Ask about Breast Enhancement

Who are getting breast enhancements?

Women choose to enhance their breasts for many reasons. Most common is the woman who has had children and has lost volume.  Many women have never had much breast development, or lost volume from weight loss or menopause.  

How do I know if I am a candidate for a breast enlargement or if I need a lift?

If there is significant sagging or the breasts have an unusual shape they may be better corrected with an implant and a lift.   Just simply placing an implant into the breast if the breast is very saggy or a different shape is not enough.  For instance, if your nipple hangs well below the crease under your breast, chances are that you will need some sort of lift to avoid the appearance of an implant bulge separate from your breast.. 

What are the risks involved and what things should I consider?

There are risks and future costs to consider before you decide to have this type of surgery.  Implants are mechanical devices and will not last forever.  Just like an artificial hip, knee or heart valve, they eventually wear out.  You likely will need surgery again on your breasts at some point in the future, either to remove or replace the implants.  The implants used for augmentation are saline filled in a silicone plastic envelope or silicone gel in a silicone plastic envelope.

When an implant fails, it will deflate or leak.  When a saline implant leaks, it will deflate over a few days or weeks.  The breast will look smaller on that side.  It is not a medical emergency, and can be replaced most times when you have time.

Detecting a silicone leak may take a special MRI. The new gel silicone is stickier and does not ooze out like the older silicone gel. Older silicone implants leaked significantly when their shell was disrupted and even through the intact envelope.    

It is not an emergency when the silicone has leaked; it is something to remove and repair at your convenience.  If there is a significant silicone gel leak directly in your breast or soft tissue it might cause a granuloma, or scar that could be painful and cause a lump in your breast, and would need to be removed. 

Another consideration is that your mammogram will be affected by the implant.  Both silicone and saline filled breast implants will block a portion of your breast from being evaluated by a mammogram.  Extra views will be necessary to make a more complete examination of your breast.  The mammogram is somewhat less affected by placing the implant under the muscle rather than over the muscle.  I prefer to place the implant under the muscle if possible, but there are times that the appearance of the breast is much more natural looking if the implant is placed above the muscle.  This is the case if there is mild to moderate sagging of the breast tissue.

What are the advantages of silicone implants versus saline and how do I choose?

The silicone filled breast implant has an advantage over the saline filled breast implant in its texture and appearance.  If the original breast is small and the implant is large, or the tissue covering the implant is very thin the silicone may give a better appearance and more natural feel.  Sometimes the saline filled breast implant will have a visible edge with rippling.  If you are going from a very small breast to a large breast, are very thin or are placing the implant on top of the muscle with very little breast tissue or fat covering it, then silicone may be a good choice if the texture and lack of rippling is important to you.  For example competitive body builders or fitness contestants may do better with a silicone implant over the muscle. However, if you are increasing the size a modest amount or if you have a moderate amount of breast or soft tissue to cover it then a saline implant may work very well.  To place a silicone implant, the incision, and therefore the scar, has to be longer than that for a saline filled implant.  The implant itself costs more than a saline implant. In the future, to evaluate whether the silicone implant has leaked or not, an MRI may be necessary and the MRI may not be covered by your insurance carrier.  If the implant has leaked, then silicone will be outside of the implant coating the scar around the implant, or perhaps even leaked beyond the scar into your breast tissue. To remove the silicone you will also need to remove the capsule around the implant. 

Are silicone implants safe?

The silicone implant information collected over a fifteen year prospective study and presented to the FDA revealed no increased incidence of immune disorders with silicone implants (i.e. Rheumatoid arthritis, scleroderma, lupus, etc.) 

One of the possible complications of breast implants is that your body may form a tight scar or capsular contracture around them.  This is true for either silicone filled or saline filled implants.  It may be necessary to re-operate to release the scar and make the breast soft again, and unfortunately it’s possible that even after a surgical release that the tight scar could recur. 

Who should do my surgery and where should I have it?