Breast Augmentation: What Are Your Breast Implant Options?

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The two main categories of breast implants are silicone gel or saline-filled implants. Silicone gel implants have been popular since the early 1960s, and they have gone through multiple generations of improvements since that time. Silicone gel implants have undergone rigorous studies which have shown they are safe and do not cause breast cancer nor connective tissue disorders.

The main advantage of silicone implants is that they feel more natural than saline implants. Gel implants are less prone to rippling than saline, which makes them particularly advantageous for thin patients. The current 5th generation of silicone implants are cohesive, meaning that the gel is viscous enough that even if the implant ruptures the gel tends to remain in the same place, a little like jelly. Previous generations, the silicone was more like thick maple syrup.

Saline (ie. saltwater) implants have a long record of safety too and are less expensive than silicone gel implants. They are generally placed when they are empty and filled once they are inside the breast pocket, so that the access incisions may be even smaller. When a saline implant leaks, most of the saline from the implant is rapidly and harmlessly absorbed by the body. The deflation is usually obvious, and the patient returns for removal and replacement of the saline implant. This may be done under local anaesthesia if the patient is an appropriate candidate. The primary disadvantage of saline implants is that they don’t look or feel as natural as the silicone gel implants. This is a particularly important issue for women who are thin or have decreased elasticity of their skin.

 To learn more about breast augmentation, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

Breast Augmentation Part 2 of 4: The Procedure

The things you need to know to make better choices regarding Breast Augmentation are the following:

 

1)  Match your desires with reality

The surgeon can only work with the issues you bring him. If you want the best result, you have to balance what you want with what your breast tissue will allow you to have and what it can support over time. Also, no woman has two breasts that are the same, and no surgeon can create two breasts exactly the same. Cup size is extremely variable and inconsistent from one brand of bra to another. Women tend to buy a bra that they can fill (or that pushes their breast tissue where they want it to go to create a specific appearance), not necessarily a bra that fits.

Last of all, the bigger the breast you request (i.e. the bigger the breast augmentation), the worse it will look over time. You can’t pick out a breast from a book or magazine and expect the same result unless the woman in the picture looked exactly like you before surgery.

 

2)  Know about the implants

Breast implants are not perfect, don’t last forever, and require some maintenance. If you can’t accept these facts, don’t have a breast augmentation. If you do, then you need to think about:

a) Implant pocket location

Implants can be placed in front of, or behind the muscle. There are less capsular contracture rates when the implant is placed behind the muscle and you can obtain better or more accurate mammograms too. Also, in thin women, behind the muscle is preferable because adequate tissue coverage is most important. Think when you lie in bed, if you are covered by a bed sheet only, one can see the contours of your body a lot better than if you were to be covered by a doona cover, where they are less distinct. Having said that, an implant placed in front of the muscle, will always more predictably control breast shape. How do you decide whether to go in front or behind the muscle? If you pinch the breast tissue in the upper pole and it’s < 2 cm, your best option would be to go beneath the muscle, otherwise, you run risks of seeing the edges of the implant.

One aspect that often gets overlooked is the way the pocket is created. Blunt dissection techniques are fast and efficient but create more tissue trauma, tear tissues, create more bleeding, and result in longer recovery times. Electrocautery dissection techniques use an electric current to seal blood vessels and are thus, less traumatic and have shorter recovery times.

b) Implant Shape

Shapes of implants can either be round or teardrop (anatomical). There is a trend today of women wanting more upper pole fullness and therefore opting for round implants. Given that the breast is constantly evolving and that over time there is a loss of upper pole fullness as the breast tissue “melts away”, breast augmentation with round implants may be a good option for maintaining upper pole fullness in the long term. The other added advantage is that if it rotates, it doesn’t affect the shape of the breast. In contrast, a teardrop implant which is fuller at the bottom and tapers at the top will give an odd shape to the breast if it does rotate. However, breast augmentation with teardrop implants may be better in women who have oddly shaped chests (either long or wide for example) because you can tailor the dimensions of the implant more specifically to fit the breast “foot print” on the chest. Tear drop implants may also be beneficial in women with mild sagging breasts who do not want scars on their breast from elevating the nipple. Tear drop implants have a “bucket-handle” effect on the nipple, elevating them to a higher position on the breast.

