|Return to Daily Activities||6 Weeks|
|Back To Work||4-10 Days|
|Average Procedure Time||0-2 Hours|
Saline or Silicone - A Conversation With Dr. Mark Peters
Breast augmentation surgery has become the most popular cosmetic surgery procedure with over 318,000 cases in 2010 according to statistics released by the American Society of Aesthetic Plastic Surgery. The growth of this procedure can be attributed to the extensive study of breast implant safety, particularly silicone gel filled implants. In fact, 68% of women chose silicone gel implants for their breast augmentation in 2010. This will likely continue to increase with the new cohesive silicone gel implants (“gummy bear”) are an exciting addition to the choices available for augmenting the breasts.
The positive effect on her sexual life and interpersonal relationships has been noted.¹ One study has found that 96% of women felt that the operation met their expectations and 97% stated they would undergo the operation again.A majority of women considering breast augmentation have similar objectives in that they desire an enhanced self-image and more feminine appearance. Whether it is due to a loss of breast volume following the birth of a child or never having had a great deal of breast tissue, breast augmentation is an excellent method to achieve your aesthetic goal.
"97% of women would undergo surgery again"
The consultation is important to both the patient and the plastic surgeon. In a relatively short time (usually about an hour total), the patient needs to make sure they are comfortable with the surgeon and staff while the surgeon tries to determine the expectations of the patient. The goal of the consultation time is to make sure that the patient understands the procedure, the expected results, potential complications, and the expected recovery. I want to be able to make sure each patient understands that their safety is the top priority in this process.
After the examination, I will have a better idea of what implant volume would be best for you. Using the base width measurement to guide me, I can determine the proper implant profile in the context of the desired volume. Other anatomic considerations such as overall height of the patient, length of torso, position of the breasts on the torso, and the presence of congenital deformities are considered before I make a suggestion of implant volume. While it would be easy if a certain volume would result in a certain bra cup size, it is simply not the case.
I will then attempt to simulate the breast volume for you by placing implants into a bra to give you an idea of what I recommend after considering all factors. You will then meet with the patient coordinator who will provide information about costs, scheduling, and other administrative details. You may schedule your consultation online or read below to learn more about breast augmentation surgery.
SALINE OR SILICONE IMPLANTS
Saline implants had been the device of choice for breast augmentation surgery primarily because of safety concerns associated with the silicone gel filled implants. After a number of studies demonstrated that women who had silicone gel filled implants were not at an increased risk for autoimmune diseases and the FDA approval of the new cohesive silicone gel ( also known as “gummy bear implants”), the number of women choosing silicone gel filled implants has increased. The silicone gel filled implant has now become the more common choice for breast augmentation.
During the consultation, I will spend time determining different aspects of the result that the patient is attempting to achieve. Then, I can discuss the specific aspects of each implant and how it can be used to produce the result they are seeking. Regardless of what shape or size, there are certain differences that exist between silicone gel filled and saline filled implants:
- Silicone gel implants require a longer incision and cost more than saline.
- Silicone gel implants have a lower rupture rate than saline implants.
- Silicone gel implants generally have a higher capsular contracture rate than saline implants.
- Saline implants have more flexibility when attempting to obtain symmetry since saline can be adjusted in the operating room.
- Saline filled implants are more likely to be felt through the skin. This is called rippling and is common especially in thinner patients.
Location of Incisions
Location of the incisions is very important and there are multiple factors which influence the selection. Generally, there are three accepted approaches to placing the implant.
The most common is the inframammary incision, which is located in the fold where the breasts and the chest meet. There are several advantages to this incision: provides easy access for the surgeon, better visualization, and allows for more precision when creating the “pocket” for the implant. The disadvantage of this incision is its location on the breast itself.
This also applies to another approach, which is the periareolar incision. It is located at the edge of the colored area of the breasts in a half circle. This incision is considered the most versatile. While the areola does provide an excellent “camouflage” of the incision for some patients, it also has a higher incidence of affecting the nipple-areolar sensitivity, albeit very rare occurrence.
