Breast Implants & Augmentation
Many women would love to have breast enlargement but are afraid of the discomfort and the down time. In fact, the experience is very varied depending upon the technique and the management of the recovery. I believe that it is absolutely true that implants under the muscle give a better, more natural result. It is absolutely not true, that breast augmentation need to be painful or associated with a long recovery time
Dr. Studin is the developer of a technique and holds the patent for an associated technology that allows implants to be placed under the muscle with minimal discomfort and a remarkably rapid recovery. These are the highlights.
The first part of this advance in breast enlargement surgery involves minimizing the injury to the muscle itself. If the pectoral muscle is elevated to accommodate the pocket with very little trauma, healing and discomfort are tremendously minimized. Dr. Studin pioneered a technique to accomplish this and has used it successfully for well over a thousand patients.
Another piece of the mosaic involves anesthesia. A long-acting local anesthetic is used to decrease the need for pain medicine, because if you wake up comfortable, the need for pain medicine is MUCH less and you just feel BETTER! This will be followed by carefully planned medication to stop the pain BEFORE it happens. If you meet a past patient, the vast majority will tell you that this combination allowed them to have their implants with remarkably little discomfort.
Breast Implant surgery takes only about half an hour in my practice and is done in my accredited private surgery center with a board-certified anesthesiologist. The anesthesia is very short-acting, similar to that used for colonoscopy so you wake up quickly and feeling much better than with older types of anesthesia. Managed properly, there should be very little pain. In most cases if surgery is Wednesday, you are back to work or school on Monday! Upper body exercise is usually deferred for 2-3 weeks.
During your free consultation, this information and a lot more is covered and you will discuss how the surgery should be individually tailored to you.
Breast Implants & Augmentation FAQ’s
Should I get breast implants?
Many patients feel self-conscious about their desire for bigger breasts. People will only realize that your breast size has changed if you want them to! In a tight top that hugs the midriff, even moderate sized breasts will draw attention. On the other hand, if one wears a button-down sport shirt and a conservative bra, no one will know whether you are an A cup or a C cup. So your decision should not be based upon being noticed. It should be based upon achieving the proportion that you desire.The interesting fact is, that in my experience, most patients don’t want very large breasts. Instead, they are worried about filling out their clothing with a more beautiful feminine figure.
Proportion really makes a difference when it comes to breast size. With a small chest a person looks like they have big hips! When breast size increases, the hips and waist look much smaller. The right chest to hip proportion can actually make you look thinner. Of course, you won’t achieve that if you over-do it with implants that are very large.
What size breast implants do I want?
In my opinion, this question is much easier to answer than you might think. First lets talk about what I disagree with. Looking at other people’s pictures or at the results of a friend can be very misleading. It’s what you start with PLUS what implant you add that will determine the size you achieve. Computer imaging??? I have computer imaging in the office, but do not use it for this type of surgery. It is heading in the right direction, but still not perfect.
The best method that I have found in over 25 years of doing this is to put on a sports bra, stand in front of the mirror and put implants in your bra. You plus the implant will look back at you in the mirror exactly! A trick here… black sweaters hide them and white T-shirts accentuate them. Bring both and clothing in-between these extremes.
Unders, Partials or Overs?
In the vast majority of cases it is my strong opinion that breast implants completely under the pectoral muscle will give the most natural results. Implants under the muscle are hidden better, tend to feel more natural and sag less than those that are just under the skin and breast tissue. They take a bit longer to drop into position but the wait is well worth the result.
There are several places to make the incision to place your implants. This is an individual choice based upon your case and I find that people often have the wrong impression about the pluses and minuses of each choice. Specifically, many people think that they avoid loss of feeling by an armpit approach. This is not the case. The reason lies in the path of the nerve that gives feeling to the nipple, the 4th intercostal nerve. In most, I think the edge of the areola is best. This is not at the nipple, but at the lower edge of the areola.This is past where the nerve has already entered the nipple area. I have found that it is very rare to lose feeling in the nipple. I feel that the scars going under the breast or through the armpit are much more obvious and likely to be noticed. The belly button incision is possible with salines, but a long discussion during your free consultation is needed to explain this choice. Ultimately, the choice of incision for your breast augmentation will be totally yours, but you should discuss it at length with the doctor.
Silicone vs. Saline?
