Cosmetic Surgery Tips

Best plastic surgeon in south florida for breast augmentation

South Florida is one of the most popular destinations for people looking to undergo breast augmentation surgery. The area boasts a wide range of surgeons and clinics that offer top-of-the-line care and many different types of procedures, including saline implants, silicone implants, and fat grafting. Whether you’re looking to increase your cup size or decrease it, you’ll find a surgeon in South Florida who can help you achieve your goals. The majority of these doctors have experience with all kinds of breast enhancement surgeries and know how to deliver excellent results.

If you live in South Florida or are thinking about moving here for this purpose, we recommend that you schedule appointments with different surgeons before making any decisions about which one will perform your procedure. This way, you can be sure that the doctor you choose has experience with what you want done and will be able to provide expert care throughout the entire process.

You may find it hard to access the right information on the internet, so we are here to help you in the following article, providing the best and updated information on Best plastic surgeon in south florida for breast augmentation, choosing your breast implants. Read on to learn more. We at cosmeticsurgerytips have all the information that you need about risks of breast augmentation. Read on to learn more.

Best plastic surgeon in south florida for breast augmentation

Breast augmentation, also known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breasts. Approximately 400,000 women choose to undergo breast augmentation in the United States each year, making it the second most popular cosmetic procedure in the United States after liposuction. There are many reasons a woman may pursue breast augmentation:

  • She may feel that her breasts are too small for her body
  • She may feel that her upper body is out of proportion to her lower body
  • She may have breasts that differ in size and/or shape
  • She may wish to restore breast volume lost as a result of pregnancy, breast feeding or weight loss

Breast augmentation is among the plastic surgery procedures with the highest patient satisfaction ratings. Many women experience an immediate improvement in their self-esteem and discover a greater self-confidence. In a recent study, 90% of breast augmentation patients responded that they undertook the procedure to improve the way they feel about themselves, and respondents overwhelmingly cited themselves as the primary motivator in their decision to have breast augmentation surgery (94%). In addition, many women find greater access to different clothing styles and fashions following breast augmentation.

If you think you might be a good candidate for breast augmentation, this page will give you a basic understanding of the procedure and the results you can expect. Because of Dr. Revis’ special interest in this procedure, he has developed a systematic approach to optimize your satisfaction and reduce the need for revisionary procedures following breast augmentation. This approach includes a thorough preoperative evaluation, accurate preoperative sizing, an emphasis on achieving a natural feel and appearance following breast augmentation, and the prevention of complications such as capsular contracture.

Breast Augmentation: Before and After PhotosBreast Augmentation: Before and After Photos
BeforeAfter

Photos show an 18 year old patient, at pre-op and six months post-op. Breast augmentation was perfomed using moderate profile saline implants filled to 350cc.

The cornerstone of Dr. Revis’ approach is to individualize treatment to your specific circumstances and goals and to ensure that you have an adequate understanding of the issues involved so that you are able to make a fully informed decision. This will help you achieve the appearance you desire with the least invasive procedure available, thus creating a mutually rewarding experience. Dr. Revis invites you to visit his office for a complimentary consultation to discuss the procedure in greater detail. You are also invited to email Dr. Revis with your questions, or we can mail you more detailed information regarding the procedure.

As you consider plastic surgery, one of the most important decisions you will make is choosing your surgeon. Our pledge to you is to provide the latest, state of the art cosmetic plastic surgery in a safe and professional environment. Dr. Revis is a recognized specialist in the field of cosmetic plastic surgery and is board certified by the American Board of Plastic Surgery, the only plastic surgery board recognized by the American Board of Medical Specialties. He is also an active member of the American Society of Plastic Surgeons and The American Society for Aesthetic Plastic Surgery and has been named among “America’s Top Surgeons” by The Consumers’ Research Council of America. 

Our goal is to provide you with the ultimate patient experience. Our well-trained staff will help you understand your procedure, our financial policies, the scheduling of your surgery, and your post-operative care. We are available to assist you during our regular office hours, Monday through Friday. Dr. Revis is also available 24 hours a day to post-surgical patients; he will give you his cell phone number after surgery so that you will always be able to reach him with any questions or concerns you might have during your recovery.

The Consultation

During your initial consultation, Dr. Revis will inquire about your medical history, prior procedures, medications, allergies, and your motivations for seeking plastic surgery. It is very important that you be thorough when providing your medical history, as this information helps to prevent complications during your care. When asked about medications, be sure to include any vitamin or herbal preparations, as these can affect your blood pressure and clotting ability. Honesty regarding your use of tobacco and alcohol is also very important, as these may have a profound impact on your recovery period and your ability to heal following your procedure.

After reviewing your medical history, Dr. Revis will discuss your concerns, priorities and motivations for pursuing plastic surgery, as well as your fears. After examining you, Dr. Revis will be able to offer advice and options to help you achieve the appearance you desire. He will explain the advantages and disadvantages of the different options you have before you. You will also be shown the different types of breast implants, and you will have the opportunity to try on breast implant sizers with a soft surgical bra during your preoperative appointment. This will enable you to visualize how you will appear following your surgery and will assist you in selecting the proper size implant to meet your expectations.

At the completion of your consultation, you will be given a written estimate of the cost of your procedure. At this time, you will also have the option to schedule your procedure if you so choose. The decision to undergo surgery is a very important one, and the final decision should be given very careful consideration. Dr. Revis realizes the importance of this decision, and at no time will you be pressured to make a decision. You are also encouraged to bring your spouse, significant other, family member, or a friend to your consultation.

Breast implants come in many different types, and they may be placed through different incisions and in different locations. Once you have decided to undergo augmentation, there are three main choices you must make — incision location, implant type and size, and whether or not the implants will be placed above or below the muscle of the chest wall. This can be quite confusing, and the following information is to help you understand the various issues involved in making your decision.  

Types of Breast Implants

Silicone Gel vs. Saline Filled Implants Breast Implants

There are two basic types of implants, silicone gel and saline filled. The new silicone gel implants arrive from the manufacturer already filled with cohesive silicone gel (not liquid silicone) in their sterile packaging. Saline implants arrive from the manufacturer empty, in sterile packaging, and are actually filled with sterile saline solution in the operating room.

After 15 years of intensive research, the new silicone gel implants were approved by the FDA in November 2006 and continue to be studied. To date, there have been numerous studies involving over one million women with the new silicone gel implants, and these studies clearly show no link between silicone gel implants and any type of disease.

During the 1992-2005 FDA study period of silicone gel implants, there were strict limitations on which women qualified to enter the FDA study protocol. Because of these limitations, the majority of women undergoing breast implant surgery chose saline implants. Now that the restrictions have been lifted and silicone gel implants are available to everyone, the numbers are much more equal in terms of what type of implant a woman chooses.

Silicone gel implants have an advantage in some patients because of their softer, more natural feel. In fact, many women who have saline or the older type of silicone implants are now having them replaced with the new silicone gel implants.  Saline implants have an advantage in some patients because they may be adjusted if your breasts are different sizes, they are less expensive than silicone implants, and they may be placed through a smaller incision.

There are several reasons a woman might choose one type of implant over another, and these include cost, body type, current breast size, and the desired look and feel after surgery. During your consultation, Dr. Revis will discuss with you which implant type might be the best choice for your individual needs.

Moderate Profile vs. Moderate Plus Profile vs. High Profile Breast Implants

Both saline and silicone round breast implants are available in three different profiles — Moderate, Moderate Plus and High. Silicone implants also come in UltraHigh profile. The difference between these types is the diameter and projection. The traditional, or original, profile available was the Moderate. For any given size in cc, the Moderate profile implant will have the widest diameter and the least projection. The UltraHigh profile implant is the narrowest in diameter with the greatest projection. Moderate Plus profile and High Profile implants fall in between. We will discuss which implant type and style would best fit your needs during your consultation based on the measurements Dr. Revis takes of your chest, the review of pre- and postop photographs, and when you try on the implant sizers.

Incision Placement

The incision for breast augmentation may be placed underneath the breast, around the areola (the pigmented skin surrounding the nipple), in the armpit, or in the belly button. Dr. Revis performs all of these types of incisions, and he will discuss which might be the best for your specific situation at the time of your consultation.

