Am I a candidate for breast augmentation?

You may be a candidate for breast augmentation if:

• Your breasts are smaller than desired
• You have changes in your breasts after multiple pregnancies
• Your breasts appear deflated after undergoing weight loss

Placing an implant restores volume and shape. Women with almost no breast tissue and no crease definition under the breasts are also good candidates for breast augmentation.  Some breast shapes present a greater challenge, including ones that droop. Breast augmentation alone is often sufficient to achieve an excellent result in these cases. Other times a lift that entails additional scars must be added in order to achieve the best result possible.

Sometimes the breasts are very uneven to begin with. This problem is often solved by placing two different size implants or adding a lift on one side.

What type of implant is best?

Saline vs. Silicone

• Both saline and silicone implants are approved by the FDA.
• Both implant types are safe
• Saline and silicone implants of the same size & shape will look the same

Many also are under the mistaken notion that breast implants must be replaced every ten years. Though both implant types may eventually need to be surgically replaced, this is in no way mandatory for all patients, and is only done on an as needed basis.

Saline vs. Silicone – Differences

Saline

• Do not contain silicone gel and do not require any special tests for long term monitoring (current guidelines are for an MRI every three years)
• Are sometimes easier to feel on the side and bottom of the breasts, most commonly in very thin women
• May cause visible wrinkles in thin women
• Can deflate prematurely after only a few years in about 5 percent, a harmless but inconvenient event that requires implant replacement
• Occasionally can exhibit a conspicuous bump or knuckle due to an implant fold

Silicone

• Feel more natural to the touch
• Require special tests such as an MRI scan in order to monitor shell integrity as the years pass. These scans are not typically covered by insurance
• Usually require a slightly larger incision for insertion
• Less tendency to exhibit wrinkles compared to saline implants
• Do not completely prevent wrinkles in very thin women with scant amounts of breast tissue. Occasionally saline implants can exhibit a conspicuous bump or knuckle due to an implant fold, something which does not occur as much with silicone implants.
• Less likely to exhibit a knuckle or implant fold

Round vs. Shaped Implants

There are many implant shapes available and are grouped into two broad categories: round and shaped. The latter are also termed “anatomic” or “tear-drop” types. The vast majority of plastic surgeons today use round implants. Round implants in the upright position behave like shaped implants in that the filler material migrates to the bottom of the implant, leaving less at the top. While lying down the filler material is evenly distributed and resembles a natural breast shape in that position. If anatomic implants rotate inside the pocket both shape and symmetry can be adversely affected

Which incision is best?

Breast implants can be placed either through an incision in the armpit, under the breast, or around the lower edge of the areola. An incision around the navel is also an option. However it is extremely challenging to place implants under the muscle with this approach and it is the least popular option.

Incisions can be as short as an inch for saline implants to two inches for silicone implants. Women who choose silicone implants are limited to using either an incision around the bottom edge of the areola or one that is under the breast. When the areolar diameter is too small an incision under the breast is the best choice available.

Where is the surgery performed?

Surgery is performed on an outpatient basis either at an ambulatory surgery center or local hospital, based on patient desire.  You will be discharged home several hours after the procedure. Breast augmentation generally takes up to two hours and is performed entirely by Dr. Sirota

What type of anesthesia is used?

Breast augmentation requires general anesthesia in order to completely relax the chest muscles and thereby facilitate implant placement

What is the recovery like?

Aftercare is minimal. Either an elastic binder across the top of the breasts or surgical bra is placed at the time of surgery, the choice depending on the specifics of the procedure. Most discomfort subsides within 48 hours. Skin stitches do not require removal. It is usually possible to return to work after one week. Most normal activities can resume by two weeks. Strenuous physical exercise involving the upper body must be avoided for at least six weeks.

What are the risks associated with breast augmentation surgery?

The general risks of any surgical procedure still apply in breast augmentation surgery. These include but are not limited to risk of bleeding, infection and anesthesia related risks.

The general risks of any surgical procedure still apply in breast augmentation surgery. These include but are not limited to risk of bleeding, infection and anesthesia related risks.

• Implants may need to be replaced, perhaps as often as every ten years.
• Implants can start to feel hard on one or both sides in approximately five percent of women. This “capsular contracture” is due to thickening of the normally thin scar tissue layer that surrounds the implant. The implant itself is not affected
• Breast augmentation can result in a change in nipple sensation (such as numbness or increased sensitivity) and decreased sensation in the lower part of the breast skin. Fortunately, this does not occur in most women
• All research to date indicates that the risk of breast cancer is not increased in women who have breast augmentation. However, breast implants can make mammograms more difficult to read because the implant obscures some of the tissue and also compresses it. Most experienced radiologists can adequately assess the gland despite this.
• Some women with breast implants have reported symptoms similar to those of immune system diseases such as systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and other arthritis-like conditions. There has been no scientific evidence to date that shows a cause and effect relationship between breast implants and any of these diseases.

What type of long-term implant monitoring is required after surgery?

• Saline implants do not require any active monitoring because deflation, a harmless event, is obvious when the implant finally wears out.
• Rupture of silicone implants is typically a silent event because there is no loss of volume due to the semi-solid nature of the filler material. Therefore silicone implants require active screening with periodic MRI scans to detect failure of the outside shell. The study is repeated every three years thereafter until a shell change suggesting implant replacement is demonstrated.