FAQ's – Breast Augmentation

Introduction – read this only if you are serious about breast augmentation and want to learn more…

Breast augmentation is probably the most common cosmetic surgical procedure performed today. There are many options to consider: type of implant (saline or silicone gel), shape (round or anatomic "teardrop"), surface texture (smooth or "textured"), placement of implant (above the muscle or below it), implant size, technique (dual plane type I, II or III), whether or not a breast lift (mastopexy) is also needed and should it be performed at the time of surgery or later.

Most women who desire breast augmentation are good candidates for it. There are some limitations; the surgeon can only work with the tissue he is given. Some patients have issues that may compromise the results or make the surgery a little more difficult. This includes differences in breast size, shape and position on the chest; chest wall (rib cage) asymmetry; overstretched tissue from pregnancy or weight loss; drooping of the nipple (ptosis); and drooping ("bottoming out") of the glandular tissue.

I define a successful outcome in breast augmentation surgery as one in which the patient goes into surgery with realistic expectations, and a surgical result is delivered which meets those expectations. Because the patient has been properly educated as to what is a likely outcome, and that outcome is met, then the patient (and the surgeon!) will be satisfied with the outcome.

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The key to success is education and proper decision making. Proper decision making in plastic surgery is a joint effort between the surgeon and the patient. The patient is presented with many options and decisions to make. If the patient is not properly educated as to how to consider and make the necessary decisions, then there is no assurance of a good outcome.

The purpose of this rather lengthy, detailed Frequently Asked Questions ("FAQ") for breast augmentation is not to "wet the prospective patient's appetite" for breast augmentation, rather, it is for the patient who is serious about breast augmentation and wants to learn more. The more you, the patient, educates yourself, the more you will derive from your consultation, and the better your ability to make all the right decisions to ensure that you obtain the result that you so desire and deserve. Although not all inclusive, this set of FAQ's should well prepare you for your initial consultation with the surgeon of your choice.

What is Breast Augmentation?

Breast Augmentation surgery involves the placement of a prosthesis (commonly known as a breast implant) underneath the breast. Breast Augmentation surgery can give women with small or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of saline or silicone implants in the breast. Women may elect to undergo breast augmentation for many different reasons, including increasing or balancing breast size and compensating for reduced breast mass after pregnancy or surgery, and correcting a congenital breast defect. The procedure may be combined with others such as a breast lift to correct drooping (ptosis). According to the American Society of Aesthetic Plastic Surgeons, Breast Augmentation surgery is one of the most commonly performed cosmetic surgical procedure in the United States. In 2008, 355,371 breast augmentation procedures were performed. Under Dr. Epstein's expert care, patients can enjoy great-looking, natural-feeling and looking breasts that are one or more cup sizes larger after the operation.

Fully Customized Breast Enhancement

Every woman is unique in both her desires and her body shape. With that in mind, Dr. Epstein takes the time during the pre-operative consultation to learn what each patient hopes to gain from breast augmentation surgery and to decide which implant type, size and placement is best. In this way, each patient enjoys completely customized treatment designed with her specific goals in mind.

During your consultation with Dr. Epstein, you will make decisions together about the type, size, incision and placement of your implants. Your anatomy, as well as the tissue characteristics of your breasts, play a major role in these decisions. Dr. Epstein will discuss with you the options available for breast augmentation surgery.

What is the difference between Saline and Silicone Gel Breast Implants?

Implants are silicone shells filled with either saline (salt water) or silicone gel (approved by the FDA November, 2006). There are two primary types of fillers used in breast implants: saline filled and silicone gel filled implants. Saline implants have a silicone shell filled with sterile saline (salt water) liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel. Saline implants are firmer than silicone gel implants. Silicone gel implants better resemble the texture and feel of natural breast tissue. Both implant types are very safe, and each offers its own specific advantages. Dr. Epstein will help you decide which kind is right for you. For additional information on silicone breast implants, please see Silicone Breast Implants: What You Need to Know.