Nationally as well as in Dr. Revis’ practice, most patients choose an incision around the nipple or in the crease underneath the breast. This provides the surgeon with the most precise control over implant placement, especially when your breasts differ in size or shape. When performed properly, an incision around the nipple or in the crease underneath the breast is minimally noticeable and should in no way prevent breastfeeding or alter nipple sensitivity.

Implant Placement

Subglandular vs. Partially Submuscular vs. Totally Submuscular Implant Placement

Breast implants may be placed beneath the tissue of the breast (subglandular), or may be placed even deeper, beneath the muscle of the chest wall (totally submuscular). There is also a subpectoral (or partially submuscular) placement that some surgeons use, meaning that the implant is placed beneath the pectoralis major muscle only, leaving the outer, lower 1/3 of the implant not covered by muscle tissue. The decision is a very individual one, and it is determined by the natural shape of your breasts and chest wall muscles.

 Implant placement in subglandular and submuscular augmentation
A cross-sectional diagram of subglandular (left) and submuscular (right) augmentation

Whenever possible, Dr. Revis prefers to place the implants in a totally submuscular position. Dr. Revis believes that the advantages of placing the implants completely beneath the muscle of the chest wall greatly improve the long-term appearance of your breasts following augmentation. This is for three main reasons. First, mammography is easier and the quality is better when the breast implant is separated from the breast tissue by the layer of muscle. Secondly, there is a lower incidence of capsular contracture when the implants are placed totally beneath the muscle. Capsular contracture occurs when the body produces scar tissue around the implant. This may change the shape of the implant and make the breasts asymmetric. Finally, placing the implants beneath the muscle of the chest wall makes your breasts appear more natural because there is more of your own tissue covering the implant, making it less likely that you will be able to see or feel the implant.

Dr. Revis uses a special technique and instruments to place the implants 100% beneath the muscle of the chest wall without cutting any of the muscle tissue. This entirely submuscular placement will improve your long-term results and minimize your potential complications. It also yields little or no bruising post-operatively.

Choosing the Proper Implant Size

This is one of the most important decisions you will make. Because of this, we use several approaches to help you make the best decision based on your anatomy, personal preferences, and the appearance you wish to achieve. Interestingly, in a recent national survey, over 80% of patients undergoing breast augmentation stated that a C cup was their desired post-operative goal. A D cup was the second most popular request.

We begin by showing you numerous examples of patients who have had augmentation. By finding someone who has a similar preoperative appearance and evaluating their results with the size they chose, you can get an idea of whether or not you like the size they chose or if you would like to be smaller or larger than their final appearance. You may also wish to bring photographs from magazines or websites to better communicate with Dr. Revis regarding the exact size, shape and look you are trying to achieve.

Dr. Revis will also measure your natural breast and chest shape. This gives him an idea of what size implant will help you achieve the size you want post-operatively. As implant size increases, so does the diameter of the implant. There is an implant that will perfectly match the diameter of your natural breast, and that is a good starting point for discussion. Choosing an implant smaller than your natural breast shape will not provide the proper cleavage and shape following the procedure, and most commonly results in a large gap between the breasts. Similarly, choosing an implant too large for your natural chest shape is more likely to give you an unnatural appearance.

Unfortunately, implants do not come in cup sizes. Rather, they are categorized by the volume of filler (saline or silicone gel) they are designed to hold. There are several reasons for this. First, your final cup size will be partially determined by your preoperative breast size, and everyone is different in this regard. Secondly, a C cup from one bra manufacturer is not necessarily the same as a C cup from another manufacturer. Although everyone is built differently and bras are not manufactured to a set standard, you can expect that a cup size is approximately 200cc in a person of average height and average build. If you are tall or have broad shoulders, you can expect that number to be slightly higher. Similarly, if you are shorter or have a more narrow chest, you can expect that number to be slightly lower. Although a desire for a certain cup size is helpful to Dr. Revis in guiding you in the selection of the proper implants, it is more helpful to focus on the shape and appearance that you wish to achieve.

Finally, we will have you try on various implant sizers in a surgical bra. You may wish to bring a bathing suit, tank top or other clothing to see how you will look with different implant sizes. This helps confirm that you are making the right implant choice. We usually perform the trying on of breast implant sizers during the preoperative visit. This is because the initial consultation is very thorough, lasts approximately one hour, and tends to provide you with a tremendous amount of information to digest. In his experience, trying on implants at this point in the developing physician-patient relationship rarely leads to a conclusive decision and almost always needs to be repeated. However, we also understand that many patients travel a long distance for a consultation with Dr. Revis. With that in mind, we are willing to be as flexible as possible with out of town patients and allow the trying on of implant sizers during the initial consultation if we are given enough advance notice to schedule a more lengthy appointment. Also, please feel free to make as many trips to the office as you need to be satisfied with your implant selection. Our goal and the measure of our success is your happiness.

Using these three approaches, you will be able to accurately select the implant that will give you the appearance you desire. When asked about size post-operatively, over 95% of our patients feel they chose the right size implant to achieve the appearance they envisioned. The remaining few state that they might have gone larger if they were to choose again. We almost never hear that a patient wishes they had chosen a smaller implant. Therefore, if you are debating between two sizes, it is probably a better decision to opt for the larger size. 

Hopefully the above information has helped to clarify some of the issues surrounding breast augmentation. The following information will help prepare you for your procedure.

Where Your Procedure Will Be Performed

Dr. Revis has been granted staff privileges at our local hospitals and outpatient surgery centers. In the interest of the safety of his patients, he only performs surgery in fully accredited facilities with the proper services and staff. Dr. Revis usually performs breast augmentation at Broward General Medical Center or Imperial Point Medical Center (both fully accredited hospitals) or the Imperial Point Surgery Center (a fully accredited ambulatory surgery center). The staff of these facilities are very experienced in the care of plastic surgery patients in general and specifically in the care of Dr. Revis’ patients.

Types of Anesthesia

Anesthesia is an essential part of any surgical procedure and must be performed safely. General anesthesia is the deepest form of anesthesia. You are asleep, feel no pain, and will not remember the procedure. This form of anesthesia is usually not required for breast augmentation unless the patient specifically requests general anesthesia.

Intravenous sedation, called twilight sleep, is a combination of local anesthetic administered at the surgical site by Dr. Revis and intravenous sedation administered by the anesthesiologist. You breathe for yourself, but you are in a deep sleep throughout the procedure. You should feel no pain, and you will not remember the procedure.

An intermediate form of anesthesia, the laryngeal mask airway (LMA), is a relatively new technique. This technique is similar to twilight sleep in that you are breathing on your own, but the method of sedation differs. With an LMA, you actually breathe anesthetic gases administered by the anesthesiologist, rather than receive intravenous sedation via your intravenous line. These anesthetic gases cause you to sleep during the procedure. At the completion of the procedure, the gases are turned off and you wake up from your sleep. You will feel no pain, and you will not remember the procedure. This is the most common type of anesthesia used by Dr. Revis because he feels that the effects of this type of anesthesia leave your body the fastest, allowing you to feel better faster with very little likelihood of post-operative nausea.

The prevention of post-operative nausea and vomiting is also a focus of Dr. Revis’ approach to breast augmentation. To improve your overall experience and ensure you feel better faster following your augmentation, he has developed a technique that has resulted in a very low incidence of post-operative nausea and vomiting. You will be given an intravenous dose of Zofran at the beginning of your operation. Zofran is a new drug which is currently the best medication available to prevent nausea and vomiting. Dr. Revis feels it is a very important component of his overall approach to make sure that your experience is as pleasant as possible.

Dr. Revis will discuss all of these options with you more thoroughly at the time of your consultation, and please ask him about anything you do not understand.

Details of the Procedure

Breast augmentationusually takes one to one and a half hours to perform. After you have changed into a gown and had your intravenous line started, you will be given a dose of intravenous antibiotics as a precautionary measure. Dr. Revis will use a surgical marking pen to identify certain landmarks on your chest. This ensures proper implant placement and symmetry post-operatively. He will also review the entire operative plan with you including incision location and implant type and size. 

