I specialize in doing tasteful and classic breast augmentations. My style is conservative; I don’t use overly projecting implants that look huge or “stuck on”.
My clientele prefers a natural yet beautiful appearance; enhancement rather than distortion is my preferred outcome.
Many women are self conscious about their disproportionately small breasts. Some have always been that way—genetics and a thin stature generally cannot be changed without some surgical help. Many acquire smaller and droopier breasts after breast feeding their children. Restoration of a fuller and perkier look is frequently the goal of women who have lost breast volume following weight loss as well. To view all of my before and after photos, click here to visit my gallery.
This woman breast fed three children. She stated she was always small, but after breast feeding, everything “dried up” and her chest “caved in”. She wanted to look like a girl again, and especially wanted to fill out the periareolar spots that were indented.
Her result at six week following subpectoral augmentation shows good correction of both volume loss and her areolar indentation.
Implants can be put in the subglandular position-just under the breast tissue—or in the subpectoral position.
With submammary implant placement, the implant is located under the breast tissue, with the pectoral muscle left undisturbed. When this approach is used, the top of the implant is more likely to be seen as a definite line or bulge. With time, the implant is likely to “ball up” and eventually may bottom out, leaving the top of the breast hollow. Capsular contracture, rippling, and implant migration are more common with this approach.
Subpectoral placement in a “dual plane”—top of the implant under the pectoral muscle, the lower outer aspect under the glandular tissue—has been the international standard for many years now. This location has been shown to reduce the risk of capsular contracture, to provide more soft tissue coverage so that implants last longer, and to provide a more natural upper pole appearance without a “hump”. A very important factor in my choice of using this approach is mammogram quality. When taking a mammogram, if the mammographer excludes the implant placed subpectorally the entirety of the breast can be imaged.
With subglandular placement, much of the breast tissue is not able to be imaged.
Saline or gel? Many people still view saline as “safer” than gel implants, despite FDA approval of several brands of gel implants for use in breast augmentation.
The lifetime of a saline implant is generally quite a bit shorter than a cohesive gel implant’s. Most saline implants last about ten years; the new “gummy bear” type implants last 20-25 years, barring trauma. The gel implant on the left has less rippling than the saline on the right.
When viewed from the side, you can see that the saline implants tend to “bottom out”, with the volume gravitating downwards. This tendency leaves the upper pole hollow. Gel implants tend to retain more volume in the upper pole. They tend to migrate down and out into the armpit less than saline implants. Saline implants tend to deflate suddenly, causing an urgent need for repair. Cohesive gel implants do not suddenly lose volume. A significant injury would be needed to cause the gel to leak out of the shell. Because they last longer, hold a better shape, and need less replacement, I tend to use cohesive gel implants for most of my patients.
Textured or smooth implants? Textured implants were popular for a while as they were supposed to reduce the incidence of capsular contracture. However, my experience has been that contracture is actually more common with these implants. They feel a bit more firm than smooth implants, and don’t tend to shift naturally like smooth gel implants do. They are good for patients with recurrent migration. Otherwise, most of my patients prefer the smooth cohesive gel implants for a top long term result.
Question: “I went to another doctor who only uses high profile implants. Why won’t you put in implants with a high profile?”
Answer: See the patient below. She went to a doctor who “only” uses high profile implants. Her outcome was not satisfactory. Because the high profile implants have a very narrow base and a lot of projection, using them is like stuffing a grapefruit into a breast. The shape is all wrong. There is an upper hump and no lower pole fullness. The look is very unnatural.
This patient’s before (left) and after results (right) show all of my criteria for a good breast augmentation outcome, numbers 1 through 8.
There are risks with any surgery, such as bleeding, infection, contracture, migration, or implant failure with age or trauma. While complications are rare, the best outcome occurs when we take a “team” approach. I can do the surgery, but the postoperative care and activity restriction can only be done by the person who has had the surgery. Minimizing activity following surgery in order to allow time for healing to optimize is very important. Each patient must tune in and follow the guidelines in order to protect her investment.