Breast Augmentation

Your new curves can be as alluring as you want them but your outcome is primarily dependent on your choice of surgeon. Breast enlargement enhances the size and shape of your breast through the surgical insertion of saline or silicone implants. No exercises,  pills or medications advertised will have any effect on the size of your breast. BREAST AUGMENTATION is the only way to enhance the size and shape of your breast.

You also must have realistic expectations. Bigger is not always better and the current trend of a beautiful breast in the USA is to have a more natural looking breast and not exaggerated or extreme. You must realize that breast augmentation enlarges only what you already have and therefore pre-existing asymmetries will not be corrected (example: if your nipples point out to one side, they will still do that after, but your breast will be bigger).

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If you have small, underdeveloped breasts or breasts that have shrunk or atrophied after child bearing or have minimal sagging, breast augmentation can help.

Common Techniques

• The inframammary at the breast fold (where the lower part of the breast attaches to the chest): it is the preferred choice especially in the woman who may desire a future pregnancy since it best preserves the ability to breastfeed.
• The periareolar or nipple (the incision is placed around the dark colored area surrounding the nipple at the junction with the skin): it is associated with additional scarring in the lower breast and the areola region and a higher risk of loss of nipple sensation.
• The axillary in the armpit (the endoscopic Breast Augmentation is performed through this incision): has a higher risk of redo-surgery because of higher chance of asymmetry and often the scar appears irritated or darker because of the sweat glands.

In many cases the choice of the incision is the patients but remember also that your choice may not be necessarily the best for you.

After creating the incision, the surgeon lifts the breast tissue to create a pocket either directly under the breast tissue or underneath the muscle depending on the surgeon’s judgment and the patient’s physique.

Before and After Photos

Types of Breast Implants

The FDA recently changed the IDEAL IMPLANT name from “Saline-filled” to “Structured” (IDEAL IMPLANT® Structured Breast Implant), which officially and clearly distinguishes it from traditional saline implants. Now there are THREE types of implants: Saline, Silicone Gel,and Structured:

• Saline – no internal structure – less natural feel and wrinkling likely
• Silicone Gel – internal structure provided by cohesive gel – natural feel, high rate of silent rupture
• Structured – internal structure provided by nested shells – natural feel, advantages over silicone gel (attached): no silent rupture, no MRIs, look in mirror to know implants are intact, only saline for peace of mind, lower capsule contracture rate (5-year), lower rupture rate (5-year)

Structured Implants

The newest double lumen implant with an internal structure and saline inside – has natural feel and less wrinkling, but with advantages over silicone gel such as: no silent rupture, lower capsule contracture rate, lower rupture rate, you can look in mirror and know it is intact and because of the safety of saline you have peace of mind.

IDEAL IMPLANT Structured Breast Implant

Call us (361) 881-9999 or Contact Us and do your own side-by-side comparison of the IDEAL IMPLANT to the silicone gel implant.

Saline Implants

These implants are made with a rubberized silicone shell which is filled with saline after implant insertion. They have a less natural feel than other alternatives and can cause some wrinkling around the breast. In case of implant failure, deflation occurs and the leakage of saline is absorbed in your body (your body is made of 70% saline and therefore there is no harm to you). You will notice deflation almost immediately and the manufactures offers a 10 year warranty covering your cost should this event occur. There are two styles of saline implants: round and anatomic (the anatomic are textured and are no longer in use today) and two types of saline implants that can be placed in the pocket, smooth and textured. The textured implants have been pulled out of the market today due to their concern of causing a very rare cancer. There are also different choices of smooth round implants: low profile, moderate profile (most commonly used) and high profile (they offer the most projection and are useful in flat breast with little volume). In my hands both the saline and structured implants offer the best option to minimize complications. The implant manufacturers show that about 30% of women will require revision surgery within 3 years while Dr. Gentile`s is less than 5%. This emphasizes the importance of a proper plastic surgeon selection.

Silicone Implants

Silicones are a family of chemicals naturally occurring in sand and rocks. They are very biocompatible, reliable, and flexible making them an ideal choice for implantable medical devices. Silicones are used in a wide variety of everyday products; examples are hairsprays, moisturizing creams, suntan lotions, etc. as well as medical devices such as artificial joints, catheters, facial implants and of course breast implants. Silicone-gel filled Breast Implants are indicated for women at least 22 years of age and the advantage is that they may feel more natural when compared to saline implants (but it depends on how much breast tissue you have) . Like the saline implants they come in a variety of sizes and shapes. Drawbacks are that the incision is longer, the cost higher and lifetime follow-up is required with an MRI (a specialized X-ray study) to detect silent ruptures, which can add significantly to the initial cost. The risk of having complications such as capsular contraction and failure or rupture of the implant is much higher compared to saline and this will also translate in higher costs in the future. For this reason Dr. Gentile uses saline or structured (Ideal) implants.