After you are properly anesthetized in the operating room, Dr. Revis will inject a solution of local anesthetics along the borders of your breasts, underneath the intended incision site, and into the muscle under which the implants will be placed. This injection solution consists of a special combination of lidocaine (xylocaine), marcaine (sensorcaine, bupivicaine) and epinephrine. This accomplishes several objectives. First, the epinephrine causes vasoconstriction of the area, reducing your potential for bleeding and bruising. Secondly, the lidocaine provides a rapid numbing of the area. Although you are asleep, this prevents the brain from registering any pain from the region during the operation. Studies have shown that this preemptive analgesia actually decreases your sensation of pain post-operatively, decreases the amount and length of time you will need to take pain medication post-operatively, and also leads to a more rapid return to normal daily activities. Finally, the marcaine component of this local anesthetic mixture is a long-acting local anesthetic. This actually prolongs the numbness of the area, making you more comfortable following surgery and delaying the time at which you will begin to need any pain medications. 

Incisions and Pocket Creation

After allowing time for the local anesthetic mixture to take effect, Dr. Revis will make the incisions necessary for placement of the implants. Using the newest techniques and instruments, Dr. Revis is able to create a pocket beneath the muscle of the chest wall without cutting any of the muscle. This is extremely important for the maintenance of long-term results. 

Insertion and Filling of Saline Implants

Once the pockets have been created, the breast implants are inserted and filled with saline. Dr. Revis uses a no touch technique when placing the implants into the pocket. This includes using new sterile towels to drape around the breasts, changing his gloves and washing the outer surface of these new gloves in sterile saline, and only opening the sterile implant packaging immediately prior to insertion. Dr. Revis is the only person who ever touches the implants, and his goal is to minimize the time the implant is exposed to the air in the operating room prior to insertion into the pocket. Additionally, Dr. Revis does not allow the implant to come into contact with any instruments or the skin during the insertion process. He feels that this minimizes the possibility of any foreign material coming into contact with the implant and causing any inflammation.

During the filling process for saline implants, Dr. Revis uses a closed system to fill the implants with saline. This means that the saline that enters the implant is never at any time exposed to the air in the operating room. The saline flows from a sterile bag through a sterile tubing directly into the implant. Dr. Revis feels this additional precaution prevents any foreign material from inadvertently being injected inside the implant.

Insertion of Silicone Breast Implants

Dr. Revis will use the innovative Keller Funnel to place the silicone breast implants into the new pockets. The Keller Funnel employs the no-touch technique, reduces trauma to both the implant and patient tissues, and allows the use of smaller incisions. 

Keller Funnel™ Certification Seal of Approval

Dr. Revis is certified by Keller Medical and uses the Keller Funnel in every silicone breast implant procedure he performs, as part of his ongoing effort to continuously improve surgical results for his patients.

Suturing and Dressing

After the implants have been placed (and filled properly, in the case of saline implants) and Dr. Revis has assessed your final shape and size, the incisions are carefully closed with absorbable sutures to minimize your scar. A sterile dressing is applied to the incisions, and a soft surgical bra is placed over your breasts. Dr. Revis uses a technique in which all of the sutures are placed beneath the skin and are absorbed by your body. Not having to undergo suture removal has improved patient comfort and satisfaction.

Products to Help You Heal

Silagen Made with 100% pure medical grade silicone, Silagen 100% Pure Silicone Gel for Scars is a clear, fast drying gel that will help flatten, soften and smooth scars. It also helps reduce redness, discoloration, itching, and pain.

SinEcch Arnica Montana is a natural product from Sweden which has been shown in clinical studies to reduce post-operative bruising and swelling. Begun the evening prior to surgery, this product is continued for four days post-operatively.

These products are available for purchase in our office. Please ask us about these products and others if you have any further questions about whether or not these would be beneficial for you during your healing period. 

After Your Procedure

Breast augmentation is performed as an outpatient procedure. After recovering in the recovery room for approximately one hour, you will be able to go home in the company of a friend or family member. Dr. Revis will also give you his cell phone number so that you may reach him directly at any time with any questions you might have. 

When you wake up from your procedure, you will be in the recovery room and will be wearing a soft surgical bra or sports bra. You may remove this bra on the second day following surgery and begin showering daily. After showering, simply pat your incisions dry and replace your surgical bra, a sports bra, or feel free to wear no bra at all. It is important not to wear a bra with underwires initially, because this may prevent your breasts from assuming their natural shape. 

The antibiotics that were prescribed during your preoperative visit (usually Augmentin) should be taken twice daily beginning on the evening prior to surgery. Continue this medication for five days post-operatively or until it is gone. The pain medication prescribed by Dr. Revis during your preoperative visit (usually Lortab or Vicodin) should be taken fairly regularly, every four hours or so, during the first 24 hours (when you are not asleep, of course). Most patients find that they are able to transition to Tylenol after three or four days. It is not safe to drive a car within 24 hours of taking pain medication, as your reflexes and alertness may be altered. Dr. Revis may prescribe a muscle relaxant (usually Flexeril) for you if he suspects that your muscles may be tight and uncomfortable following surgery. If so, you may take one tablet every eight hours if needed for muscle tightness.

You should plan to take it easy following your surgery. No strenuous activities, heavy lifting (over 20 pounds), aerobic exercises, swimming, contact sports, tennis, or golf should be planned for the first three weeks. As Dr. Revis monitors your recovery, he will advise you when it is safe to resume specific activities. 

Unlike many surgeons, Dr. Revis does not feel that you must follow any specific regimen of straps, massaging, etc., following your augmentation. His philosophy is that the time to place the implants properly and precisely is in the operating room through careful technique and attention to detail. In his opinion, there is very little manipulation that straps or massaging will accomplish in the post-operative period to change the position or shape of an improperly or hastily placed implant. Dr. Revis will, however, occasionally recommend gentle massaging as a way to relax the muscle under which the implant is placed. In select patients, this can lead to a more rapid relaxation of the muscle and a softening of the breasts. Dr. Revis will instruct you during your post-operative visits in the proper technique of massaging the implants if he feels this would be of benefit to you.

Dr. Revis will also discuss the use of a scar-healing product with you following surgery. Beginning three weeks post-operatively, daily or twice daily use of this product will stimulate rapid wound maturation and fading of your scar to a barely noticeable thin line.

Rapid Recovery Breast Augmentation

In your research leading up to your selection of a plastic surgeon, you may have heard of Rapid Recovery, also called Flash, Quick, or One Day Recovery. These are often used merely as marketing terms to mislead a potential patient into thinking a particular surgeon has invented some type of revolutionary approach for breast augmentation.

It is common sense plastic surgery to place patient safety, comfort and satisfaction above all else. In Dr. Revis’ opinion, the principles of a systematic approach to breast augmentation should be considered standard in the industry for every board certified plastic surgeon.

In Dr. Revis’ practice, this systematic approach includes the following:

Preoperatively:

  • Precise breast and chest measurements
  • Accurate preoperative sizing using implant sizers and photos
  • Careful preoperative marking

Intraoperatively:

  • Efficient use of the operating room to reduce operative time
  • No intubation
  • No paralysis
  • No ventilator
  • Combination anesthetic involving IV, gas and local anesthetics
  • Careful, precise dissection of the pocket with minimal tissue trauma
  • Minimal bleeding
  • No touch technique for implant insertion
  • Keller funnel for silicone implant insertion
  • Avoidance of cutting the pectoralis muscle
  • Avoidance of blunt dissection
  • Prevention of nausea

The Results You Can Expect

You will notice an improvement in your breast shape and size immediately. You may experience tightness in your chest, but this rapidly resolves as the muscles relax. A very mild swelling usually takes several weeks to subside. You should be able to resume your normal daily activities the day after surgery, and you should be able to resume all of your physical activities (sports, aerobics, running, etc.) within three weeks of surgery. Please see our Preoperative Instructions and Postoperative Instructions for additional information.

