Breast Augmentation

Your outcome is primarily dependent on your choice of surgeon. Breast enlargement enhances the size and shape of the breast through the surgical insertion of saline or silicone implants. No exercises, devices, pills or medications advertised have any effect on the size of the breast. Breast Augmentation is the only way to enhance the size and shape of your breast.

You also must have realistic expectations. You should realize that breast augmentation only enlarges the breast tissue that you already have and therefore pre-existing asymmetries will not be corrected. It is normal to have asymmetries and everyone knows that one side of our face does not match the other. Similarly your breast will also have asymmetries. All women will have a breast that is higher, usually the left one, and you need to understand that all the asymmetries will not change after breast augmentation.

(1) the inframmamary, at the fold underneath the breast; it is the preferred choice since it best preserves the ability to breastfeed and it is the only technique that it is associated with minimal bleeding.

(2) the periareolar, around the nipple; it is associated with additional scarring and there is a higher risk of loss of nipple sensation.

(3) the axillary, in the armpit; has a higher risk of redo surgery because of the implant can ride higher and sometimes the resultant scar appears darker and irritated because of the sweat glands.

BREAST IMPLANT TYPES

Saline Implants

All FDA-approved implants are filled with sterile saline - water that contains biological concentrations of salt similar to your body. If the implant ruptures, your body will reabsorb the harmless saline.

Silicone Gel Implants

The new silicone gel implants have been approved by the FDA in 2007, following a 1992 FDA imposed moratorium, for breast augmentation with the provision that the women be older than 22 years of age and that she agrees to undergo MRI (a specialized X-ray) every 2-3 years. These silicone gel implants are available to all women undergoing breast reconstruction, revisions of previous breast augmentations and women undergoing breast augmentation with breast lift surgery. The only advantage over saline is they somewhat feel more natural but it depends on how much breast tissue you have. Drawbacks are that the incision is longer and the cost higher. The FDA also requires that you agree to a lifetime follow up with an MRI (a specialized X-ray study) to detect silent ruptures, which will add to the initial cost. The risk of having complications such as capsular contraction and failure or rupture of the silicone implants is much higher compared to saline or gummy bear implants, again resulting in future additional expenses.

Gummy Bear Implants

There is a new implant type filled with a cohesive silicone gel that is currently undergoing clinical trials in the United States and may be approved by the FDA later this year. If the implant envelope ruptures, the gel does not leak into the surrounding tissues when compared with the regular silicone implants. The consistency of the gel is often likened to gummy bears. If you cut it with a knife it's the same as cutting a gummy bear. The great advantages over the Silicone gel implant is that (1) if they rupture they do not leak and therefore complications such as capsular contraction and failure are reduced, (2) there is less rippling as they maintain their shape and consistency, (3) in many cases they offer a better breast shape.

Smooth Breast Implants VS Textured Breast Implants--

The difference between these implant types is that one has a textured surface and the other one is smooth. Smooth implants move more freely in the pocket in which they are inserted. Their shells are thinner when compared to textured implants. Textured implants were originally designed to prevent a complication called capsular contracture - whether they achieve that continues to be debated. However, the textured implant and the adherent tissue to it can move in opposite directions creating tension which cause visible folds on the skin called rippling. Rippling does not occur as often with smooth implants. For these reasons Dr. Herve` Gentile prefers smooth implants.

Round Breast Implants VS Contoured Breast Implants--

Implants are available in two kinds of shapes: round and contoured. The first is self-explanatory. Round implants also come in different profiles according to the projection they can achieve: low profile, which has the least projection and is almost never used by Dr. Gentile, moderate profile which assumes the shape of the natural breast and is the one most often used and high profile which is indicated in patients who have a flat breast or need more volume fill because of looseness. Contoured implants - sometimes called anatomical implants - were originally designed for reconstructive purposes but have also been used for breast augmentation. They are "bottom-heavy," meaning that because of their conical shape more of the volume is distributed to the bottom when held upright. Contoured implants can turn or flip in the pocket, so they are usually implanted in a textured form to maintain their position but are not in common use today since they have been replaced by the moderate and high profile round implants.

Placement of Breast Implant--

After creating the incision, Dr. Herve` Gentile will lift the breast tissue to create a pocket either directly underneath the breast itself or under the muscle depending on his judgment and the patient's physique. Therefore placement of an implant is commonly referred to as "over or under the muscle" which refers to the implant being placed above or under the pectoralis major muscle.

You will find a lot of information about this subject on the web and many surgeons have different and often opposite opinions on the subject. This can create a lot of confusion, especially if you get 2 different opinions from 2 different surgeons you consult with.

