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Archive for the ‘Breast Augmentation / Implants’ Category

I am 47 years old and had 300cc saline breast implants 3 1/2 weeks ago behind the muscle, but am worried that they are too big for my small 110 lb. frame.

Friday, December 11th, 2009

After any surgery, there will a period of time when there is increased swelling followed by recovery and resolution of the swelling. Typically, the swelling increases for the first 4-5 days and peaks out about day 5. Then there is a relatively rapid decrease in swelling for about 6 weeks. At this time usually about 80% of the swelling has resolved. The remaining 20% may take several more months to resolve entirely.

Immediately after breast augmentation there is also some tightness about the implant as these tissues are draped over the implants. As time goes on the tissues will slowly stretch and accommodate to the implant. This entire process may take up to 4-6 months. During this time there is continued softening of the breasts and relaxation of the implant within its pocket.

About a month after surgery, although the entire healing process is not yet complete, the breasts begin to have a very pretty appearance since enough of the swelling has resolved and some softening has developed. Nevertheless, the final result will not be apparent until about 6 months.

Finally, after having done breast augmentations for more than a decade, my experience is that, with rare exception, most women after about 6 months wish they had chosen an implant somewhat larger than what they actually did choose. My recommendation to you is that you be patient for the time being, allow things to heal and settle down before you make a decision about changing size. In the big scheme of things you are still relatively early in the healing period.

Posted in Breast Augmentation / Implants, Cosmetic Surgery, Nashville, Plastic Surgery, breast | 1 Comment »

Breast Augmentation – Five Things You Need to Know before Surgery

Tuesday, November 24th, 2009

1. Size matters.
Obviously any woman desiring a breast augmentation wants to be fuller and larger and this can be readily accomplished with a large variety of implant sizes and/or types. Women who have had previous pregnancies often have some breast skin laxity. In order to get an optimal result, it may be advantageous to choose an implant large enough to fill out the breast and restore the projection and “perkiness” of the breast. This will also fill out clothing and add to the feminine figure. Nevertheless, the initial enthusiasm for choosing a large implant should be weighed against the potential long term disadvantages of supporting the weight of these implants. Large heavy implants can over time lead to stretch of the skin and excessive dropping of the implant. It is difficult to predict exactly what size will lead to this situation and the recommendation of the surgeon should be carefully considered.

2. Incision doesn’t matter.
The three most common locations for the incision are in the skin crease at the bottom of the breast, around the edge of the nipple and in the armpit. An excellent cosmetic result can be achieved with any of these incisions. The recovery, scarring and risks are all essentially the same. Some surgeons (including myself) may have a personal preference but the final result should be independent of which incision is used.

3. Implants are different.
Breast implants are filled with either saline (a salt water solution such as IV fluid) or silicone. Both are good implants and excellent results can be achieved with either type of implant. Nevertheless, there are some differences. The silicone implants feel softer and more realistic. Further, after augmentation the tissues of the breast tend to drape over the silicone implants a in a more natural fashion and give a prettier appearance. After years of study, the FDA has determined that there are no health hazards associated with silicone filled implants as compared to saline filled breast implants. They are available to any woman 22 years old or older.

4. Placement can be either above or below the chest wall muscle.
The pectoralis major muscle can be used to add additional padding or coverage over the implant during breast augmentation. This is especially advantageous when using saline filled implants, which have a tendency to ripple. The rippling can cause the appearance of waves on the surface of the breast especially in the upper portion and especially if there is relatively little breast tissue covering the implant. Placing the implant under the muscle minimizes this risk.

5. Surgeon choice matters.
Surgeons certified by the American Board of Plastic Surgery (ABPS) have undergone extensive training and testing under the guidelines of the ABPS specifically related to plastic surgery including cosmetic surgery. Plastic surgeons who are members of the American Society for Aesthetic Plastic Surgery (ASAPS) have also demonstrated particular interest in cosmetic surgery and are required to maintain levels of continuing education. In addition to credentials, you must feel comfortable with your choice of surgeon and also realize that this is your operation. Your surgeon should give you information and advice about the procedure, but in the end the decision should be yours. You should be able to choose your own implant size, style, location of incision and so forth.