Because Dr. Revis places the implants 100% behind the muscle (totally submuscular) without cutting any of the muscle, your implants initially will appear too high. This is to be expected because the muscle will take a variable amount of time to relax. As your muscle relaxes, your implants will drop or settle into their intended position.

Total submuscular placement provides excellent long term support for your implants, helping maintain your results over time. The patient photos shown below illustrate the long-term results of submuscular implant placement. See long-term surgical results by Dr. Revis for patients two years or more post-op.

Breast Augmentation: Submuscular Placement Pre-OpBreast Augmentation: Submuscular Placement 3 Months Post-OpBreast Augmentation: Submuscular Placement 10 Years Post-Op
Pre-Op3 Months Post-Op10 Years Post-Op

Photos show a 27 year old patient at pre-op, then three months post-op and ten years post-op. Breast augmentation was perfomed using smooth round moderate profile saline implants filled to 450cc.

Choosing your breast implants

The sheer number of breast implant variations available to patients and surgeons can lead to confusion; however, careful measurement, proper analysis of your anatomy, and experienced decision-making can help our plastic surgeons give you the best breast enlargement possible.

Unfortunately, some surgical recommendations are made on the basis of marketing, surgeon habit, or profit, rather than careful listening to the patient’s goals and concerns. As leading Minnesota aesthetic plastic surgery providers, our American Board of Plastic Surgery-certified plastic surgeons and experienced nursing staff help patients choose their breast implants with the benefit of extensive expertise and over 50 years of combined experience with thousands of patients.

Since breast augmentation is performed so frequently at Minneapolis Plastic Surgery, Ltd., we maintain an extensive on-site inventory of breast implants in virtually every size and profile, in both two types of cohesive silicone, as well as saline. Your implants don’t have to be ordered in advance, you don’t have to worry about us having the “right ones” in surgery, and on-time delivery is not an issue—they are already here!

Minneapolis Plastic Surgery’s AAAASF-accredited surgical facility is one of the first in the country to offer a complete on-site stock of Allergan Natrelle Inspira (Responsive) cohesive silicone gel implants in all sizes and profiles. Natrelle Inspira Responsive (cohesivity type 1) are higher-fill implants designed to reduce visible implant rippling compared to the previous  Allergan Natrelle silicone gel implants.

MPS now also offers a complete (all sizes and profiles) on-site consignment of Inspira Soft-Touch (cohesivity type 2) cohesive silicone gel implants with even more ripple resistance. In the unlikely event your anatomy requires the even-more crosslinked Inspira Cohesive implants (cohesivity type 3–identical to the style 410 cohesivity explained in more detail below), we can have multiple sizes and profiles of implants overnight express delivered to fulfill your requirements.

Breast Implant Information–What are the Options?

Types of Breast Implants

Breast implants come in numerous sizes (100cc – 800cc, or about 3 to 27 ounces each), shapes (round, oval, or teardrop “anatomic”), surface characteristics (smooth or textured), and fill material. Most breast implants are filled with saline or silicone gel, and occasionally other materials (though none of these “other materials” are FDA approved at the present time). Silicone gel implants presently come no larger than 800cc, but 800cc saline implants can be “overfilled” to volumes higher than this when requested in select patients.

Since the material inside breast implants is what gives them their “feel,” filler material choices have generated much controversy and media interest, not to mention scientific debate. We can provide both the science and years of expertise to help you determine whether saline or silicone is best for you.

Until March 9th, 2012, only two manufacturers produced breast implants FDA-approved for use in the United States (Mentor Corp., now part of Johnson and Johnson; and Inamed Corp., previously McGhan Medical, now owned by Allergan, Inc.). For the first time in 20 years in the United States, a third company (Sientra) has received FDA approval to sell their Silimed brand of silicone and saline implants, including textured anatomic silicone gel implants.

Prior to the FDA restrictions of 1991-1992, numerous companies produced breast implants with different designs, surfaces, and filler materials, including polyurethane-coated silicone gel implants, silicone-saline double-lumen implants (the Becker implant), and PVP hydrogel filled implants designed to pass mammography X-rays and have a feel more like silicone than saline (the Bioplasty Misti-Gold implant). After the FDA restrictions, these implant options and companies were lost to USA patients, though some of these companies and options remain available in other countries.

In the United States, besides the presently-available Mentor, Allergan, and now Silimed implants, several companies have produced investigational implants that are not yet FDA-approved and are implanted only by plastic surgeons associated with the FDA investigation/approval process.

Silicone or Saline? (How about fat?)

At Minneapolis Plastic Surgery we offer both saline and the latest cohesive silicone breast implants.

Saline identical to intravenous fluid was the most common type of breast implant filler material used in the United States from 1992 until November 2006, when the FDA re-approved the use of silicone gel-filled implants for primary elective breast augmentation. Prior to the 1992 FDA restrictions,and again after 2006, silicone gel implants are utilized in over 85 percent of all breast augmentation procedures in the United States, and remain the most commonly used breast implants worldwide.

Other types of filler material have been evaluated over the years prior to the introduction of silicone gel implants in 1963, and one or more problems are associated with these. Paraffin, sponges, and other unusual materials were used in early efforts to enlarge breasts; results were dismal until silicone came into use in the 1960s.

More recently, during the FDA restrictions from 1992-2006, soybean oil-filled implants were studied extensively, and were used in many patients in Europe, as well as a few U.S. patients in FDA studies. Breakdown of the oil, rancid smell, and other concerns ultimately led to withdrawal of this implant (Trilucent™) in the US and in Europe. Fat as implant fill material has the same concern, and is not used.

Fat graft injections of a patient’s own liposuction fat (directly into or beneath the breasts) have been performed by some physicians. Among other names, this has been termed “natural breast augmentation” since the surgeon uses the woman’s own fat tissue (and you have to pay for the liposuction used to obtain the fat)! The American College of Surgeons and the American Society of Plastic Surgeons have been cautious in endorsing breast augmentation via fat grafting because 30-50% of the transferred fat always dies, and can cause microcalcifications, scar tissue lumps, and/or oil cysts within the breast. These can be seen on mammography, and may confuse or obscure diagnosis of early or small breast malignancies.

Though many radiologists state that they can tell the difference between dead-fat microcalcifications (from fat grafting), and dead-fat microcalcifications (from possible breast cancer), many plastic surgeons (including those here at MPS) are not willing to risk your life for a procedure that remains unproven regarding long-term safety, especially since 1 in 8 or 9 women will develop breast cancer in her lifetime. And also since implants are still a superior choice lacking these mammographic concerns.

Scientific studies confirm that fat cells removed via “standard” liposuction are mostly destroyed and non-living; improper storage of the fat for later use (freezing) kills even more cells (ice crystals puncturing cell walls kill the fat cells), so this is worthless and potentially harmful. The same goes for fat harvested with SmartLipo (laser destroys the living fat cells) or excessive ultrasonic liposuction (too much ultrasonic energy ruptures the living fat cells). Dead fat cannot turn into living grafts that maintain volume.

Unless your surgeon uses appropriate fat harvest technique, and transplants the still-living fat globules into carefully-spaced tunnels with tiny fat grafts surrounded by abundant healthy tissue for blood supply, fat damaged by poor liposuction techniques, or grafted haphazardly in big blobs, will not survive. Any breast enlargement initially achieved is gradually and ultimately lost as the dead fat cells are absorbed and carried away by the body—potentially leaving scars, lumps, and calcifications. Pretreatment with Brava suction devices may enhance fat “take,” but at best, most women realize no more than ½ to 1 bra cup size enlargement via grafting.

Breasts augmented with fat grafts that die, calcify, or become scarred nodules within the breast are far from “natural.” And as the dead cells are removed by the woman’s body, the once-larger breasts
gradually lose size, making lasting enlargement uncommon. We see many unhappy former fat graft breast patients who return for the implants they should have had in the first place.

The latest marketing “hype” around fat grafting for breast enlargement uses the term “stem cell breast augmentation.” This is the same procedure as fat grafting, but with the possible addition of centrifugation or addition of blood plasma to “concentrate” or “enrich” the “stem cells.” Until peer-reviewed scientific research validates breast augmentation via fat grafting (or stem-cell breast enlargement), this should be considered experimental only! Soft, natural, and lasting breast augmentation is (still) best achieved by skillful placement of breast implants.