When reading on the internet about implant placement it seems that the majority of women have implants placed partially under the muscle. The majority of women have little breast tissue to begin with so this placement is definitely recommended, but also many surgeons prefer to use this method, since they feel the risk of capsular contracture (= scarring that develops around the implant) is higher when placing the implant above the muscle. Other surgeons such as Dr. Herve` Gentile see no more capsular contracture in their above vs. under and therefore use both placements. Often plastic surgeons do not offer women choices. You should understand that the technique used will influence whether you will be able to achieve your best results. Dr. Herve` Gentile believes this is just as an important choice for you as is the type and size of the implant. In most cases it is best to place the saline or silicone implant under the muscle to decrease the chance of rippling, especially if the patient has thin skin envelope. On the other hand if the woman has some sagginess and also a good amount of tissue then she will benefit the most by locating the implant above the muscle. In the vast majority of cases Dr. Herve` Gentile places the implant underneath the muscle, but only a detailed discussion with him will maximize your chance of obtaining your desired results. The newer cohesive gel implant have a lower risk of developing visible ripples therefore either placement could be recommended.

With the subglandular (retromammary) technique the implant is placed in a pocket created above the muscle and therefore it is located underneath your breast tissue. This procedure is less painful post-surgery as only the skin and fat are lifted to place the implant.

If you have little breast tissue this placement is not recommended as there is more chance you will feel and see rippling of the implant with both the saline and silicone gel implants. This could be avoided if you choose the newer cohesive silicone gel implants.

If you have mild ptosis (sagginess) of your breasts this placement may be recommended thereby avoiding a breast lift. If you place the implant below the muscle without a lift your breast implant may ride high and you may be unhappy with the results. Only a consultation with Dr. Herve` Gentile will tell you what will be best for you. It should be noted that if you have a family history of breast cancer this technique may prevent complete visualization of your breast tissue at mammography and therefore underneath the muscle is a better choice.

Submuscular Breast Implant Placement (Below the Muscle)

With submuscular placement the implant is placed in a pocket which is formed underneath the pectoralis major muscle. The result will be more upper pole fullness as the muscle is pushed forwards by the implant. The vast majority of breast augmentations are performed using this technique. The advantage is that the implant is more protected by the overlying muscle therefore reducing the risk of rippling and also the breast tissue is better seen at mammography.

During the consultation you will have with Dr. Herve` Gentile, in addition to a review of your medical history, a personal evaluation of what is appropriate for you, your body size and frame as well as your breast size and sag if any.

Since breast implants enhance the breast you should not think of them as a substitute for breast tissue and also like any device you should not think of them as permanent. However, I do not recommend a specific time of replacement. Very large implants will result in early sagging and are associated with a much higher risk of scar formation (capsular contraction), bottoming out, thinning of the tissues and rippling. All these problems, needless to say, will result in additional surgery, which sometimes can also prove to be unsatisfactory. The key determining factor is the type and quality of your skin envelope and your outcome is primarily dependent on your choice of surgeon more so than other procedures. You will also need to decide whether a saline or a silicone implant is best for you. Most women will have asymmetries of their breast and just like 1/2 of your face doesn't match the other half you should view that as normal.

The procedure takes about 1 - 1 1/2 hours, and is performed in our office accredited surgical center. After surgery you are taken to the recovery room and monitored until you are ready to be discharged. Recovery depends from person to person but also on your choice of surgeon. Usually medication can control any pain or discomfort which should subside in 2 - 3 days. Swelling, and rarely there is bruising, will disappear gradually. Although you will be up and about a day or two after surgery, you should take it easy and avoid any lifting or elevating your arms over your head and shoulders for the next few weeks. Most likely you can return to work on the 3rd or 4th day with some restrictions and you will receive detailed instructions from Dr. Herve` Gentile on what activities you can do. Since Dr. Herve` Gentile uses a unique and bloodless technique to do your breast augmentation you do not need to wear a bra for the first few days. This will cause you less pain, permit your implants to descend quicker and result in a quicker recovery with less complications. You will be seen in the office at 1 - 2 and 4 - 6 weeks post-op and less frequently thereafter depending on your progress. The usually fade with time and are barely noticeable. At this time your newly acquired figure should be able to better fill out your clothes but remember that although breast augmentation can improve your look and make you feel good, it is not a guarantee for happiness.

Most augmentations cost between $4,900 and $7,000. Prices vary depending on the type of anesthesia used, who provides the anesthesia, whether the procedure is performed in the hospital or in an office surgical center and type of implant as well as the experience of the surgeon. Remember you get what you pay for...so choose a surgeon based on qualifications. Do you really want to go to the cheapest for your surgery?...considering that you may end up paying a lot more to undo and correct the problems from the bargain surgery.

BREAST AUGMENTATION

BREAST IMPLANT TYPES