c) Implant surface (or shell)

The surface of the implant is made of a silicone rubber and can be textured or smooth. Textured implants have a lower risk of capsular contracture than smooth implants.

d) Implant “stuffing”

The stuffing or filler of the implant can be silicone or saline. Saline is salt-water and is harmless if the implant ruptures. Its biggest disadvantage is rippling and that it takes up the ambient temperature, meaning if you went to the beach for a swim, when you got out, your implants would feel cold. Silicone gel filler, on the other hand, is more natural, more predictable and it is safe. There are grades of silicone gel that range from “jelly” consistency to that of “gummy bears”.

e) Implant size

Remember, the larger the implant, the more tradeoffs and risks you’ll encounter, especially long term.

f) Incision location

The scar can be placed in three areas. The breast fold incision offers the best degree of control for the wide range of breast types and is the commonest type used by far. The periareolar incision (around the nipple-areola) usually heals well because it’s located in the thinner skin but is limited and can’t be used if the areola is not large enough for access. The biggest problem is the increased exposure of the implant to bacteria if any of the breast ducts were to be cut. The armpit (axillary) incision places no scar on the breast but takes longer to perform and harder to control the position of the breast fold.

 

3)  Get well acquainted with the tradeoffs, problems, and risks

Tradeoffs always depend on the details of each specific case, the characteristics of your tissues, and the experience of your surgeon with different options. Every breast augmentation operation carries inherent risks and medical complications are not totally preventable by you or your surgeon. Remember, don’t have a breast augmentation unless you thoroughly understand and accept the potential risks and tradeoffs of the procedure.

 

4)  Know about the recovery

The more tissue trauma caused by your surgery, the longer and more difficult your recovery. That is why it takes longer to recover from a pocket created behind the muscle. Excessively large implants can produce excessive stretch marks that cause more discomfort and temporary or permanent sensory loss. Most women return back to normal duties within four weeks and athletic activities in six weeks.

Question:  Do you think that the benefits far outweigh the trade-offs for breast augmentation? You can leave a comment below.

Breast Augmentation Part 4 of 4: The Surgical Facility

Your safety is of paramount importance when undergoing breast augmentation. Always have your surgery in an accredited hospital or day surgery facility. If you are young and healthy, then a day surgery facility is fine. If you are older and have health problems, then a hospital would be a better place to have the procedure performed because of the availability and back-up of an intensive care unit and other highly specialised healthcare professionals.

Accredited means that the surgical facility has passed a set of rigorous examinations to assure that the equipment and procedures meet standards for optimal safety. The hospital or day surgery facility should be fully accredited by the Australian Council on Healthcare Standards (ACHS) or a set of ISO standards that provide the highest standards of service. Patient health, safety, and comfort should be the surgical facilities main concerns and they should continually monitor and evaluate their performance to achieve these outcomes. Another requirement of accreditation is to assure that personnel is trained, experienced, and skilled healthcare professionals and procedures and equipment are in place to deal with any emergency from a power outage to cardiac arrest.

Sometimes it’s reassuring to visit the accredited facility yourself. If you’re not comfortable with a surgical facility, don’t have the breast augmentation surgery there. What you want to see is modern and comfortable surroundings, as well as caring and warm personnel. The operating room should appear state-of-the-art, spotlessly clean, and equipped with the most up-to-date equipment. The recovery area should be immediately adjacent to the operating rooms. Some surgical facilities provide overnight accommodations with one-on-one nursing care especially for patients who need overnight care for more extensive procedures.