Claims that silicone implants caused a particular disease have to be tempered with the fact that, with over two million women with breast implants, there are going to be women with virtually every disease imaginable that have implants! Many studies have been done regarding the relationship of implants to cancer and auto-immune diseases such as arthritis. The preponderance of data shows no increase in the incidence of these diseases in women with implants. Armed with that data, the FDA released silicone implants again in late 2006. As a clinical investigator for both Mentor and Allergan in the studies done to arrive at that conclusion, I never had to stop using silicone implants and have been using both silicone and saline breast implants for over 25 years. So which one is better for you?
First, silicone and saline implants do not look different except for one thing. It is more possible to see rippling of the implant with saline. As far as shape, they are the same and both silicone and saline are available in each contour. The real difference is in how they feel. You can often feel the edge of a saline implant when you touch the breast. Especially if you are thin. Silicone implants are usually not detectable to feel.
Memory Gel is the name used for cohesive gel implants by Mentor. These implants do not run easily when cut. This MemoryGel™ breast implant is cut in half to plainly show how the material holds together uniformly (no leaking) while still retaining the natural give of breast tissue. It does this because of a cohesive, gelatin-like substance that acts as a solid rather than a liquid.
Changing Breast Implants
Many people are under the impression that breast implant patients should have a proverbial “tire change” every ten years. This is not true but some explaining is necessary to completely understand this topic.
From about 1978 until 1986 implant manufacturers used second generation implant shells which were made with a process called room temperature vulcanization. These suffered from a very high rate of failure. After 1986 most manufacturers changed to high-temperature vulcanization. I have found the failure rate of third generation implants to be very low in my practice. No one, however, knows what the forty-year failure rate of these third generation implants is going to be! We only know that from 1986 till now, the implant failure rate is much lower.
Given my present experience with third generation implants I believe the failure rate will not prove to be high, but only time will tell. The good news is that changing an implant that has deflated can usually be done very quickly and the major implant companies often have warrantee coverage for both the new implant and the procedure.
Breast Implant Shapes
Teardrop breast implants have become popular among some surgeons in recent years. I will use them if requested, but don’t recommend them in most cases.
A teardrop breast implant favors fullness at the lower part of the breast. Most of my breast implant patients are equally concerned with the filling the upper portion of the breast to create some fullness up top. A round breast implant tends to create fullness throughout the breast.
There may also prove to be a higher rate of fold failure in anatomical breast implants or teardrop breast implants that may lead to deflation.
When you hold a round breast implant up on it’s side, hanging it from the top, which is the position it is in when you stand, it becomes a teardrop shape anyway! The filler, whether saline or silicone, has weight and therefore stretches the bottom somewhat. The top then collapses somewhat. If you start with a smaller top, and the bottom stretches slightly over time, the top can end up empty when you stand. This would allow the empty area to rub, front against back, and theoretically increase the possibility of fold failure. (This deflation theory is theoretical at present and has not been proven statistically to my knowledge!)
Does a round implant make a round breast?….No!
I do not see a very big difference in the shape of the breast when standing after the implant settles into it’s optimal position! This is because a breast implant is easily molded into whatever shape it is pushed into. A soft breast implant cannot overcome the pressure of the overlying muscle and skin very much, if at all.
Therefore, in my opinion, the ultimate shape of the breast will mostly depend upon the size and position of the pocket we make, the shape, elasticity and thickness of the muscles and skin, and the size of the implant we use. An artificially round breast usually occurs due to placing the implant outside the muscle in a situation where there isn’t good skin and fat coverage.
The possibility of less fullness across the upper portion of the breast after settling is something that should be considered in making this choice. I do not think teardrop breast implants are medically unwise and do not force the choice. I will allow the patient to choose whichever implants they prefer. Considering these issues, however, I recommend staying with round breast implants for most patients.
Smooth vs. Textured Implants
The implant shells were originally smooth. Then some surgeons thought that using a rough or textures surface would reduce the probability of capsular contracture. The vast majority of implants ordered by surgeons today are smooth because most of us feel that the texture does not work to reduce capsular contracture and the smooth implants give a more natural result.
High or Low Profile Implants?
As you see here, implants come in different projections. At each given size, they can be either wider or higher. Wider implants give better cleavage but can stick out under your arms on the sides. Higher implants tend to give younger, more uplifted looking breasts. If you have breasts that are somewhat hanging, often just choosing high profiles can eliminate the need for a lift. Each person is different as hang and chest width will be taken into account. When you do your sizing in a bra, the effect of each profile can be easily seen!
Alternative fillers such as soybean oil and peanut oil are not approved or, at the time of this writing, even in active patient trials in the United States. Soy implants were recently abandoned in European studies because they caused several problems. Early complications with these appear to have sent researchers back to their drawing boards and we do not expect to see anything new approved in the near future.