Why Do Women Get Breast Implants
The amount of breast development in an adult female varies considerably. Some women simply never develop a large amount of breast tissue. Others note that their breast tissue becomes noticeably less in amount following pregnancies. The majority of women seeking this surgery seek only to have normal size breasts that relate to their body proportions and they are not seeking to be exceptionally buxom. Breast implants make small breast larger. They may, but do not necessarily, improve their shape. Breasts made larger by implants may have the same tendency to droop and sag as the same size breasts without implants might. Drooping and sagging breast sometimes, however, can be corrected partially with implants. In the 1970s and 1980s, breast implant surgery was the most common cosmetic surgery in the United States. After the “silicone scare” of the 1990s, it is once again one of the most common cosmetic surgeries. Currently, over 100,000 such surgeries per year are now performed in America. At least 1.5 million women in this country have breast implants.Types of Breast Implants
Before 1992 and the FDA scare, seven implant manufacturers existed. Today, only Allergan and Mentor survive. Saline implants produce a reduced incidence of capsular contracture, require smaller incisions, and they have an overall reputation of greater safety. Silicone gel is now available for first time augmentation and reconstruction surgery, should the patient choose it. The patient must be 22 years of age or older. Different shapes and “projections” are available, and the saline “bag” surface can be textured or smooth. The literature regarding implants is massive and confusing, and different surgeons constantly debate which implant type and shape is the best. Most surgeons whom I respect and have worked with prefer the following implant characteristics for primary implantation: • A smooth shell, without texturing, filled with saline or silicone • Spherical (not “anatomic” or “teardrop”) shape • High profile or moderate profileHospital, Surgical Center, or Office Surgery for your Breast Implants
Breast implant surgery can be safely and effectively performed in any of these settings. Surgical center and office settings are usually more convenient for all involved, are more confidential, have lower rates of infection, are less expensive, are often safer, and provide a more pleasant surgical experience.Anesthesia Type: General, IV Sedation, or Local for Breast Implant Procedures
True local anesthetic is the safest, but is rarely adequate for breast implant surgery, except in very selective cases. IV sedation is also very safe, and is routinely performed in almost all ambulatory surgical centers. An example of this type of sedation is the IV sedation routinely given by oral surgeons (dentists with advance anesthetic and surgical training) for the extraction of wisdom teeth. General anesthesia involves intubation (a tube in your throat) and a breathing machine. In our facility a combination of a local anesthetic and IV sedation is used.Breast Implant Placement & Position
The surgeon’s preferences and experience will almost always be the determining factor. This decision should be discussed with you in detail, because the position of the implant is critical to the final appearance and possible complications. Three types of placement are possible: Subglandular (under the breast, but over the muscle); Sub-pectoral (under the muscle); and Sub-fascial (under the breast, over the muscle, but under the very tough covering of the muscle, the fascia).
As you can see, each of the implant positions has its advantages and disadvantages. This is why discussion with your surgeon is critical.
Advantages of placing the implant under the muscular fascia include:
• Discomfort and operative injury are less
• Rippling of the implant under the skin is decreased
• Flattening and distortion of the inflated implant are less
• The implant “rides” in a lower, more natural looking position
• Surgery control is better, bleeding is reduced
• The breasts feel softer, and more natural
• Better results for mild to moderately sagging breast
| Under Gland | Under Muscle | Under Fascia | |
|---|---|---|---|
| Ease of surgery | Equal | Easiest | Equal |
| Potential Surgical Bleeding | Slightly higher | Slightly less | Slightly less |
| Discussed in literature | Frequently | Frequently | Uncommonly |
| Popularity with patients | Somewhat less | Somewhat higher | Somewhat higher |
| Done with TUBA incision | Frequently | Sometimes | Never |
| Done with underarm incision | Rarely | Frequently | Frequently |
| Done with sub mammary or areola incision | Frequently | Frequently | Rarely |
| Chances of a “stuck on” or “softball” look | Less | More | Less |
| Chance of nipple numbness | Slightly greater | Slightly less | Slightly less |
| Implants separated from breast tissue by muscle or fascial barrier | No | Yes | Yes |
| Comfortable for serious amateur athletes or very active women | More comfortable | Less Comfortable | More Comfortable |
What are my choices at Skinsational Liposculpture?
We can discuss any other options with you at anytime, other then the options below: • Moderate or High profile Mentor implants • Sub-fascial placement position is preferred • Axillary (underarm) incision (without incisions or scarring of the breast) is preferred • Office local tumescent anesthesia, with or without IV sedation These choices are made for maximum safety, minimal complications, shortest downtime, and the best looking, lasting cosmetic result possible.Complications of Breast Augmentation surgery
These complications are aggregate (across the United States), and are for all surgeons, all implant types, all incisions, all placement positions, and all other variables. The incidence of some complications may be decreased by various factors, which will be discussed as you read on. At Skinsational Liposculpture, we believe that many of these numbers can be significantly reduced by experience, implant choice, implant placement, and incision type. Some of the complications require another surgery (sometimes within days, some after months or years).
Remember this: although some complications clearly must be corrected by further surgery, many complications will improve with time. Many are acceptable to the patients (and do not require further intervention), and some patients will not accept even the slightest abnormality.
If you don’t want to accept small, often temporary complications, do not have breast implant surgery. If you have perfect breasts, you shouldn’t be considering implant surgery. If you have imperfect breasts (almost all women) and you wish to improve their volume (and possibly equalize their size), do not expect implant surgery to correct nipple size and position or any other “pre-existing” breast abnormality. In other words, your breasts will look very much like they did before the surgery, only larger and wider, possibly with mild enlargement of the areola.
Most Common Complications/Complaints with Breast Implants
| Saline | Silicone | |
|---|---|---|
| Excessive Rippling | 50% | 5% |
| Excessive Firmness (hard implants) | 3-5% | 10-15% |
| Chronic, Long Term Deflation | 100% | 0% |
| Palpability | 100% | 100% |
| Noticeable Scars | 50% | 50% |
| Problems with shape, position | 10% | 10% |
| Asymmetry | 10% | 20% |
| Numbness of breast or nipple | 10% | 10% |
| Hematoma | 1% | 1% |
| Pneumothorax | 0.1% | 0.1% |
| Seroma | 0.5% | 0.5% |
| Infection | 0.5% | 0.5% |
| Capsular contracture requiring re-operation | 3-5% | 10-15% |