Cohesive Gel/Form Stable ( Gummy Bear ) Implants

The cohesive gel implants are nicknamed gummy bear implants because they are semi-solid and they have begun a new era in breast augmentation. If you cut them with a knife it’s the same as cutting a gummy bear; in other words if you cut them in half you will have two pieces. They are available in a variety of sizes, shapes, heights, projections and therefore the plastic surgeon has the opportunity to customize the procedure. They have generated a lot of publicity because of their advantages: (1) if ruptured they do not leak the gel as readily like the silicone implants and therefore have less complications such as capsular contraction; (2) they maintain their shape and because of their consistency there is no rippling; (3) they may better shape the breast in some cases because they can add volume where needed. The ideal candidate is a woman with a small breast and thin skin. They have been in use in Europe for more than a decade with great success before the Federal Drug Administration (FDA) made them available here in the US.

Alternatives to Implants

The BRAVA System

The Brava AFT system was designed to prepare your breast for transfer of your own fat. It is a painless and gentle process which enlarges your breast without surgery.  It works by creating a scaffold using vacuum pressure. The device is held in place for 3 weeks by a comfortable bra. Then your fat is suctioned and transferred in the spaces created by the Brava system.  With one treatment generally you gain at least a cup size.

Fat Grafting

Fat Grafting alone to enlarge a breast requires multiple treatments and obviously the woman needs to have at least some minimal fat available for grafting. Unfortunately results so far have been variable and many sessions are required which adds significantly to the cost. One of the biggest shortcomings is the fact that it is associated with the development of micro-calcifications which are indistinguishable from the ones produced by breast cancer.  However, Fat Grafting in combination with the Brava AFT system has significantly improved the results and is an option if you do not desire breast augmentation with implants.  Dr. Gentile very commonly uses fat grafting to contour other parts of the body such as face, buttocks and thighs.

Breast Implant Shapes

Round

Round breast implants can be selected in three different profiles, or degrees of projection. Moderate profile, the most common choice, conforms closest to the natural breast shape. High profile is necessary for those with flat breasts who would benefit from the most projection. Low profile, which has the least projection, is not used as often.

Contoured

Contoured breast implants, or anatomical implants, are not as popular as they once were, except when it comes to gummy bear implants. Contoured implants are considered to be bottom-heavy, so they add more volume to the lower area of the breast. They have a habit of changing orientation within the breast pocket unless implanted in a textured form. At first, these implants were created for use with breast reconstruction.

Breast Implant Placement

Breast implants are inserted into a pocket made in the tissue underneath the breast. This pocket is made either above or below the pectoralis major muscle. Dr. Gentile feels that this choice is extremely important for patients undergoing this procedure. During a consultation, the two of you will discuss the benefits and drawbacks of either choice in relation to your goals.

The Internet offers a great deal of information regarding breast implant placement, and much of this information is contradictory and confusing. Placing the pocket beneath the muscle tissue appears to be the most popular location, since most women do not have a large amount of breast tissue. Surgeons often choose this method to lessen the risk of capsular contracture (thickening of the scar capsule that forms around a breast implant).

Dr. Gentile has not seen a significant difference in capsular contracture whether the breast implant is placed above or below the muscle tissue. He feels that it’s typically best to implant silicone or saline implants beneath the muscles, especially for thin-skinned patients, since this lessens the risk of ripples appearing on the breast surface. With women who have drooping breasts and thicker skin, he may instead choose above the muscle. Either placement works well with the new gummy bear breast implants, since ripples are unlikely with this type of implant.

Placement Below The Muscle

Placing a breast implant below the pectoralis major muscle is the most popular option when it comes to breast augmentation.

During mammography, it’s easier to see the breast tissue with this method. Because there are more layers of tissue between the implant and the breast skin, rippling is also less likely than with the above-muscle method. This technique also offers more volume in the upper pole area of the breast, since the implant pushes the pectoralis major muscle forward.

If sagginess is present, a breast lift may be helpful with this placement, since the implant has the potential to ride high on the chest without one.

Placement Above The Muscle

Placing a breast implant above the pectoralis major muscle situates it in a subglandular, or retromammary, position, meaning underneath the breast tissue.

This placement may be better for those patients with a great deal of breast tissue and some breast sagginess, especially since it can provide enough lift to make a breast lift unnecessary.

