Breast augmentation

WHO IS A GOOD CANDIDATE?

Patients who want larger, fuller and more lifted breasts are good candidates for a breast augmentation with implants. While fat transfer to the breasts can bring patients up one cup size, implants can bring someone one or more cup sizes larger. For patients with some degree of breast ptosis (sag), implants can sometimes provide enough of a lift to avoid having to do a full breast lift, however if there is enough skin that the implant will not lift the breast enough to reach the patient's aesthetic goals, then a breast lift with implants can be considered.

CHOOSING AN IMPLANT SIZE

Everyone has different shaped breasts and different degrees of ptosis. This does influence how the patient will look post operatively. Sizing in our office is done first by asking the patient's current size and seeing what their goal breast size is. On the day of the consultation, we will go over this, and we will size the patient either at the time of consultation or at the time of their pre-surgery appointment, depending on available time. Bring a sports bra and clothing such as a tank top, as this will help most with seeing the appearance with different sized implants. We will try on various sizes under the clothing to help narrow down the range. We usually order a range of sizes, so the patient is not committed to any size until the day of surgery. Photos of desired size/shape as well as what the patient feels is too small or too large are helpful.

*Up/Downsizing Policy: Patients wanting to upsize or downsize within 1 year after surgery will need to cover the cost of the implants and operating room/anesthesia, the surgeon's fee is waived. Our primary goal is to ensure patients are happy with their results.

THE PROCEDURE

Breast augmentation with implants is done as an outpatient procedure in an ambulatory surgery center. The procedure is done under general anesthesia and takes about 1 hour. An incision is made either under the breast (inframammary fold) or around the nipple (peri-areolar), and a saline or silicone implant is placed either above the muscle (subglandular) or below the pectoralis major muscle (subpectoral). The patient and Dr. Kayan will have a discussion at the initial consultation regarding the pros and cons of each incision location and whether the implant will be above or below your chest muscle. The incisions are closed with dissolvable sutures and skin glue, and the patient is wrapped in a compressive ACE wrap. The length of the incisions depends on what type of implant is being placed, as well as how large the implant is. Saline implants require smaller incisions (4 cm or less) because the implant is placed into the body empty and filled once the implant is inside the breast. Silicone implants come pre-filled. Most silicone implants between 225-325 cc can be done through an incision around 4 cm in length. For silicone implants in the 325-450 cc range, the incision is between 4.5-5 cm, and larger implants above that will require incisions >5 cm. Very slightly larger incisions are needed for more cohesive gel (so called "gummy bear") implants because these implants are less deformable and do not fit through a smaller incision as easily as standard gel or saline implants.

IMPLANT TYPES

Both saline and silicone implants are commonly used, and both are FDA approved and safe. In addition to the price difference (saline implants are less expensive), there are other important differences. Both have an outer shell made of silicone. Saline implants come deflated and are filled with sterile saline during your surgery. Silicone implants come pre-filled and with set sizes. Projection refers to how much the implants project forward from the body - moderate, high and extra high. We have sizers for each one to determine what the patient's goal look is. Silicone also comes in different levels of cohesivity and in textured and anatomic types. The most commonly used implants in our practice are smooth round silicone implants, and among this group, it is the patient's choice if they want regular gel, the most cohesive gel, or the hybrid type. Prices differ between each type, with a higher price for each level of extra cohesivity. The advantage of a more cohesive implant is the silicone gel is less likely to leak into the surrounding tissue in the case of a rupture. More cohesive implants also have less tendency to ripple, which is advantageous if a patient is very thin with very little breast tissue. The only difference in feel is that more cohesive implants can feel firmer.

RECOVERY

All dressings can be removed, and showering may resume 48 hours after surgery. After showering, most patients will either re-wrap in the ACE or put on a tight, front closure sports bra. These can be purchased online or at any sports apparel store. We advise patients not to do any overhead reaching for 1 week and avoid lifting more than 5l bs or high-end exercise for 4-6 weeks after surgery, as this can disrupt healing and cause bleeding. A sports bra mat be worn 24/7 for the full 4-6 weeks, and the patient may look to be fitted for a bra after 6 weeks or when the incisions are fully healed. The implants will appear to sit very high up on the chest at first and will start to settle down into place starting around 1 month after surgery. It takes anywhere from 3-6 months or longer for the implants to settle into their final position.

LONG-TERM IMPLANT MAINTENANCE

If a saline implant ruptures, it is noticeable as the breast will noticeably shrink. If a silicone implant ruptures, it is not outwardly obvious. The FDA recommends that patients with silicone breast implants get an MRI 3 years after their initial surgery, and every 5-6 years thereafter to screen for implant rupture. The lifespan of a breast implant is 10-15 years.