Cohesive Gel or Saline Implants

Over the past decade, advancements in silicone gel implants have been developed and introduced, including a more firm, teardrop-shaped, textured-surface cohesive silicone gel (the “gummy-bear” implant). Like all cohesive implants, this “highly-cohesive” implant retains its form and innate integrity even when its outer shell is punctured. This implant is more firm (like a “gummy bear” or silicone bathtub seal) than the softer, latest-generation, cohesive silicone gel implant, and requires a larger 2.5 inch incision for placement. (It’s also more costly.) This implant–Allergan (formerly McGhan) style 410–has recently been FDA approved, but we feel this implant configuration is usually more appropriate for reconstructive or “rescue” operations than for primary cosmetic breast augmentation.

Between 1992 and 2006, FDA restrictions on the use of silicone gel implants for elective, first-time breast augmentation meant that most women received saline-filled silicone-shell implants. Minneapolis Plastic Surgery has many satisfied patients with saline-filled implants who underwent their breast augmentation during these years, and many are shown in our photo gallery. Because of our significant numbers of patients who received them during this period, we also became well-aware of the pros and cons of saline-filled implants.

Numerous scientific studies were performed during these years of implant controversy, and to date, there has not been one credible peer-reviewed study that shows cause-and-effect relationship between silicone gel or saline implants and any sort of auto-immune disease or illness. Saline implants can leak and deflate, particularly if they are not filled properly, and they have also been shown to have a higher visibility of rippling or wrinkling on the implant surface. This rippling can cause unsightly and unnatural breast appearance, and tends to be worse when bending over or when wearing swimsuits or cleavage-revealing clothing. Implant placement below the pectoralis major muscles reduces saline-implant ripples, and usually eliminates or significantly reduces them when silicone gel implants are used.

Saline implants cost less, and can be inserted via a slightly shorter incision, though we continue to be surprised by the length and position of breast augmentation incisions (both saline and silicone) in patients we see from other practices. Incision length is much less a factor of saline vs. silicone than choice of surgeon. We have also found that the cost differential between saline and silicone gel implants is not always passed on to the patient, making saline implants more profitable than silicone in some doctors’ offices.

Surgeons who tend to promote the use of saline implants may do so out of training, their own experiences, habit, or profit motive, but those who scare patients with (disproved) autoimmune illness association, or tell them of the (outdated) FDA recommendation for MRI scans to check for “leaks” in silicone implant patients (unnecessary for all latest-generation cohesive silicone gel implants), only serve their own interests, not those of their patients. These are old, outdated, and inapplicable “concerns” that have been exhaustively studied and we believe no longer apply.

Leak and deflation of saline implants require surgical replacement (the implant manufacturers provide free lifetime implant replacement, and will cover a majority of the surgical costs for the first ten years after initial implantation). But another operation is needed, including time off from work or social activities, and restrictions during healing. When saline implant leak requires re-operation, most patients choose cohesive silicone gel implants to replace both of their saline ones, ensuring that leak and deflation can never again occur. Significant numbers of MPS patients who initially received saline breast implants have undergone a second procedure (whether they had a leak or not) to replace their saline implants with the latest generation of cohesive silicone gel implants. Rippling is eliminated or significantly reduced, softness and natural “feel” is enhanced, and leak or deflation is no longer a concern. Many also use this opportunity to choose a larger size. Whatever the reason, and despite the fact that many happy saline implant patients remain without concerns and with excellent results, a majority of our patients now choose silicone gel implants.

The newest generation of cohesive silicone breast implants provides incredibly natural-looking and feeling results, and also a high level of safety. The latest types of silicone gel breast implants have been used as part of the more general FDA study since 1992, and are soft, yet still a cohesive solid gel that cannot leak. These implants do not leak even if the shell is cut or punctured, and can be inserted via a 1.5 inch incision. Slicing open one of this latest generation of breast implants is like cutting Jell-O—you get two solid intact parts and leakage does not occur. (These implants are often erroneously called “gummy bear” implants since they are cohesive, though the true first “gummy bear” implants were the Allergan style 410s.)

Now that a third implant manufacturer (Sientra) is producing implants that are FDA-approved for use in this country, additional options exist for patient and surgeon choice. Sientra markets their version of high-strength cohesive silicone gel implants (smooth, round, textured, and teardrop-shaped) as “gummy bear” implants, further confusing this designation, which should probably be abandoned since it no longer describes a single type (or company’s) implants! Sientra has decided to sell their products only to American Board of Plastic Surgery-certified plastic surgeons (a laudable position), whereas Mentor and Allergan will sell their implants to any licensed physician, regardless of specialty. (This is how Dermatologists, Family Practitioners, and doctors with little or no plastic surgical training can legally obtain breast implants, and insert them into unwitting patients who think that these “cosmetic surgeons” have the same training and certification as ABPS-certified plastic surgeons.) Whether or not this will confer better statistics, outcome studies, or lower complication rates than the other companies’ practices remains to be seen.

Sientra also was the first company to receive FDA approval for their own brand of “high-strength” cohesive, textured-surface, teardrop-shaped (form stable) silicone gel implants, as their approval pre-dated Allergan’s style 410 FDA approval. This further confused individuals who use the “gummy bear” moniker to describe the Sientra version of the Allergan Style 410. For this reason, I personally believe that although the term “gummy bear” is descriptive and “catchy” to use, it has now become confusing, since each implant manufacturer has its own version of textured-surface, shaped, cohesive, “high-strength,” or “highly cohesive” silicone gel implants. Plus, the “regular” smooth round silicone implants (from all 3 breast implant manufacturers) are also cohesive. So they’re ALL “gummy bears” and they’re NOT all “gummy bears,” depending on how you define the term.

With silicone gel or saline breast implants, microscopic silicone molecules can still enter a patient’s body, just as liquid silicone does in the patient who has an injection with a needle lubricated with liquid silicone. No scientific study to date has provided credible evidence that silicone has any cause-and-effect relationship with autoimmune diseases or conditions such as rheumatoid arthritis, lupus, scleroderma, or so-called “human adjuvant illnesses.” With these studies in mind, silicone gel breast implants were FDA-approved in November 2006 for elective first-time cosmetic breast enlargement in women over the age of 22. Use of silicone gel implants in women under age 22 is considered “off-label” use and is perfectly legal. We support the right of properly-informed women between the ages of 18 and 22 to consent to and request the implants of their choice, including silicone gel implants.

The present soft cohesive silicone implants made by Allergan are Natrelle implants, and newer Natrelle Inspira cohesive silicone implants are identical to the previous Natrelle implants, but with additional gel “fill” in the silicone shell, about 95% vs. 85%. Increased fill with the same soft (level 1 cohesivity) gel in the Inspira implant reduces visible rippling in thin patients with little tissue coverage. For even thinner patients that might still have ripple issues, Allergan now offers “Soft-Touch” level 2 cohesivity implants, with increased crosslinking to decrease rippling, and Natrelle Inspira “Cohesive” level 3 cohesivity implants, to decrease rippling further. Each increased cohesivity level is slightly less soft, more expensive, but offers progressively less potential for rippling in women with little tissue coverage.

Is an MRI really necessary every two years with silicone implants?

If your silicone implants were produced before the FDA restrictions of 1992, they were previous-generation devices that had a thinner shell and less-cohesive gel filler. In other words, if one of these older implants was damaged or defective, the silicone gel could indeed “leak” into surrounding tissues, eventually causing scar formation and capsular contracture. MRI studies proved to be more effective at detecting these kinds of implant damage and leak than physician exam, leading to this “recommendation” from the FDA.