With this method of placement, surgeons may not be able to get full visualization during mammography for patients who have a history of breast cancer in their families.

Placing an implant above the muscle is a bit less invasive than placing it underneath, and because of this, there is less pain after the procedure.

What To Expect During The Consultation

In most cases Dr. Gentile places the implant partially underneath the pectoralis major muscle as some reports suggest it may slightly decrease capsule formation (capsular contraction), a form of scarring that can develop around the implant. However there are advantages and disadvantages for each choice of placing the implant above the muscle or underneath it and a detailed discussion with Dr. Hervé Gentile will maximize your chance of obtaining the desired result. It is the quality of your skin envelope, the soft tissues of your breast and your anatomy including your frame and height, as well as, the shape of your breast that determine where to position the implant underneath the muscle or beneath the breast. Often plastic surgeons do not offer women choices and this frequently dictates the result. Many patients are not willing to accept a higher risk of scar formation in the future and therefore choose placement of the implants underneath the muscle. An additional advantage is that it offers greater breast visibility on mammograms, a concern if you have a family history of breast cancer. The anatomical style implant which is sloped and shaped as a tear drop may be the natural choice for the woman who desire fullness in the upper pole of her breast while a higher profile implant is best for the woman who requires a more fuller and projecting breast. Generally, for most women, a medium profile round smooth saline or a cohesive shaped silicone implant is chosen, which may lessen the rippling effect or the folds which occur with all implants.

During the consultation you will have, in addition to a review of your medical history, a personal evaluation of what is appropriate for you, your body size and frame as well as your breast size and sag if any. In the latter case the implant is better placed above the muscle to increase breast projection and improve the droopiness. Since breast implants enhance the breast you should not view them as a substitute for breast tissue and also like any mechanical device you should not think of them as permanent. However,  Dr. Gentile does not recommend a specific time for replacement.

Very large implants will result in early sagging and are associated with a much higher risk of scar formation, bottoming out, thinning of the tissues and rippling. All of these problems, needless to say, will result in additional surgery, which sometimes can also prove to be unsatisfactory. The key determining factor is the type and quality of your skin envelope and your outcome is primarily dependent on your choice of surgeon more so than other procedures. You will also need to decide whether a saline or a silicone implant is best for you and understand that no surgical options are perfect and are without a tradeoff. Although we have the software to do computer imaging, our office does not use because it is fraught with errors and provides a falsified view of your breast that can lead you to have unrealistic expectations. The latest computer imaging is VECTRA XT and although it is an improvement over previous versions it is not the panacea it is meant to be and in no way can determine your ultimate result. Simply put it is one of many communication tools and a gimmick which adds to the costs.

Procedure & Recovery

The procedure takes about 1 – 1 1/2 hours, and after surgery you are taken to the recovery room and monitored and kept there until you are ready to be discharged. Recovery is variable and depends from person to person but usually medication can control any pain or discomfort which should subside in 2-3 days. Swelling and any bruising of the breast will disappear gradually. Although you will be up and about a day or two after surgery, you should take it easy and avoid any lifting or elevating your arms over your head and shoulders for 4- 6 weeks. Most patients can return to work at the 3rd or 4th day with some restrictions but you will receive detailed instructions from Dr. Hervé Gentile on what activities you can do. Dr. Hervé Gentile uses a unique and bloodless technique to perform your breast augmentation and therefore you do not need to wear a bra for the first few days and consequently this will cause less pain and permit your implants to descend quicker. You will be seen in the office at 1-2 and 4-6 weeks post-operatively and less frequently thereafter depending on your progress. The scars usually fade with time and are barely noticeable. At this time your newly acquired figure should be able to better fill out clothes but remember that although breast augmentation can improve your look and make you feel good, it is not a guarantee for happiness.

Cost

Your total cost for breast augmentation will vary between $4,900 and $7,000…Call us for our specials.  The quote we provide you is all inclusive and prices vary depending on the type of implant, whether the procedure is performed in our office surgical center or in the hospital.  Remember you get what you pay for…so choose your surgeon based on qualifications. Do you really want to go the cheapest person for your surgery?… considering that you may end up paying a lot more later to undo and correct the problems from bargain surgery.  So it is mandatory that you carefully and conscientiously research your surgeon and make sure that he has considerable experience in breast augmentation surgery, a stellar reputation  and a resume of consistently favorable results.

Photographs

For your convenience you may view a few selected cases in our Breast Augmentation Before & After photo gallery. To see our extensive photographic catalogues of pre-operative and post-operative photographs please contact our office and schedule a complimentary consultation.