Cosmetic Breast Surgery

Breast Augmentations

Women are often unsatisfied with their breasts.  Many women feel their breasts are too small, too large, are unsightly and asymmetric, or droop. Procedures such as breast augmentation with implants, breast reduction, and breast lifting are helpful in improving the appearance of the breasts.

Breast Augmentations increase the size of the breasts. Incisions are made in the creases under the breasts and pockets are created either under or over the pectoralis muscle and either silicone rubber implants inflated with sterile saline (salt water) or silicone gel are inserted. The incisions are then repaired, using sutures that do not leave cross marks.

In most cases, the results are natural. The patient satisfaction rate is very high.

I usually place breast implants with the “DUAL PLANE TECHNIQUE”. In this procedure the implant is placed partially under the muscle and partially over the muscle. Conceptually, it may be difficult to understand. However, the important thing is that the operation preserves the ability to have a breast lift in the future and it also decreases the likelihood of seeing implant wrinkles. Upper breast bulging is also less likely. If you are not planning on having more children and if your breasts do not droop significantly, you may be a candidate to have your implants placed in front of the muscle. This procedure has the added advantage of significantly less pain after surgery.

After a 14 year ban, silicone gel breast implants were approved by the FDA for cosmetic and reconstructive reasons. The new versions of silicone implants are better than the old ones.  They feel more natural than saline and have less wrinkling. On the other hand, the incisions are longer and rupturing is still an issue. During your consultation, I will discuss the various options open to you.

“Gummy Bear” implants are the new silicone breast implants that are "game changers" in cosmetic breast surgery. I’ve been using them for a few years and they are a huge improvement over prior generations of implants.  These implants are placed through incisions in the crease and are usually, but not always, placed under the muscle.  There is a lower chance of rupture and scarring around these implants.

Are Implants Safe? A good question. Silicone gel implants were taken off the market in 1992 because they were thought to be unsafe. The implants ruptured and leaked gel. Many women and attorneys claimed that the implants caused diseases such as rheumatoid arthritis or scleroderma. In fact, over the last decade, there have been a number of studies looking at thousands of women with implants. Women with and without implants were compared for the presence of any disease. No diseases were found to be increased in women with implants. The gel implants certainly are problematic in that they can leak. Gooey gel spreads throughout the chest wall requiring a complicated surgical removal. There have been a very small number of lymphomas that appear to be caused by textured implants. While the FDA has not taken these off the market, I no longer recommend textured implants. I also recommend MRIs of the breasts to be sure there are no abnormalities. (More on this a few paragraphs down.)

The two types of implants currently available are silicone/saline implants and silicone gel implants. Saline implants have the advantage of not having silicone gel that can leak. The main disadvantage of saline implants is that they feel abnormal in many women. Saline has the consistency (or viscosity) of water and gel implants have the viscosity of breast tissue. Because of the low viscosity, the implants might show wrinkles. Not everyone has this problem - it is most common in very small breasted women with stretched out breasts who have had textured saline implants placed.

The advantage of saline implants is the fact that if they leak, no gel spreads. In addition, the incision required to place these implants is half the size required for gel implants. You can have saline implants at age 18, but have to wait until you’re 22 to receove gel implants (interesting FDA logic!).

All implants block mammograms. This is a major problem and will require the patient to undergo costly MRI studies in order to be see the breast tissue. My recommendation is to have MRIs of the breasts every other year, alternating years with digital mammograms. Your health insurance will not pay for the MRIs. If you can not afford the fees for these tests, you simply should not have a breast augmentation.

Breast Reductions decrease the size of the breasts. Incisions are made around the areola (the pigmented area around the nipple), vertically connecting the areola and the crease under the breast, and horizontally under the breast. Skin, fat, and breast tissue are removed, the nipple is elevated to an appropriate position, and the skin is closed, holding the breast in a more youthful position. Women who are plagued by excessively large breasts are usually relieved of back and neck strain, bra straps that dig into their shoulders, and recurrent rashes under the breasts after this surgery. For these reasons, sometimes health insurance will pay for a portion of the procedure.

Breast Lifts elevate the breast tissue. Various procedures are used, depending on the amount of droop. The simplest leaves a scar around the areola. The most complex leaves the same scars as a breast reduction. The operation chosen depends on your wishes and anatomical needs. The overwhelming majority of women who have breast lifts say, "why didn't I do this sooner?"