However, since all 3 USA breast implant manufacturers now make cohesive or highly cohesive silicone gel implants, “leakage” does not occur, and since the shells are thicker and much more durable, implant rupture from manufacturers’ defect is extremely rare, and surgeon damage during insertion is the most common cause of implant “rupture.” Use of the Keller Funnel decreases forces on implants during insertion, and taking care to avoid contact with needles, instruments, or other sources of implant damage can virtually eliminate rupture. Since present-day solid cohesive silicone gel implants (from all 3 manufacturers) cannot “leak,” many plastic surgeons, including both plastic surgeons at MPS, do not believe there is value in MRI evaluation of asymptomatic breast implant patients. In fact, there is also a “false positive” rate of 21%, where absolutely normal intact implants are erroneously read as “ruptured” by MRI. I do not recommend MRI on asymptomatic patients whose breasts are soft and implants move normally.

How long do implants last? This is a common and appropriate question, since it takes an operation to replace them for any reason, including request for different size. No implants (by any of the three USA manufacturers) are intended to be lifetime devices. That being said, barring complications regarding size, position, contracture, or infection, we believe that the latest cohesive silicone gel implants will last much longer than the majority of their human recipients. They cannot “leak,” rarely have a manufacturer’s defect or rupture (requiring extreme injuring force or surgeon damage during insertion), and if kept from becoming bacterially contaminated at the time of surgery or subsequent dental work, they do NOT require “replacement” after ten years, or usually ever. We certainly have a significantly lower re-operation rate than the 47% in 7 years quoted in some of the implant manufacturer data. But then again, that data includes doctors of any type who decide they want to place implants, even without training and certification by the American Board of Plastic Surgery—hence, the higher numbers.

Smooth or Textured? Above or Below Muscles?

The surface of present-day breast implants can be smooth or textured, and the filler material silicone gel or saline. When silicone gel implants were used prior to the FDA restrictions of 1992, placement above the muscle was also the preferred implant position for many plastic surgeons. (Capsular contracture was also common.) Texturing the surface of the silicone gel implant reduced the incidence of capsular contracture in this position (above the muscle and just below the breast tissue).

Once the FDA restriction on silicone gel implants led to the increased use of saline-filled implants, placement above the muscle led to unacceptable wrinkling that could sometimes be felt or seen. This caused most plastic surgeons to place saline breast implants below the muscle to increase tissue coverage and reduce these concerns. Even placement of saline-filled implants below the muscle will not always eliminate implant wrinkles, particularly in thin patients and/or patients with very little overlying breast tissue. Now that silicone gel implants are again available, more patients will be able to avoid the “water-balloon” feel and rippling seen in some saline implant patients. Although each patient’s circumstances are unique, our experienced plastic surgeons frequently use silicone breast implants to provide the most natural looking results. Of course, at Minneapolis Plastic Surgery, Ltd., we will help you determine the appropriate size, shape, surface configuration, and filler material to meet your needs.

Based on the choice of saline or silicone, textured or smooth, and the patient’s unique body type, appropriate surgical placement will be determined. Using textured breast implants below the muscle can cause unnatural adherence to the chest and restricted natural movement of the breast. With textured saline implants, the lack of gel to act as a lubricant inside the implant (saline is a poor lubricant) can allow flexing and creasing of the implant shell surface with each movement or breath of the patient. This can ultimately lead to a higher risk of failure at one of the low spots in the textured surface, with leakage and deflation of the saline implant. The textured implant shell is also thicker and more palpable. Submuscular placement already reduces the incidence of capsular contracture, so smooth breast implants in this location are preferable to adherent textured-surface implants. The smooth-shell saline-filled implant placed below the muscle is soft, less palpable, and less likely to deflate (if properly filled), and has lower rates of capsular contracture formation. It also moves with the patient’s position and therefore more natural and breast-like. Yet, saline implants (even below the muscles—”unders”) have increased rates of visible rippling in the cleavage areas or sides of the breasts.

However, smooth-shell silicone-gel-filled implants are even more homogeneous with breast tissue and provide the softest, most breast-like, and most natural “feel” of any implant. Since the newest generation of silicone gel implants is also cohesive, they cannot leak or deflate. While the vast majority of patients are again choosing silicone implants for their breast enhancement surgery, we believe that the best and most experienced breast surgeons offer their patients a choice of either silicone or saline breast implants. With careful evaluation of the patient’s individual requests and needs, and detailed discussion of the pros and cons of the two surface textures available, our ABPS-certified plastic surgeons can help you choose not only the implant but the location and proper profile for your anatomy.

One final consideration should be noted regarding textured implants (either saline or silicone)—in 2011, an unusual type of lymphoma (BIA-ALCL: Breast Implant Associated-Anaplastic Large Cell Lymphoma—a cancer of the immune system) was reported in small numbers of breast implant patients who developed symptoms including breast enlargement, pain, asymmetry, lump in the breast or armpit, overlying skin rash, hardening of the breast, or a large fluid collection typically developing at least more than one year after receiving an implant, and on average after 8 to 10 years. BIA-ALCL is a rare and highly treatable type of lymphoma that can develop around breast implants. BIA-ALCL occurs most frequently in patients who have breast implants with textured surfaces. This is a cancer of the immune system, not a type of breast cancer. The current lifetime risk of BIA-ALCL is estimated to be 1:3817 – 1:30,000 women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades. When caught early, BIA-ALCL is usually curable.

BIA-ALCL has been found with both silicone and saline implants and both breast cancer reconstruction and cosmetic patients. To date, there are few confirmed BIA-ALCL cases that involve only a smooth implant. BIA-ALCL patients seem to have a reaction to textured devices over many years. Given this information, we are happy to report that the vast majority of MPS breast augmentation patients over the past two decades have received only smooth implants.

Teardrop (Anatomic) or Round?

Breast implants come in round or teardrop (“anatomic”) shapes. While some plastic surgeons prefer the teardrop-shaped implants in some situations, smooth round implants are generally the softest, most natural in appearance (upright and lying down), least likely to be felt externally, and (for saline implants) least likely to leak. Round, smooth implants also cost less than teardrop-shaped textured implants, yet are superior in most cases.

Teardrop-shaped implants must have proper positioning and must stay in that position (sloped part up, rounded part down) to take advantage of their innate shape. (Upside-down teardrop implants really would look weird.) They are textured so that the body’s tissues can adhere to and maintain the proper position of the implants. Thus, the teardrop or textured “anatomic” implants cannot move as the patient changes from a standing to a reclining position. Also, the teardrop implant remains teardrop-shaped when the patient is lying down, whereas the natural breast flattens out and assumes a round appearance. Tissue adherence makes initial positioning critical—textured implants do not settle or drop over time. Post-op tissue swelling and tightness diminish, giving a softer feel, but position (by definition) is determined by initial placement and adherence of the textured surface to the adjacent tissues. The smooth round implant does just what a natural breast does: it is teardrop-shaped when the patient is upright, and flattens and moves slightly to the side when the patient reclines. Thus, the round implant is actually more anatomically realistic than the teardrop, or so-called “anatomic implant.”

Loss of adherence with trauma or activity can allow rotation and distortion of appearance, and this is something noted only with shaped implants, since they are designed to remain in a given position. Loss of that intended positioning can be difficult to correct, as the adherence is now gone, and the implant can freely rotate in its pocket. Round implants do not have this rotational concern, since they look the same in any position. Textured implants should not be “massaged” post-op, as this can prevent adhesion.

Some implant manufacturers and plastic surgeons have suggested that the “anatomic” or teardrop- shaped breast implant has a more natural look than a round implant, and much advertising and marketing has been used to promote “anatomic” implants to the public. These implants are perfectly good devices, but are more expensive than smooth, round implants, and whether or not they are truly more “anatomic” is debatable (see above).

A recent study compared actual women with smooth, round implants to women with textured, teardrop- shaped implants. Mammograms were performed in upright and supine (laying-down) positions, and digital tracings computerized and compared. Both the round and teardrop-shaped implants had a sloped, teardrop shape when the women were upright. In fact, in upright patients, teardrop and round implants were indistinguishable on X-ray. But when a woman is laying down, the natural non-augmented breast flattens, drops slightly to the side of the chest, and assumes a round shape, as does the round smooth implant. The teardrop-shaped implant stays teardrop-shaped in the laying-down position, which makes this unusual appearance actually LESS anatomic or natural than the round implant! Still, in rare situations, the textured or teardrop-shaped implant may be an appropriate choice.