The following checklist should help you “tie things up” when organising your breast augmentation:

1)  Check the date of surgery and pay scheduling deposit if required

2)  Review surgeon’s financial policies and policies for refunds

3)  Sign informed consent and operative consent forms for breast augmentation

4)  Schedule laboratory tests and mammography/ultrasound if required

5)  Review medications to avoid and ones to take before surgery

6)  Review post-operative instructions the night before surgery

7)  On the day of surgery wear comfortable clothes, get someone to drive you home and be with you overnight, wear no make-up, and leave your jewellery and valuables at home

Question: What things do you consider important in the surgical facility when having a breast augmentation? You can leave a comment below

Breast Lift and Augmentation: The facts you need to know!

The goals of breast lift with or without breast augmentation are to restore shape, volume, and nipple-areola position. However, simultaneous breast lift and augmentation present multiple problems, specifically because it becomes harder to control all of the variables affecting the outcome when combining the two procedures. No single method is best to treat all types of sagging (ptosis), and maintaining a good blood supply to the nipple-areola complex is of paramount importance, so a staged procedure may be necessary at times.

Why is combining a breast lift and breast augmentation the most difficult of all cosmetic breast surgery procedures? The surgery involves manoeuvres that can be counterproductive to each other since the skin is being removed and when closed back up again, pushes the breast in and upwards, whilst an implant stretches the skin in an out and in a downwards direction. These conflicting tensions can adversely affect the blood supply to the breast and skin which may affect wound healing, scar quality etc. Positioning of both the nipple and breast fold also becomes more challenging during simultaneous lift and augmentation. Secondly, no two breasts are the same, and each patient is seeking a different endpoint, sometimes with unrealistic expectations.

The first thing that I do when evaluating a patient for a breast lift is to ask them if they are happy with their present breast volume. You can simply do this by pinching the skin below the breast and pushing it up where it belongs. Most women are amazed at how little of breast volume they actually have. If that is the case, then volume enhancement, usually with an implant, is necessary along with a lift. If the volume is satisfactory, then a breast lift will suffice.

The second thing to do is grade the amount of breast sagging. This is done by using Regnault’s classification which looks at the position of the nipple as follows:

1)  Grade 1 (minor): nipple at breast fold
2)  Grade 2 (moderate): nipple is below the fold but above the lower breast contour
3)  Grade 3 (major): nipple is below the fold and below breast contour
4)  Pseudoptosis (“false sagging”): nipple lies above the fold, there is little breast volume, some of which lies below the fold

Other characteristics that one looks out for are:

1) Skin: elasticity and excess;
2)  Breast tissue:  firm and fibrous or soft and fatty; and
3)  Skin-breast tissue relationship: firm and adherent or loosely adherent and is the breast full or empty. Skin quality and the skin-breast tissue relationship are the key factors in determining the breast lift procedure and the quality and longevity of the final result.

As a general rule, if the skin elasticity is normal, the breast envelope is full, and the skin is adherent to the underlying breast tissue, then the scars would be limited, and vice versa. In other words, one progresses from limited scars such as periareolar scars (scars around the nipple-areola complex) to periareolar-vertical scars (scars that run down the front of the breast below the nipple-areola complex) to more extensive, full-length inverted-T or anchor scars.

For the patient with “pseudoptosis,” inserting a breast implant alone, usually tear-dropped shaped, is typically all that is needed. For Grade I sagging, an implant alone or a lift plus an implant may be required.

Depending on a number of factors, the lift may be performed via a crescent, periareolar, or vertical approach. A vertical approach is preferred if there is significant looseness below the nipple. However, the periareolar incision is generally used in just a few specific situations. Since this skin-only incision is unable to lift much weight, it is an option in women with small breasts who need only a small amount of nipple repositioning, usually < 2 cm.

In addition, it is considered advantageous in women with pointed, conical or tubular breasts, because it causes areolar flattening and eliminates the tubular nature. The main issue I have with performing a periareolar breast lift is its tendency to cause areolar flattening and leave the areola more prone to stretching.