An advantage of saline breast implants is that, if ruptured, the saline (salt solution) is absorbed by the body. A disadvantage is that saline breast implants are firmer than silicone gel implants and natural breast tissue, and are subject to fourteen times the amount of rippling and wrinkling as a silicone gel implant. Also, saline implants have a valve used to fill them during surgery (they arrive deflated from the manufacturer), which is another potential point of failure (leakage) not found in silicone gel implants, which arrive pre-filled from the manufacturer. This is especially important for very thin women who have little breast tissue to cover the implant, or for women who have a breast injury or need breast reconstruction.

Silicone gel-filled implants may provide a more natural feel and are the implant choice of most of Dr. Epstein's patients. In November 2006, after fifteen years, the U.S. Food and Drug Administration (FDA) has approved silicone breast implants for breast augmentation surgery. Dr. Epstein is proud to offer patients the option of silicone gel-filled breast implants, since they are much softer and feel more natural than saline-filled breast implants.

What is the difference between round and teardrop shaped implants?

When choosing breast implants, shape is an important consideration. The two basic breast implant shapes are round and teardrop. Breasts differ greatly from woman to woman, so the ideal breast implant shape for each patient must be determined with care.

Round Breast Implants. Of the two breast implant shapes, the round breast implant is the most common type used by most plastic surgeons for breast augmentation. Round implants are easier for the surgeon to work with. If a round implant is turned, it is still round. Many women choose round implants because they believe that they tend to provide the greatest amount of lift, fullness, and cleavage. This is in fact, not entirely true. When the implants are overfilled, they may see these characteristics, but there is loss of the naturalness to the overall look of the augmented breast. Some women, however, feel that the results produced with round implants appear artificial, so they seek out more natural-looking alternatives (anatomical or "teardrop" implant).

A round breast implant can have a smooth or textured surface. Due to a round implant's symmetrical shape, it does not pose the risk of implant rotation. If the implant should rotate, the shape is still exactly the same, round.

Round implants come in three different variations of shape: low, medium, and high profile. A higher profile can enhance the forward projection of the breasts, which would otherwise require larger breast implants with wider bases. Dr. Epstein finds that the medium profile implants seem to give the most consistent, natural results.
Teardrop Breast Implants. As the name indicates, a teardrop breast implant, also known as a contoured breast implant, is shaped like a teardrop. Breasts attain a more gently sloping contour with teardrop breast implants. Teardrop implants better resemble the natural shape of the breast. They require much more care in placement. When inserted, they are often tilted to better follow the natural contour of the breast. The degree of tilt requires more attention if the degree of symmetry is to be optimized.

The teardrop-shaped implants often provide greater projection by volume. For women who want more naturally shaped teardrop breasts, these implants may be the ideal choice. Breasts with teardrop shaped implants typically excel in appearance in women who have loss of fullness and stretching secondary to pregnancy and lactation.

Round vs. Teardrop Implants – Which gives the breast a better shape?

A generally held belief is that round implants give more fullness in the pole (part) of the breast. This couldn't be further from the truth. If one takes a saline round implant, and a saline teardrop shaped implant, and inflates it (outside the body) to the manufacturer's recommended fill volume, and you hold it in the palm of your hand so that the bottom of the implant is against your palm (simulating the position the implant will have in the body when a woman stands upright), the round implant will exhibit more collapse at the top than the teardrop shape. The teardrop shape was specifically designed to retain its fullness at the top. So why do so many people believe round implants have more upper breast fullness? The answer is that the women who have round implants with very prominent upper pole fullness have implants that are over-filled with saline past manufacturer's specifications. If you examine the shape of these breasts out of clothing, they will not look as natural as a breast with a properly filled teardrop implant. It is Dr. Epstein's opinion, based upon critical review of his own cases, that in the case of SALINE implants (silicone are another story), that teardrop shaped implants give a more natural shape than round implants in the vast majority of cases. It is important to note that in some women, particularly those with an adequate amount of good quality breast tissue, that the shape of the implant may be less important to the overall aesthetic result. Dr. Epstein does utilize use both types of saline implants in his practice.

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