Moderate, moderate plus, or high profile? (or ultra high?)

Both saline and silicone gel breast implants come in three or four profiles: moderate “classic,” moderate plus, and high profile. For example, a 400cc (Mentor style 7000) moderate profile silicone gel implant has a base diameter of 14.5cm and a projection (height) of 3.2cm. The 400cc (Mentor style 1000) moderate plus profile silicone gel implant has a base diameter of 13.1cm and a projection of 4.0cm. The 400cc (Mentor style 4000) high profile silicone gel implant has a base diameter of 12.2cm and a projection of 5.0cm. Mentor also makes an ultra high profile (style 5000) implant with a base of 10.6cm and projection of 5.4cm for the 400cc size. Thus, various dimensions are available to help best match the desired size of implant to the patient’s breast dimensions.

Allergan Natrelle® implants also come in a total of four silicone gel profiles: moderate, moderate-plus, high, and extra-high profiles. To use similar examples, a 390cc (Natrelle style 10) moderate profile silicone gel implant has a base diameter of 13.6cm and projection (height) of 3.8cm. The 397cc (Natrelle style 15) moderate-plus profile silicone gel implant has a base diameter of 13.1cm and a projection of 4.2cm. The 400cc (Natrelle style 20) high profile silicone gel implant has a base diameter of 11.9cm and a projection of 5.0cm. As you can see by comparing these two manufacturers’ implant dimensions, near-equal volumes and profile implants from each company have nearly identical measurements. Allergan also makes an extra-high profile silicone gel implant (Natrelle style 45) with an 11.2cm base and 5.1cm projection for the 400cc size.’

The newest Allergan Natrelle® Inspira implants come in five profiles: low, low plus, moderate, full, and extra full. This allows even more surgical options for every woman’s anatomy and goals. Since Sientra implants also come in many different shapes and sizes, including smooth, textured, round, and teardrop-shaped styles, many more options exist for patient and surgeon choice.

At Minneapolis Plastic Surgery, Ltd. we first measure the patient’s breast dimensions, including base diameter, nipple to crease distance, nipple-to-nipple distance (cleavage diameter) and overall chest circumference, determine what final breast size she wants to achieve, and then see if a properly-chosen implant volume and profile can be surgically combined with her own breast tissues and skin brassiere to yield the desired results. Most of the time it can! In other cases, there , not to mention a very wide gap, unnatural-appearing cleavage.may need to be compromises to achieve a good result, or additional skin shaping and tailoring (via breast lift) may be necessary.

Any surgeon who consistently recommends high-profile implants, for example, “because I like the look of those the best” or “high profile gives more upper pole fullness” [false, BTW] is selling some of his or her patients short. A narrow-chest small-frame petite woman who wants large breasts (but has virtually no breast tissue of her own), may require high profile breast implants to achieve the look she wants. But a tall, wide-breast base, large frame woman who only wants a modest enlargement (or has a fair amount of her own breast tissue), will not be served well by high profile implants—she needs moderate profile implants to get as much base diameter as possible for the small(er) size she has selected, in order to accurately fill her own breast base. Otherwise, she would have a narrow-diameter implant “sliding around” in a large-diameter breast pocket, not to mention a very wide-gap, unnatural-appearing cleavage.

Patients are often told (by some plastic surgeons, and often in on-line forums) that “High profile implants give more upper pole fullness.” Until implants drop over the 6-12 months needed for complete healing and “final” gravity-settled position, this is indeed true. But since smooth round HP implants have narrow widths (and more projection), they also have a less-tall height (vertical diameter) that leads to LESS upper pole fullness when the implants reach their proper position at the creases. Choose the widest (vertically tallest) implant profile that fits the breast base diameter for the most upper pole fullness.

Thus, implant profile is based on each individual patient’s anatomy, pre-operative breast measurements, and requests, not on a particular surgeon’s “habit” or “routine.” We believe it is not the surgeon’s job to decide what a patient should have, and certainly not to “routinely” use only one of the 5 available profiles, but rather to listen to the patient’s requests, examine and carefully measure the patient’s individual anatomy, and then use our experience and expertise to determine how to best achieve her goals, or at least come as close as the anatomy and details allow. One profile does NOT fit all, and the widest profile that “fits” your breast base will give the closest cleavage!

What Implant Size is Right for Me?

What is the right implant size for you?

Dr. Richard H. Tholen and Dr. Douglas L. Gervais have extensive experience in helping our patients choose implant sizes that are compatible with individual anatomy, while still coming as close as possible to personal goals. Every patient has a “perfect size” in her mind’s eye: all we need to do is figure out what that size is, and whether or not it will match appropriately with the patient’s chest and breast base dimensions, skin and muscle capacity, position of the nipple-areola complex, as well as a host of individual anatomic factors. We start with breast examination, careful measurements (everyone is asymmetrical), and ask you what your goals are. Based on these anatomic factors, we then determine if your requests can be achieved. For most women, the size you choose is not only possible, but perfect for you! If not, we will tell you, and will use our experience and expertise to plan how to best get as close as possible to your ideals.

Remember, you should never have surgery to please someone else, or to try to conform to someone else’s opinion; the same goes for choosing implant size.

One of the best techniques for choosing the size of breast implants is for the patient to bring photographs of models with the desired final breast size to their consultation, or at the time of surgery at our Minneapolis / St. Paul accredited office surgical facility. The proper size and profile of implants, added to your own anatomy, that most closely achieves your goal photo appearance is then chosen in the operating room. (Since we stock all sizes and profiles of saline and silicone gel breast implants in our surgical center, we do not have to “order in advance” and can change based on your choices right up to the time of surgery). “Wish photos” have proven to be much more accurate than requesting a letter cup size, or trying to find a similar person via internet search whose anatomy and/or results approximate your goals. Don’t try to match your height, weight, or preoperative breast appearance to the photos, and don’t use a stated implant size as a guideline for choosing your implant size—just find an “AFTER” photo you like.

Also, if your breast sizes don’t match (most women have some degree of asymmetry), we can choose different implant sizes and/or profiles to achieve as much symmetry as possible. In more severe cases, we can recommend appropriate procedures (such as breast reduction, breast lift, or other surgical options) to optimize size, shape, and position between mismatched breasts. Implant choices can be made to help camouflage chest wall or other skeletal asymmetries caused by scoliosis, pectus excavatum, tuberous breasts, Poland’s syndrome, or other genetic breast conditions.

Trying on implants in a brassiere is another excellent way to provide some idea of desired final breast size and the implant volume needed to achieve that size; however, it is essential not to become overly attached to a specific bra cup size (B, C, D, etc.) or implant volume (400cc, etc.), since the implant size you like in a bra or top will always look smaller when it is under your own breast tissues and chest muscles. Typically, a woman who chooses a specific cc volume implant that she feels looks good in her bra will be disappointed (too small) after surgery if that exact volume implant is used in her body. This is because submuscular compression of the implants makes them look slightly smaller than when sizing in a bra. A good general rule of thumb is to add 10-15% to the implant volume you feel looks good if you choose to size in a brassiere. In other words, if you like how a 400cc implant looks in a bra, it will take a 440-460cc implant to look about the same size in your body. Final size and profile are chosen in the operating room where your surgeon can actually identify specific characteristics of your skin and muscle tone, chest wall (ribcage) configuration, and accurately measure your pocket diameter, not relying just on estimations of breast base width measured pre-operatively.

Minneapolis Plastic Surgery features a comfortable, discreet, implant sizing room where you can try on actual silicone implants in a stretchy top. Comfortable chairs and plenty of mirrors allow you and a spouse, friend, or confidant choose what makes you feel the best about yourself. We then take this information, goal photos, and any other input from you to help us achieve the best outcome possible.

In general, for an “average” height and weight woman, 250cc equals about one bra cup size. A 12 ounce can of soda = 360cc. Most patients cannot even see a difference of 50cc (3 tablespoons and 1 teaspoon), which is why implants are manufactured in 30-50cc increments (less than the threshold of visible difference). Thus, 400cc implants will cause an increase of about 1½ cup sizes to whatever breast volume the patient started with!