OVER OR UNDER THE MUSCLE IMPLANTS
A majority of breast implants are placed beneath the pectoralis major muscle, while the use of an implant above the muscle still may be the best option in some cases.
When the implant is placed below the muscle, the additional “tissue buffer” usually provides the coverage needed to minimize the ability to see or feel the implant. There are, of course, other practical advantages to placing the implant beneath the muscle such as a lower incidence of capsular contracture and less bleeding.
The main disadvantage of placing the implant below the muscle is occasional difficulty in achieving cleavage, which varies according to the anatomy of the individual.
The potential complications of having breast augmentation are mainly local in nature. Bleeding and infection occur in less than 3% of cases.
Capsular contracture is the complication which is least understood and most controversial. Basically, the scar tissue that normally forms around the breast implant becomes “hard” and contracts. The exact cause of this complication is unknown but there is a great deal of evidence pointing to a low-grade infection around the implant. Over the past several years, I have developed a protocol to minimize the development of capsular contracture. While the literature reports a contracture rate of around 5-8%, I have experienced less than one percent capsular contracture rate using this protocol.
The rate of deflation or rupture of the breast implants continues to increase with the age of the implant. About 4%, or 4 out of 100, of saline implants will have deflated after 7 years. Silicone gel filled implants, on the other hand, have a rupture rate of about 0.5%, or 5 out of 1000, at 4 years after being implanted. All implant companies have a lifetime guarantee on the implants and for a limited time, the company will also provide a monetary stipend toward the cost of the surgery.
Other potential complications include asymmetry of the breasts, changes in the nipple-areolar sensation, and an effect on the ability to read and interpret mammograms. With regard to the mammograms, there is a special technique to visualize the breast tissue which must be utilized. This may result in a greater exposure to radiation over a lifetime.
There is often a question of whether the appearance of the breast implant will change significantly over time. These are, of course, difficult questions to answer and varies from patient to patient. A majority of patients who undergo secondary surgery are simply wanting to have larger implants. In general, the results are regarded as long-lasting, but are subject to normal effects of aging on the skin, pregnancy, and weight changes.
OPERATION AND RECOVERY
The operation is performed on an outpatient basis and under general anesthesia. Dr. Peters performs his surgeries in licensed facilities. You will be scheduled to meet with the nurse at least two weeks prior to the operation. A detailed packet outlining expectations and postoperative care, prescriptions, and any final questions about your procedure will be addressed.
Patients begin “massage” of the breast which mobilizes the implant to maintain the pocket created in surgery and soften the scar tissue after their initial visit postoperatively. This is to be performed by the patient four to five times each day for ten minutes during the first three weeks following the procedure. Sutures are removed between two and three weeks postoperatively.
When the implant is placed beneath the muscle, your recovery time is expected to be 7-10 days, while those placed above the muscle may be 3-5 days. A 6 week time period is needed for the formation and stabilization of the capsule around the implants. You should expect that you will not return to your regular exercise routine for 6 weeks. You will wear a sports bra for a majority of the first six weeks and underwire bras are not recommended until after the 6 week window.
5′ 1″ 143 lbs BMI 27
3 child, breast fed all for 1 year each
Gastric sleeve 2 yrs prior to this surgery and lost 90 lbs
Underwent Mommy Makeover
Mastopexy with augmentation using silicone gel implants
345 cc implant on right; 330 cc implant on left Inspira smooth, round, moderate profile
1000 cc of fatty aspirate removed by liposuction
The photos are 6 months after Body Tite of the outer thighs and buttock areas.
5’6″ 175 lbs C cup
2 children, no breast feeding
Had a simultaneous mastopexy with augmentation
Sientra textured round moderate profile 435cc each
5′ 2″ 110 lbs
1 child, breast fed
Vertical mastopexy with silicone gel
Sientra 355 cc mod plus profile
5′ 0″ 107 lbs
No child, No breast feeding
Sientra silicone gel
300 cc Left and 330 cc right High Profile