Archive for the ‘Breast Augmentation’ Category

Cosmetic Surgery Basics – Post #7 – Saline versus Silicone implants

Sunday, January 8th, 2012 at 4:57 pm | Posted in Breast Augmentation, Breast Surgery

I find that the choice of implant filler material is one of the most difficult decisions that ladies in my New Jersey breast implant practice need to make. I find myself going through the following discussion multiple times almost every day:

First of all, I think that while there are many differences between the two devices, it really comes down to three issues when picking your implant.

#1 – First of all, the biggest difference on a daily basis is going to be the way the implants look and feel. In my opinion, silicone gel implants look and feel far more like natural breast tissue. Saline implants tend to feel more like a water balloon, well, because they are filled with water. Even under the muscle with adequate soft tissue coverage, silicone implants feel nicer. Most women getting this surgery want their breasts to feel as nice as possible. Silicone clearly wins on this issue. They also ripple less. If you have ever seen a picture of implant rippling, it isn’t great. Silicone implants do not ripple nearly as much as saline. If you are considering breast enhancement, holding both types of implants is very important. You cannot just read about the differences, but need to feel the implants to make an educated decision. In my Cherry Hill cosmetic surgery practice all prospective breast augmentation patients feel the implants as part of their consultation.

#2 – The second issue is safety. In the early 1990′s the safety of that generation of silicone breast implants became a major issue. This page on my website describes silicone safety however it is a major issue. We did not have access to silicone devices in this country until 2006 when the FDA released the current generation of silicone gel implants for general use. Until then, they were considered experimental. While I am not going to go into detail about the studies performed, the FDA noted that volumes of research showed silicone breast implants to be an overwhelmingly safe device. They were approved for general use and have been used in large numbers since then. I believe that they are safe, as do the majority of plastic surgeons. Most women are able to do a little research and decide for themselves that they are safe. Some ladies want nothing to do with silicone implants due to the stigma still attached to them. While I understand this emotional decision, with a little research most ladies are ok with the safety factor.

#3) Long term detection of leaks. This is a huge issue. The saline implant deflates when a crack occurs in the implant shell. The saline is absorbed and the breast becomes flat. Ladies notice this and thus call their doctor. If it has been 20 or 30 years and their surgeon has retired or they have moved elsewhere, they find a new surgeon. This is a nice feature of saline implants. Simply put, if you have a problem, you know it. With silicone gel implants I tell my NJ breast implant patients that they will likely have no idea that their implant is leaking. Perhaps the breast will change shape or get slightly harder but often there will be no sign of change at all. Because of this the FDA recommendation and the package labeling for the implants states that after silicone breast enhancement, patients get an MRI of the breasts at 3 years and then every 2 years. This is a huge issue. MRI is an expensive test. Insurance companies will likely tell you that this is a cosmetic test and that they will not pay for it. It is inconvenient and time consuming. Some ladies will find the MRI embarrassing. Overall, the MRI is an nuisance and needs to be considered.

In summary, silicone gel breast implants feel better, are safe, but are a nuisance in terms of needing follow up appointments with your surgeon to get expensive MRIs every few years. Whether or not a nicer feeling and more natural appearing breast is worth it to each patient is a personal decision that I can only guide them through.

I hope that this information is useful if you are considering breast enhancement!

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Cosmetic Surgery Basics – Post #6 – Breast implants vs. lift

Friday, January 6th, 2012 at 10:01 am | Posted in Breast Augmentation, Breast Lift, Breast Surgery

So, you decided to get your breasts enhanced? Now, you need to figure out exactly what needs to be done. One of the biggest questions I get in my southern New Jersey plastic surgery office is “Do I need a lift or just implants?” While I have discussed this issue before and there is a page on my website devoted to this issue, it certainly deserves discussing again.

There are three operations that plastic surgeons perform on the breast. The most straightforward is placement of a breast implant. If your breasts are perky and small, this is the perfect option. An implant is placed and makes the breasts bigger. We need to decide on saline or silicone implants, but this will be the topic of another day. The other extreme is the lady with very saggy breasts. Often simply due to the way they developed or with weight loss or pregnancy/breast feeding, the nipples hang down and the entire shape of the breast is pointing downward. In this case, surgical option #2 is a breast lift. A breast lift is an operation where excess skin is removed, the tissue is repositioned and tightened, and an rejuvenated slightly smaller breast is the result. Option #3 is a combination of a breast lift and an implant. This is the case where the breast needs to be lifted, but an implant is also needed for volume. It is only safe to combine lifts and implants in some circumstances, which will be a topic for another day.

How do you know which you need? Well, if you love the shape of the breast and nipples point forward and your only complaint is size, then an implant alone will likely solve the problem! Unfortunately, if the breast is starting to sag, an implant alone will not lift the breast to any significant degree. In this case, the implant will give you a bigger saggy breast. That is certainly not an ideal goal, but one that some ladies choose to accept to avoid the scars of a breast lift.
Unfortunately to lift the breast, incisions are needed to remove the excess tissue. Anytime there is an incision there is a permanent scar, and thus it is understandable that in an ideal world we would avoid lifts. This is not reality, and some breasts simply require this procedure. The amount of scarring will depend on how much excess tissue there is and what type of lift will be performed. I will discuss various lifts in the next post.

A simple test to see if you need a lift has been known as the “pencil test.” If your breasts have come down enough that you can place a pencil behind the hanging skin (in between the breast and your abdominal wall/ribcage) and it stays there by itself, you probably need a lift. If the nipple is positioned near or at the level of the breast base crease you likely require a lift.

I see ladies who have gone to other surgeons and received large implants in order to attempt to avoid a lift. They are always upset and always blame their surgeon. This plan does not work. I would highly caution any lady with sagging breasts not to simply get large implants. I hear this from ladies often that “well he said I could probably get away without a lift.” I had a lady come see me recently that I had seen 4 years ago. When I saw her initially I suggested a lift. She went to someone else in the same zip code 08003 as me who told her she would be fine without a lift. He ended up placing 600cc implants in an attempt to mask her droopiness. Now she complain that she has huge droopy breasts. I operated on her a few weeks ago performing a lift and downsizing her implants. She is delighted now that the proper procedure was performed. I worry about that comment because in my opinion a breast cosmetic surgeon should be able to look at a pair of breasts and in 2 seconds tell you what operation is best. I believe that surgeons do this because the lady doesn’t want a lift full well knowing that she will be back to get one. Beware of this.

I hope this explanation helps!

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