The 3 Most Common Breast Augmentation Questions Patients Have are ...
1. How do I pick the right size breast implant for me?
2. What is the best incision location for me?
3. Should I have the breast implant placed above or below the breast muscle?
The Right Size...
This is an easy one! In over 4,000 breast implant related cases, we have had only 3 patients desire a different size other than what they received. The odds of getting it right the first time are almost 100%.
Nationally, among all surgeons, 32% of patients report their physician chose the wrong size implants! This is totally unacceptable.
How do we achieve such success? We allow our patients to select their own implant size, not the physician. This process involves trying on implants under normal clothing, which allows us to see what image you have for yourself. It is then our job to attain your goals. We, the staff, are only there to guide our patients in order to prevent a stupid mistake. One example of a stupid mistake is choosing an implant that is way too small to be worth your money. A second mistake is selecting an implant that is way too large, resulting in an unattractive and disproportionate figure. Selecting the right size implant for your body type will help to minimize droop of your breasts over time.
What breast augmentation incision is the right one for you?
I have personally performed well over 3,500 breast augmentations and have used every imaginable incision location hundreds of times. This experience has taught us that each incision has its unique qualities and benefits and disadvantages. The armpit incision is a good one for patients who want the best upper chest fullness over the long term. Other patients benefit from the incision below the breast in order to elevate the nipple position best. Still others might choose around the areola (nipple area), but we have found that this area tend to leave the most noticable incision scar when used with larger breast implant sizes. For that reason and the increased risk of numbness to the nipple, it is our least recommended option. In cases of breast lift surgery, it is the most common option.
Should my breast implant be placed above or below the muscle?
This question can only be answered after a physical breast examination. There are advantages and disadvantages to either breast implant technique. There is no difference in the speed of the breast augmentation surgery and there is no significant difference in the techniques used to place the breast implant in either plane. The fee is the same for each.
The under the muscle placement clearly provides the most breast implant coverage. The muscle covers over 60-85% of the implant and provides another barrier of coverage to the noticability of the breast implant to others. In thin chested patients, this is a significant advantage and should be considered heavily. The trade off is the increased discomfort and delayed recovery of about 3-5 days. In over 3,500 implants placed, we have not found a difference in capsular contraction rates or breast firmness between the two options. Radiologically, it can be suggested that mammography is more precise in detection of abnormalities with the breast implant placed below the muscle. Patients with family histories of breast cancer may consider this as an indication for under the muscle placement. About 55% of our breast implants are currently placed under the muscle.
Above the muscle placement provides a quicker recovery with less pain for most breast augmentation surgeries. It provides less coverage of the breast implant and a significantly increased risk of breast capsular contraction or breast firmness over the longterm. The implant is more easily felt. For these reasons, very rarely do we ever place implants completely above the muscle today. Only when we are correcting severe conditions of abnormal breast form do we routinely recommend this location for implant placement.
Perhaps the most ideal placement for breast augmentation surgery is what I call a "muscle sandwich" or partial muscle coverage. This is when there is muscle above the breast implant and a majority of muscle below the breast implantThis technique provide the coverage of the implant, reduced capsular contraction rates over the longterm as compared to above the muscle, reduced pain and recovery time over totally below the muscle. This breast augmentation technique was innovated by Dr. Nuveen over the last 5 years and has proven to be one of the many reasons for over 99% patient satisfaction and the very high referral rate of friends to our office for their care.
The final issue is silicone or saline. The FDA has strict criteria as to who meets these requirements and we will be happy to provide you with that information. The silicone gel breast implants are more expensive, the surgery fee is the same and takes no longer to perform and has no different risks or problems from other types of breast surgery. The silicone gel implants go in full, so they do require a slightly longer incision than the saline implants do. This heals well no matter what. We will discuss these options with you on consultation and whether you meet the criteria for silicone gel as it currently stands.