesia ( at our center we use a group of doctors
specialized in anesthesia ), whether the procedure is performed in the
hospital or in an office surgical center and type of implant.
Remember you get what you pay for...so choose your surgeon based on
qualifications. Do you really want to go the cheapest person for your
surgery?... considering you may end up paying a lot later to undo and correct the
problems from bargain surgery.
PHOTOGRAPHS --
For your convenience you may
view a few selected cases by clicking the Photos button on the left. We do have extensive photographic
catalogues of pre-operative and post-operative photographs that can you can view by
contacting our office and scheduling a complimentary consultation.