Since what this surgery accomplishes is increased volume, your own skin brassiere (pre-surgery breast shape) will determine your final breast shape after implants increase your breast size. Size and implant profile will also determine just how much breast mass extends to the side of the chest (armpit area), or into the cleavage region, since proper implant positioning is determined by the position of your nipple areola complex.

For instance, a woman with widely spaced nipples will need to have her breast implants positioned more laterally (towards the armpit area), since the implant pocket and final breast mound must be properly centered beneath the nipple areola complex. If too-narrow (high profile) implants were simply placed close together in the center to give a full cleavage look, each nipple areola complex would then be positioned too far laterally, giving the nipples a “wall-eyed” appearance. Wider- profile implants may therefore be necessary to give normal cleavage as well as position.

Similarly, a woman who has more medial nipple position would have a “cross-eyed” appearance if she requested lateral fullness and her implants were placed more to the side of the chest without taking into account the nipple position atop the new breast mound.

Clearly, not only size, but also the profile and exact position of your breast implants, is critical to your final result. Your own anatomy determines shape (unless you also need a breast lift, where incisions are made to lift or otherwise shape your breast skin, or reposition too-low nipple/areola complexes).

Most women seeking breast implants at our Minneapolis / St. Paul practice emphasize that they do not wish to be “too large” after augmentation. There is a natural hesitancy to make a change that is so dramatic that “everyone will know” or that might embarrass you at the health club, swimming pool, relative’s home, or church meeting. Most patients have these concerns, and many verbalize this. However, 6 to 12 months after surgery, when these concerns evaporate, and the social settings where “someone might notice” are successfully overcome, a surprisingly large number of patients admit they now wish they had chosen larger implants. Some undergo another operation to place new, larger implants. Fortunately, when size change is requested, the surgical pocket for the implant is already created, and recovery is often easier.

Although the choice of size is entirely up to each individual patient (with some anatomic limitations), choosing just slightly larger than what you consider to be optimal pre-operatively will help you to avoid re-operation for size change, including the cost of new implants, operating room, and anesthesia.

Risks of breast augmentation

breast augmentation risks

When carried out by an expert plastic surgeon, breast augmentation is a very safe procedure with minimal risk of complications. Any type of surgery carries certain risks, and breast augmentation is no different. Your surgeon will discuss the risks and potential complications of breast augmentation at your consultation. This will allow you to weigh up the pros and cons of the procedure before making your decision.

Some of the risks of breast augmentation include (but are not limited to):

  • Anaesthesia-related complications such as anaphylaxis
  • Excessive bleeding
  • Wound infection
  • Post-operative haematoma formation
  • Seromas
  • Implant malposition
  • Change in nipple sensitivity
  • Capsular contracture – formation of excessive scar tissue around the implant
  • Implant rupture
  • Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL)
  • Excessive pain that does not improve over the first two weeks
  • Need for revision surgery

It is essential to bear in mind that many of these risks are very rare. In contrast, others, such as haematoma formation, can be easily managed by a washout procedure with the preservation of the breast implant.

Breast augmentation risks

Breast implants must be approved by the medicines and healthcare products regulatory agency (MHRA) before they are suitable for use in the UK. We also use FDA-approved implants. This means the implants have been shown to be safe and effective. The vast majority of breast augmentation patients do not develop serious complications during or after their procedure.

Several key risks should be borne in mind when considering breast augmentation. Breast implant-associated anaplastic large cell lymphoma is a severe complication of breast augmentation. However, it is extremely rare, with only a handful of cases reported worldwide out of millions of procedures performed. Breast implant illness is a condition some patients believe is due to breast implants. Patients may complain of the following symptoms:

  • Excessive fatigue
  • Generalised muscle and joint pains
  • Skin rashes
  • Cognitive impairment or ‘brain fog.’

If complications occur after breast augmentation, we would advise you to get in touch with our post-operative nursing team immediately. The next step would be to have an urgent clinical assessment by your surgeon. If you decide to have breast implant removal, we recommend discussing this with your surgeon.

Key points about breast augmentation:

  • Breast implants are not designed to last for your entire lifetime. It is recommended to have revision breast surgery to remove or replace one, or both breast implants 10 to 15 years after your first procedure.
  • The appearance of breast implants can change over time due to the influence of significant weight loss, pregnancy or menopause.
  • Excessively large breast implants could exacerbate breast sagging. A breast lift may be required in combination with breast augmentation to treat saggy breasts.
  • X-ray mammograms can be more challenging to interpret in the presence of breast implants. However, x-ray technology has significantly improved over the last ten years, making this less of a problem.
  • We would advise regular checks to monitor for breast implant rupture. Centre for Surgery is one of the few clinics to offer complimentary high-resolution ultrasound scans to monitor the condition of your silicone breast implants. If a potential rupture is detected, we advise having an MRI scan to confirm the diagnosis.
  • Breastfeeding can, in some cases, be affected by breast augmentation. Although many women can breastfeed normally after surgery, other women may find it more difficult.
  • Women who have breast augmentation will require regular post-operative reviews to monitor the condition of the breasts and ensure capsular contracture or implant rupture has not occurred.

If you think your breasts or implants appear different in some way after the surgery and/or you have symptoms of pain and discomfort, please get in touch with us to arrange a consultation with your surgeon for further evaluation.

Am I suitable for breast augmentation?

We would recommend women be familiar with the potential risks of breast augmentation before considering their suitability for the procedure:

  • Patients should be in good physical and mental health with no chronic medical conditions or active bacterial infection. If you have a significant medical condition, discussing this with your doctor at the consultation is essential to determine if any further investigations will be required to confirm your suitability for the procedure.
  • Patients with a flat chest or have saggy or tubular breasts are ideal candidates for breast enlargement surgery.
  • We recommend patients stop smoking and avoid excessive amounts of alcohol for at least six weeks before and after the procedure.
  • The procedure is designed to significantly improve the appearance of your chest for permanent results. Therefore, we recommend being in optimum mental health to embrace the changes after the procedure.
  • Breast augmentation is not designed to address body image problems such as body dysmorphic disorder or to make you look like a completely different person. It is vital to have realistic expectations about what the surgery can achieve.
  • It is essential to follow the post-operative instructions in full. Taking at least one week off work to allow breast augmentation recovery will help ensure your healing is as smooth as possible. You should avoid lifting heavy objects and have someone around you to help with everyday tasks.

What happens at the consultation?

The breast augmentation consultation is an ideal opportunity to enquire further about the risks of breast implants. Your surgeon will ask the following questions as part of the clinical assessment:

  • Your reasons for wanting the procedure and your treatment expectations
  • Any medical conditions you may have and potential allergies to medicines
  • What medicines you are currently taking, including any over-the-counter herbal supplements
  • Whether you have a personal or family history of breast cancer

What does the procedure involve?

Breast augmentation is most commonly carried out under a general anaesthetic to ensure your comfort during and after the procedure. There are three main types of breast augmentation incisions which can be used for breast implant placement, including:

  • Incisions under the breast crease (inframammary)
  • Incisions around the nipple (periareolar)
  • Incisions under the arm (transaxillary)

Once the incision has been made, the surgeon will gently separate the overlying breast tissue from the pectoralis muscle. This leads to creating a breast pocket positioned either on top of the chest muscle or beneath it. The surgeon will then place the implant in the pocket and ensure the implant is correctly centred behind the nipple to prevent implant malposition. The implants are inserted using a breast funnel as part of a ‘no-touch’ technique to minimise implant-related infection. Once the implants are correctly positioned, the incisions will be closed with dissolvable stitches, followed by applying sterile dressings. A post-operative support bra will be applied before the anaesthetist wakes you up. It is normal to have localised swelling and mild post-operative discomfort for up to 2 weeks after the procedure. Any breast augmentation scars will gradually become less noticeable over time, although they will not disappear completely.

If you develop pain, redness or localised warmth around your incisions or you generally feel unwell, we would advise seeking an urgent clinical assessment from your surgeon as these symptoms could be signs of infection.

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