For more information about breast augmentation and other plastic surgery procedures, call us at 615-327-0201 or visit our website at http://www.DrNein.com

Posted in Breast Augmentation / Implants, Cosmetic Surgery, Nashville, Plastic Surgery, breast | 7 Comments »

Should breast implants be placed under or over the muscle? my friend went under the breast muscle w/ her implants…but now it looks rippling on the bottom. During consultation with a respected plastic surgeon in LA he told me under the pectoral muscle is much better… less risk from capsular contracture, safer for breast cancer screening, more natural (less stripper looking…his words, not mine!). Thoughts?

Wednesday, July 8th, 2009

One of the primary choices in breast augmentation is whether to have the implants placed “under” or “over” the muscle (submuscular or subglandular). This muscle is the pectoralis major muscle which lies over the rib cage and underneath the breast. It is the chest muscle that is commonly developed in weight lifters.

Traditionally, when the majority of implants were silicone, implants were most often placed underneath the breast gland and on top of the muscle. With the more common use of saline filled implants, it was noticed in women who were thinner or who had relatively little breast tissue to cover the implants, that there was a tendency to develop “rippling” or a waviness in the skin overlying the implant. This is especially true with the use of the “textured” or rough surfaced implants. In an effort to decrease the incidence of rippling and the potential for capsular contracture, there has been a move to place implants in the space beneath the pectoralis major muscle. Submuscular placement increases the padding overlying the implant offering more coverage and camouflage to the shape of the implant. Using this technique, rippling has become a rare problem

Today many more women have the option of silicone implants. The silicone implants are softer, re realistic in fell and the tissues tend to drape over them more realistically. They are also less prone to rippling. Consequently, it is possible to place them in a subglandular position more often while decreasing the risk of rippling. In fact a possible solution for rippling saline implants can be to replace them with silicone implants.

There are, however, some breast shapes that are better suited to a subglandular (“over” the muscle) placement of the implant. These women typically have breasts that at one time were much larger than the present. When there is a very large volume decrease and there is little or no shrinkage in the size of the skin envelope surrounding the breast tissue, then the shape approaches that of an “empty bag”. Under these circumstances it is sometimes better to place the implant in a subglandular position in order to allow the implant to fill out the skin envelope of the breast.

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How can I tell if a silicone breast implant is leaking?

Tuesday, April 7th, 2009

The current generation of silicone breast implants is more advanced than other previous silicone implants. Whereas older silicone implants may have been filled with a liquid silicone that could slowly leak out of a rupture in the implant shell in fashion similar to molasses, the newer silicone implants are filled with a cohesive silicone gel. This cohesive silicone tends not to flow out like a liquid but actually tends to stay within the shell even when the shell has a defect. In fact, one manufacturer has a photograph of their silicone implant that has been cut in half. This photograph shows the cut half of the implant with the cohesive silicone still within the half in a fashion similar to gelatin.

It may therefor be more difficult to determine if there is a rupture or leak in the shell of a silicone implant. The FDA recommends an MRI at 3 years to evaluate the implant, however, unless the implant coincidentally has a rupture at that time, this study will not provide lifetime information about whether the implant is intact.

More likely is that when a woman is performing her monthly self breast exam, she may feel that there is an abnormal change in the feel of the implant and/or its shell. If that is the case then an examination by her plastic surgeon followed by a mammogram, ultrasound or MRI as necessary may be necessary to determine if the implant has ruptured. A small rent in the surface of the implant may not be detectable by physical examination alone until it enlarges.

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Posted in Breast Augmentation / Implants, breast | 1 Comment »

How can I tell if a saline breast implant is leaking?

Friday, April 3rd, 2009

Saline implants are made of a shell that is filled with a salt water solution.  Specifically, this fluid is IV fluid which is identical to the fluid which flows into your veins when an IV is started in the hospital. Should the implant leak, the fluid will be harmlessly absorbed by your body. There is no pain or discomfort in fact one cannot feel the implant leak at all. Generally, when a woman dresses in the morning she may notice that one breast is somewhat smaller than the other and by the end of the day it is generally clear that the implant is leaking because the breast has noticeably decreased in size.

