What you need to know

Implant choices:

• Silicone gel implants are available for women 22 years and older unless there are certain “reconstructive” issues (significant asymmetry, rib cage deformities, developmental deformities, breast sagging requiring a lift, etc.).
• We can achieve very nice results with either implant, although silicone gel implants feel more natural and are chosen by the majority of women for that reason.
• Silicone gel implants were studied by the FDA for 15 years before they were found to not be toxic to the body and to not cause any disease, declared by the FDA to be safe, and allowed to return to the market in 2006.
• Implants will not last forever. Saline implants will let you know if they deflate, silicone gel implants require imaging at some expense (MRI, High- Resolution Ultrasound) to diagnose a rupture.
• Anatomic or “gummy bear” implants are firmer than other silicone gel implants. They may be useful in reconstruction after mastectomy and in women with completely flat and very tight breasts who do not want much upper breast fullness. For most other women, round implants feel softer and more natural and give a very natural and pleasing shape.
• Textured implants may lower the risk of capsular contracture and may hold their position better. Their edges and wrinkles may be felt more by the fingertips under the breast especially in women with thinner tissue.

Capsular contracture:

• Capsular contracture is the most common problem associated with breast implants, and despite everything we do to decrease this risk, somewhere between 1-10% of women may experience it, and its treatment may lead to further surgery at further expense.

Implant position:

• Almost all breast implants are placed under the muscle, as this: 1) provides additional tissue thickness to better camouflage the edges and wrinkles of the implant in the upper breast, 2) lowers the risk of capsular contracture, 3) resists tissue stretching somewhat better over the years, 4) allows for better quality mammograms, and 5) results in a more natural shape.
• When implants are placed under the muscle, contracting the muscle will result in some movement or distortion of the breast. This is usually only visible when your clothes are off and you are using the pectoralis muscle.
• Incision placement:
• Most cosmetic surgeons by far favor placing the incision in the fold under the breast, as this: 1) offers the most visibility and accuracy of pocket dissection, 2) does not violate the breast tissue or place scar tissue in the breast, and 3) may reducethe risk of capsular contracture and infection.
• Periareolar incisions require cutting through the breast tissue, and as a result exposes the implant to the bacteria in the ductal system that may cause capsular contracture or even infection. Also, there may be a higher risk of interfering with the ability to nurse, loss of nipple sensation, and sometimes may result in internal scarring that can distort the areola and the lower pole of the breast.
• Incisions placed in the armpit or belly button provide less exposure and less precise control of the pocket, can cause trauma during insertion of the implant, and does not allow control of bleeding which in turn can cause capsular contracture or re-operation. Silicone gel implants cannot be safely inserted through the belly button incision.

Sizing:

• Cup size is not a consistent measurement and can vary from one manufacturer to another. No surgeon can guarantee a specific cup size after a breast augmentation surgery.
• How much tissue you have and especially how much and how stretchable your skin is will determine how large a breast you can achieve.
• Very large and heavy implants (for YOUR anatomy) will look worse as you age. Unpredictable stretching and thinning of your tissues over the years is a greater risk with larger and heavier implants, and may lead to further surgeries and more extensive scars in order to lift the breasts and deal with overly stretched and thinned tissues.
• Trying sizers on will help us determine how much volume you would like to add to your breasts IF YOUR TISSUES WILL COOPERATE. We use a special contoured sizing system that is easier for patient and surgeon to interpret.
• Photographs can be useful to help communicate what you are trying to achieve. No surgeon can make your breasts look like someone else’s, but photographs can show us whether you are looking for a more natural result versus a more obviously implantedlook.
• The only photographs that are useful are front views of women without clothing. Clothing, bras, and swimsuits lift, push, and distort the breast contour and are not helpful.

Nipple position/overhanging breasts:

• Implants do NOT lift breasts, they fill breasts out WHERE THEY ARE. Sometimes the nipple can look a little higher as the bottom of the breast is filled, but this is more illusion than reality.
• If there is excessive overhang of the breast too far past the fold under the breast, the implant (whose bottom rests at the fold) will not fill this out, and the bottom of the breast will hang off of the implant. In this case, only by adding a breast lift will we achieve a good result.

Cleavage:

• Cleavage is the amount of fullness of breast tissue you have near the breastbone towards the middle of your chest. Your anatomy will determine how “close together” your implants will be after surgery.
• The more natural breast tissue you have near your midline, the more cleavage you will have after breast augmentation procedure.
• The farther apart your breasts are, the less cleavage you can achieve. The more “tipped to the sides” your ribcage is, and the more “outwardly
• facing” your breasts are, the less cleavage you can achieve. Results:
• The thicker your tissues before surgery, the more natural your result will be after surgery.
• There are developmental problems of the breast shape and ribcage shape that will make surgery more difficult and limit what can be achieved by surgery.
• If you are thin and can feel your ribs beneath your breasts with your fingertips, you will feel the edges of the implant after it is in your body.
• The surgeon can only work with the tissue you have.  The overwhelming majority of patients are extremely pleased with their
• results.