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breast implants

saline vs. silicone implants

Until recently, the majority of my patients chose saline implants located behind the pectoral muscle. There are pros and cons to every choice.

Saline implants behind the muscle gives a natural look, helps reduce the risk of implant hardening, has little risk with deflation, and minimizes interference with breast examinations and mammography. The negative to saline is wrinkling or rippling, particularly with lower profile implants. There are tricks we use to minimize this, but it can be an issue for women with thin tissue.

Silicone implants were reintroduced in November 2006 for breast augmentation patients. Silicone implants never fully left the market. They restricted our use to patients who qualified for a study, for which I was a member of Inamed and Mentor. The gel implants I use are the newest third generation of “cohesive gel” implants. The benefit of silicone implants is the feel. They look the same as saline implants. But when you feel the breast, particularly in a thin patient with little natural breast tissue, silicone implants feel more like fat and natural breast tissue. The true downside is a higher risk of capsular contracture, “turning hard.”

As for how to choose, the look of saline and gel is similar. The difference is in the feel. Some women do not like the idea of silicone in their body. I understand, and for these women saline implants are better. For others, they need the breast to feel as “real” as possible, so gels may be a better choice. Again, I find silicone implants particularly useful for breast enhancement in thin patients, as thin patients have higher risk for palpable rippling with a saline implant. This is a difficult decision for most patients. For additional information please see: www.natrelle.com/breast_augmentation.aspx and http://www.mentorcorp.com/.

They are absolutely perfect. I feel so much more comfortable, confident and beautiful and now it all beams through my body language.
– B.B., San Francisco

implant size

I like you to have a ballpark idea of cup size, but I find trying on sizing implants the most accurate way to choose the appropriate volume. You will try on sizing implants in my office.

I urge you not to focus on a certain cup size. There is no standard for bra sizing. What is a 34C in one company, is not in another. What you think is a 34C may not be . Focus on liking what you see in the mirror with the sizers.

I recommend you get used to seeing yourself with breasts. Many women have an initial shock when they see themselves with breasts. To help you pick a more accurate size and avoid the “I wish I would have gone a little bit bigger” phenomenon, stuff your bra for a while before surgery. Padding your bra, inserts, the rice test: all are good ways to test out the new size. Are you comfortable? How do you feel in your workout gear? work wear? picking up the kids? going for a run? out on a Saturday night?

Bring in form fitting tops to try on the sizers. High crew necked shirts in light colors or a tight fitting turtleneck will make you look the largest. You need to be comfortable in all your clothes.

implant shape

There are two basic shapes of implant: round or anatomic.  Round are the traditional implants, which still are the most used implant.  The media has liked the term “gummy bear” implant. The true gummy bear is a more cohesive gel implant, the style 410, which is a shaped form stable implant. The style 410 was released into the market in February 2013. It has benefits of less rippling, more shape (particularly for super thin patients or breast cancer patients), and less mobility, which is good for some ribcage shapes. There are some negatives, such as size of incision and firmness of implant.  Again, we review this during your consultation process, where you can actually feel the different implants

implant profile

There are many different profiles of implant within “round” or “shaped.”  Within each of these categories, there are different choices for the same volume.  In round we now have 5 profiles: super low profile, low profile, medium profile, high profile, and super high profile.  These vary in width and projection, which gives a different look.  For shaped implants we have different heights and projections.  I will help you pick a shape and profile once I have seen your anatomy, know the volume you choose when trying on breast sizing implants, and understand how you want your breasts to look and feel.

capsular contracture & biofilm

One of the biggest negatives to implants is if they turn hard. If they do, it can be uncomfortable, look rigid and round, and cause asymmetry with your other breast.  If your breast feels hard after implants it is not the implant. What happens is the capsule around the implant has thickened or contracted.

Whenever you put something foreign into your body, your body walls it off with a layer of scar.  This is a capsule.  It does not exist right now.  It forms as a reaction to your implant.  Why would the capsule turn hard? There are many theories for why this happens, but the two leading theories are inflammation or a low grade infection called biofilm.

I believe in this, and I go to great lengths to minimize this risk.  How the implant is prepared, skin prep, antibiotic use, incision placement, placement behind the muscle, use of the Keller Funnel for inserting the implant, a “no touch” technique– all contribute to the health of your implant and minimizing your contracture risk.  I will review all of this at your visit.


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