This is not an emergency. Simply contact your plastic surgeon and have the implant replaced within the next couple of weeks. If the implant is replaced in a short period of time, it is a simple matter of putting a new implant in the same pocket. If one waits too long (a month or more), the pocket may begin to decrease in size. Then it becomes a greater matter to reopen the implant pocket to create enough room to replace the deflated implant. This may require a partial or complete removal of the pocket capsule.

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Are silicone breast implants dangerous compared to saline implants?

Thursday, April 2nd, 2009

There is no current evidence that there is any additional health risk to a woman who has silicone implants versus saline implants. The FDA at one time placed a restriction on the use of silicone implants for cosmetic breast enlargement because they were unsure if there was any health risk associated with silicone implants. They were never removed from the market. Silicone implants could just not be used for pure cosmetic breast enlargement. There was no restriction on their use for breast reconstruction, provided the proper documentation was carried out.

The restriction of cosmetic use of silicone implants was lifted after years of study of women who already had silicone implants and women who received silicone implants after the restrictions were placed. The restriction was lifted at the recommendation of the review board because they could find no safety issues related to the use of silicone implants compared to saline implants. Specific information about the studies and further links may be found at http://drnein.com/silicone-breast-implant-safety

Now any woman 22 years of age or older may have the option of silicone implants if she wishes.

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What’s the difference between saline and silicone implants?

Thursday, April 2nd, 2009

Both of these implants are good implants and one is not inherently better than the other. There are, however, some differences which may influence the decision to choose one implant type over the other.

Saline implants are made of a shell that is filled with a salt water solution, Specifically, this fluid is IV fluid which is identical to the fluid which flows into your veins when an IV is started in the hospital. Should the implant leak, the fluid will be harmlessly absorbed by your body, and the implant will flatten.

The saline implants look quite nice and are very durable. The disadvantage of the saline implants is that the round ones tend to give the breast a slightly circular appearance, they tend to be somewhat firmer in feel and they tend to ripple.

An implant ripples when the fluid in the implant shifts (generally towards the bottom of the implant when the woman is upright) and because there is less filling of saline in part of the implant, the surface of the implant changes shape and gets waves in it. If there is not enough padding over the implant (meaning not enough breast tissue), especially near the top of the breast, then the rippling may be visible on the surface of the breast as well – commonly referred to as visible rippling. This can be eliminated or minimized in the majority of cases by putting the implant underneath the pectoralis major muscle of the chest wall. (More on this later).

The silicone implants tend to be noticeably softer, the tissues tend to drape over them in a more natural fashion and they tend not to ripple. When a woman feels her breast with a silicone implant, the edge between her natural tissue and the surface of the implant tends to be more obscure and harder to determine. The silicone within the implant flows differently than saline and tends not to ripple even when there is less natural tissue over the implant. Consequently, the tissues tend to drape over the implant in a more natural fashion and the overall appearance tends to be less like an implant. The major disadvantage of these implants is cost as they are more expensive than saline implants. This cost is from the manufacturer not from the hospital, anesthesia or us.

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How long do breast implants last?

Wednesday, March 25th, 2009

A common question that women have regarding breast implants is “How long do they last?” I’ve had a number of patients who have come for a consultation regarding breast augmentation who have made the comment “My girlfriend told me that you have to get the implants replaced every ten years.”

There is no specific time when implants need to be replaced. Clearly, if the implant deflates or leaks it should be replaced. Other than that follow the adage “If it ain’t broke, don’t fix it.” Having said that, breast implants are not considered lifetime devices. All mechanical devices are subject to failure (they can develop a leak) and all women who have breast implants should anticipate that at some point in their future they will have to replace one or both of them. Now when that will happen – nobody knows.

There are over two million women in this country with breast implants. Many of those women still have their original implants even from 30+ years ago. Theoretically, the implants could last your entire lifetime. The reality is that they might not and you shouldn’t count on it. At some point one or both implants may require replacement.

The good news is that all the implants that we use in this practice come with a lifetime warranty. We’ll detail that more later. For now, rest assured that breast implants do not need to be replaced on a routine basis but be aware that at some point they may all require replacement.

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