Breast augmentation consultations are scheduled with our Board-Certified Plastic Surgeon, Dr. Jeffrey Feiner. Dr.Feiner specializes in the latest cutting-edge procedures of the breast and has a wealth of experience.
Breast augmentation procedures increase the size of the breasts using either silicone or saline implants. Dr.Feiner also has extensive experience with natural breast enhancement utilizing liposuction and fat transfer.This technique has the added benefit of combining liposuction with your breast enhancement surgery. These procedures can also restore volume lost after weight loss/pregnancies, create a more natural shape and correct asymmetries.
During your consultation, we will review your goals for the surgery including the desired size, shape and appearance. We will assess your individual needs as some patients may also benefit from a lift in addition to breast implants.
Some of the important discussion points that will be covered during the consultation include:
- Desired Size (volume of implant) and Projection/Shape (implant profile)
- Implant Type – Saline vs. Silicone
- Incision Placement
- Implant placement- Above the muscle (subglandular or subfascial), Below the
muscle(submuscular), or dual-plane. - Need for lift
- Correction of Asymmetry
- Fat transfer
Types of Breast Implants: All implants are surrounded by a solid shell made from silicone. The major differences between them are due to the fill material and dimensions. Breast implants are the most extensively studied medical device and have a proven safety record.
Saline Implants:These implants consist of a thin, silicone shell and are filled with saltwater (IV fluid). They are filled during the surgery, which allows the surgeon to adjust the volume or size. This can be particularly helpful in cases where there is an asymmetry that needs to be addressed. If a saline implant leaks or ruptures, the fluid inside is safely absorbed.
Advantages:
- Smaller incisions and scars from placement because the implant is inserted when empty
- Cost- saline implants are less expensive than silicone implants
- Safety- Leak or Rupture is easily detected as the saline will be absorbed and expelled from the body. Saline implants are FDA approved for patients age 18 and older.
Disadvantages:
- Rippling- Saline implants tend to create more noticeable rippling, particularly if the overlying breast and skin are thin
- Less natural feel- to avoid rippling, the implants are typically overfilled
slightly, and this can result in a firmer and less natural feel to the breasts.
Silicone Implants:These implants consist of a thin, silicone shell and are filled with medical grade silicone. They come pre-filled and sealed from the manufacturer. Silicone implants are the most commonly used implants as they have a more natural feel and greater longevity than saline implants. There are many different sizes, shapes and types of fill to choose from. Dr. Feiner only uses smooth breast implants, never textured.
Silicone implants have evolved and improved from the original implants of the 1970s, which were thin shells
filled with liquid silicone. Today’s silicone implants have thicker shells with a barrier layer designed to
prevent silicone leakage. Cohesive implants have a more stable and solid silicone that holds its shape, while keeping that soft and natural feel.
Implants are sized by volume- cubic centimeters (referred to as cc) of silicone within the shell. The silicone comes with different degrees of cohesivity- as the silicone inside is bound more tightly, it
becomes less liquid and more solid – this is the “gummy bear” implant that is often referred to. The more cohesive implants hold their shape better and give the breast more projection from the chest. Implant
profile describes the amount of projection relative to the width of the implant and varies by manufacturer. Terms like low, moderate and high profile describe progressively more projection from the chest for a given implant width.
Implant selection is a critical component of the consultation and requires a surgeon with extensive experience and familiarity with the vast selection of available implants. Dr. Feiner has used implants from all of the major manufacturers, styles and fills.
Advantages:
- More natural feel while maintaining shape.
- Less rippling, especially with the more cohesive implants. Dr. Feiner prefers
cohesive silicone gel implants in breast reconstruction where this is critically important. - Safety- Silicone breast implants are the most extensively studied medical devices and have been proven safe. They are FDA approved for patients age 22 and older and for all ages of reconstructive patients.
Disadvantages:
- Incision length- Silicone implants come pre-filled and require an incision and scar that is slightly longer than that required for a saline implant. This also limits the approaches that can be used for implant placement
- Cost- Silicone implants do cost more than saline implants, and this cost increases with the more cohesive implants.
- Rupture detection- silicone implants do not deflate when the shell is ruptured. This makes it difficult to detect a rupture based on appearance. Rupture is typically detected by imaging the breasts (Ultrasound or MRI).
Choosing a size: Implants do not come in cup sizes (A, B, C, etc.). Implant sizes are measure in volumes- cubic centimeters (cc). The dimensions of an implant (width, height and projection) vary based on the style of the implant. Dr. Feiner works closely with you to select an appropriate implant based on your chest measurements, starting breast size and desired goals.
Incisions and Placement: Implants can be inserted through a variety of incisions. The decision about which decision is best depends on a number of factors including the type of implant to be used and desired scar location. The implant can be placed on top of the muscle, behind the breast tissue and muscle fascia lining. Alternatively, it may be placed behind the muscle in thinner patients with less soft tissue coverage or patients who may need a lift.
- Periareolar- Incision placed at the junction between the pigmented areola and breast skin. This has the advantage of hiding the scar in appropriate patients. There are some disadvantages such as a risk of nipple numbness, interference with breastfeeding and a scar that may indent or distort the nipple.
- Inframammary- This is the most common incision location. The scar is place in the natural crease below the breast.
- Transaxillary- The implant is placed through an incision in the armpit. This hides the scar leaving no visible scars on the breast. Implant size and type may be limited by this approach.
Typical Recovery: Surgery is done on an outpatient basis- an overnight stay is not required. It is common to have discomfort and a sensation of tightness. Medication is administered during the surgery to facilitate recovery and minimize discomfort. Patients are given a prescription for oral pain medication, which is typically used during the first few days following surgery. Activity is restricted during the first week to allow the incision time to heal. Exercise and heavy lifting may be limited for several weeks. Implants placed under the muscle often appear to be too high immediately after surgery- this is normal and is a result of muscle tightness and inflammation. They may take several weeks to settle into their final position.
Replacing Implants: It is important to be aware that breast implants do not last forever and will likely need to be revised or replaced. Implant manufacturers typically warranty implants for ten years. Implant shells can weaken and fail over time and surgery will be necessary to replace or revise them. The breast will also change as a result of the stretch and weight of the implant over time. This may culminate in the need for a breast lift in time. Issues related to cosmetic breast augmentation are not typically covered by insurance
Risks of Breast Augmentation Surgery: As in any surgery, cosmetic surgery carries with it certain risks. The risk of pain, bleeding, infection, and reactions to anesthesia may occur. There are risks specific to breast augmentation that include the risk of changes in nipple sensation(numbness), interference with breast feeding, implant rupture or leakage, asymmetry, implant position issues and changes to the overlying breast tissue including thinning and stretching out of the skin.
Patients with breast implants require special consideration when undergoing mammographic screening for breast cancer and may require additional imaging.
Capsule formation is a normal reaction of the body to the implant. In some patients, the capsules may become abnormally thick, hard, or contracted required additional surgery to address.