In Grade 2 sagging, especially where the breasts are large and heavy, a vertical breast lift is often required because it will effectively lift the breast tissue to achieve increased projection. However, a periareolar incision may still be considered for women with light breasts. When performing a vertical breast lift, the procedure may be converted into a short inverted-T lift if a difficulty is encountered controlling the nipple-to-breast fold distance.

With Grade 3 sagging, the lift technique depends on the nipple-to-breast fold distance. If it is > 10 cm, most surgeons perform an inverted-T breast lift. Otherwise, vertical breast lift remains an option that will enable control of the nipple-to-breast fold distance, as the vertical scar tends to shorten in the post-operative period with scar contraction.

Thanks for reading!

Dr. Tim – Sydney Cosmetic Plastic Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

Breast Implants: Things to Know Before Getting Them

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There are two main reasons why women get breast implants. The first one is for reconstructive purposes. This is to bring the breast back to its original form after it has been damaged by an injury or by a disease such as cancer.

The second reason has to do with cosmetic or aesthetic reasons. They may want to have fuller breast or breasts that are more symmetrical with one another. It is also a way to boost confidence in their bodies.

The cost of doing such a procedure will vary. Depending on the location, the doctor who will be doing the operation and the type of implant used the cost can run to a couple of thousand dollars.

Can Breast Implants Raise a Low Nipple Areola Complex?

A youthful, cosmetically ideal breast has a nipple areola complex diameter of about 38-42mm.  Some breasts have large areolas from the time that they develop during puberty, and some enlarge later in life with pregnancy and breastfeeding. A large areola tends to make a breast look ’matronly’ even if it is not sagging. Nipple-areola complex diameter can definitely be reduced or enlarged, and this can be performed as a stand-alone procedure or as part of any breast enhancement procedure such as a lift, augmentation or reduction.

An attractive, well-positioned, and proportionate nipple areola complex is an important goal for many women looking to achieve a beautiful breast appearance. This small area of a woman’s anatomy can have a big impact on her satisfaction with her breasts. Women who are unhappy with the appearance of their nipple areola complexes, can have them corrected either alone or in combination with any breast enhancement procedure.

Breast augmentation with breast implants will not necessarily raise the nipple areola complex position in sagging breasts and in fact in some cases may make the areola larger. There are techniques to allow the implant to fall into the lower pole of the breast to create the illusion of lifting with more of the breast volume sitting lower on the chest. This is where using a tear drop (anatomical) breast implant can help as it creates a” bucket-handle” effect on the nipple areola complex.

The submuscular (below the muscle) breast implants are” innocent bystanders” to whatever happens to the breasts, as they are really chest wall implants that simply push the breasts forward. The submuscular breast implants are supported by the overlying pectoralis major muscles. In contrast, subglandular (above the muscle) breast implants are more likely to fall with pregnancy or weight loss, as they are supported only by the overlying breast tissues.

A periareolar (around the areola) or circumvertical (lollipop type) breast lifts are reasonable choices to reduce the nipple areola complex size and raise its position on the breast. These techniques reliably elevate the breast while keeping scars to a minimum. These breast lifts are desirable because of the nipple position (usually at or below the breast fold) and because of breast sagging. Neither nipple areola complex position nor breast sagging would be corrected with breast implants alone. “Blowing up the balloon” with larger breast implants will only create excessively large, still very saggy breasts. Reshaping the breast and elevating the nipple areola complex and breast back up onto the chest will play an important role in helping one achieve a cosmetically pleasing result.

Most plastic surgeons have a clear policy defining the financial responsibility of the surgeon and the patient in case of complications involving breast lifts, both short and long term. The policy should be made clear to each patient before surgery. It may differ from surgeon to surgeon with the majority of surgeons not charging their fee for reoperating on the patient but the patient having to pay the facility and anaesthesia costs.

Many women feel uncomfortable with their breasts their whole life because they had ’droopy’ or enlarged nipples or areolas that looked abnormal. A small surgical procedure to enhance the nipple areola complex can be extremely important for a woman’s self-esteem and self-image.

Question: Does it matter to you whether the nipple areola complex is proportionate to the remaining breast? You can leave a comment below.