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 7,000 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 more than 7,000 breast surgeries, 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 begin with smaller breasts and very little droop. 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 due to stretch. The areolar incision has also been associated with increased loss of sensation, which can be very iimportant to some women. In cases of breast lift surgery, it is the most common option and often mandatory to achieve the vest results.
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 a minor increase in discomfort, recovery usually requiring pain medications for of about 2-3 days and then 600-800mg ibuprofen only. In over 7,000 implants placed, we have found a very slight decrease in capsular contraction (breast firmness around the implants) when placed below the muscle. Research internationally has also supported this reduction in scar tissue formation with submuscular placement. Radiologically, detection of minor abnormalities is more commonly and easily detected with the implant placement below the muscle. Patients with family histories of breast cancer may consider this as an indication for under the muscle placement. About 95% of our breast implants are currently placed under the muscle.
Above the muscle placement often provides a quicker recovery, but the minimal decrease in pain is often outweighed by the advantages of submuscular placement. 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 a thin layer of fascia or outer layer of muscle above the breast implant and a majority of muscle below the breast implant. This technique provides for slightly improved coverage of the implant.
Silicone or saline?
As of November of 2006, the FDA lifted its moratorium or ban of primary silicone gel augmentation. This allowed women of age 22 or older to choose silicone gel implants as the first method of augmentation, rather than limiting the options to only saline for first time augmentation patients. Slicone gel breast augmentation is more expensive due to the increased costs of the implants over saline. The surgery fee is the same. The surgery takes no longer to perform. The risks related to silicone gel augmentation are slightly different than saline and will be discussed in detail at the time of your consultation with our physicians and provided in writing for your review. The silicone gel implants go in full, so they do require a slightly longer incision than the saline implants do. Ultimately, it is good for women to have a choice and the thinnest patients are more commonly recommended the silicone gel implants due to decrease coverage and less complaints of the feel of silicone gel over saline in these patients.