August 17th, 2010
All saline and silicone gel breast implants have an outer shell that is made from solid silicone. As the name implies, smooth implants have a smooth, slick surface. Textured implants have a rough, clingy surface.
Right after breast augmentation surgery, most implants look too high and too tight. I joke with patients that their implants will look like decorative shelving for the first couple weeks. Over the course of the first month or two, the implants typically drop and look more natural, though final results do not occur for about a year.
Smooth breast implants are “slippery,” and their weight will cause them to fall after surgery. This is desirable when the implants are below muscle, and the pectoralis major muscle has adequate bulk to hold up the implants. As a result, smooth implants are used in the majority of routine submuscular breast augmentations.
Textured breast implants tend to cling to the surrounding tissues, making them more resistant to falling after surgery. This can be good for women whose breasts and/or chest muscles provide inadequate implant support. Textured implants placed in a subglandular (above muscle) position are also associated with a mildly lower risk of capsular contracture (excessive firmness of the implants) than smooth implants placed above muscle.
So which type is better? I routinely use smooth implants for most breast augmentations. But I always have textured implants available, since you never know when you might need them.
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Implants | No Comments »
July 23rd, 2010
Determining the “right” breast implant size can be a major challenge. Let me explain the most frequent methods and their pitfalls:
1. Going by bra cup size: “I’m an A cup, and I want to be a full C cup.”
The problem: There is no standardization of cup size among bra manufacturers. A Playtex C is frequently a Victoria’s Secret D. A woman who fits a 34 D cup may also fit a 36 C. So cup size is imprecise—at best—and sometimes closer to just a guess.
2. Relying on a surgeon’s determination of the “correct” size based solely on breast measurements.
It has become popular among breast implant surgeons to measure the width of the base of the breast, find an implant with the same diameter (based on a chart provided the implant manufacturers), and then tell the patient that this is the magical “right size.” Although this seems reasonable anatomically, it seems to me that your wishes regarding size are much more important than the surgeon’s. While a surgeon can and should provide guidance regarding implant size, the ultimate choice should be yours. If your “right” size is different from his, your surgeon should be flexible (rather than mindlessly following his breast diameter chart).
3. Stuffing your bra with different sizes of implants until you find the right one.
This is great for marketing purposes. You get to “try on” different implants until you find the right size. The problem is that the actual implants go under the breast tissues, not over them. Superimposing the implants on top of your breasts creates a snowman effect (one sphere stacked on top of the other), which exaggerates the projection of the breasts relative to what will actually happen in the operating room. Women commonly choose implants that are smaller than they actually wanted.
What do I do in my breast augmentation practice?
I think in terms of implant volumes: 330 cc, 360 cc, 390 cc, etc. You think in terms of cup sizes. Neither of these allows us to communicate effectively. So I use the one thing we can both see: photos.
You can choose among the before and after photos of breast augmentations on our website, among the hundreds of photos in our office photo albums, or among any photos from any magazine or internet site. (There’s obviously no shortage of available breast implant photos.) Although you might not know the cup size of the women you choose or the number of cc’s, it really doesn’t matter. You simply look through breast photos and categorize them as “too big,” “too small,” or “about right.” I will analyze the photos with you. As long as your choices look reasonable for your frame, the choice of size is yours. I believe that there is a right range of sizes rather than a specific right size. Photos of desired breast size don’t work perfectly, but they seem to work better than anything else I’ve tried.
Click here to watch a video about breast augmentation and a patient’s experience with the procedure.
For more information about breast implants, please visit http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
June 25th, 2010
If a woman has not undergone prior breast surgery, I place the vast majority of implants below the pec major (pectoralis major) muscle. Why? Submuscular breast implants have the following advantages:
1. Reduced risk of capsular contracture.
The scar tissue around the breast implants is less likely to become excessively tight if it is being stretched constantly by the motion of the overlying muscle.
2. Reduced risk of interference with mammograms.
Although any breast implant may interfere with mammograms, the muscle can be used as a divider to separate the overlying breast tissue from the underlying submuscular implant.
3. Reduced risk of excessive implant descent or “bottoming out.”
Breast implants placed below muscle are supported by the overlying muscle. In contrast, implants placed above muscle (subglandular breast implants) are supported only by the overlying skin and breast tissues.
4. Reduced risk of visible implant rippling.
All breast implants ripple along their edges. Saline breast implants ripple more than silicone gel breast implants. When implants are placed below muscle, the upper inner two-thirds of the implants are covered by the pec major muscle, significantly reducing the extent of rippling.
5. Reduced risk of unnatural bulging of the upper breasts.
The pectoralis major muscle blunts the junction of the upper implant edge and the chest wall, generally yielding a more natural breast appearance.
On the downside, placing implants below muscle requires greater surgical time, effort, and skill and often causes more immediate postoperative discomfort. In athletes, implants below muscle may sometimes weaken the pectoralis major muscle, and the implants may “jump” with forceful muscle contraction. In my 15 years of private practice, however, the advantages of subpectoral implant placement have far outweighed the disadvantages in the vast majority of women.
Click here to watch a video about my breast augmentation technique and results.
For more information about breast implants, please visit http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
May 24th, 2010
Silicone gel breast implants feel more natural and ripple less than saline implants. But are they safe?
Silicone gel implants were introduced in 1962 and were very popular in the U.S. for three decades. However, in 1992, the FDA (U.S. Food & Drug Administration) placed restrictions on the use of silicone gel following multiple reports of autoimmune diseases (such as arthritis, fibromyalgia, and lupus) reportedly linked to silicone gel. As a result, when I did my plastic surgery residency at Parkland Hospital in Dallas from 1992 to 1994, we took out many more implants than we placed. Of course, there were also $3 billion of lawsuits against the silicone gel implant manufacturers.
For the next 14 years, silicone gel beame the most thoroughly studied substance on earth. Despite multiple attempts to induce a reaction to silicone gel in lab animals, no inflammatory response could be incited. Human studies failed to demonstrate silicone antibodies. The American College of Rheumatology (rheumatologists treat autoimmune diseases) subsequently concluded that there is no demonstrable link between silicone gel breast implants and any autoimmune disease process.
In November 2006, the FDA reversed its 1992 decision and approved Allergan (formerly Inamed) and Mentor silicone gel implants for use in the United States. However, the FDA has attached some strings to the use of silicone gel. While there are no age restrictions for saline implants, silicone gel breast implants are only allowed in woman ages 22 and up. In addition, the FDA has stated that while intact silicone gel implants are safe, the safety of ruptured silicone gel implants has not been conclusively established. Therefore, the FDA recommends MRI (magnetic resonance imaging) studies of the breasts at 3 years postoperatively and every 2 years subsequently. These studies are expensive (at least $1500) and are not covered by insurance. As a result, most women are choosing not to undergo regular MRIs postoperatively.
Given the fact that the manufacturers offer a 10-year implant warranty that covers most or all surgical costs if the silicone gel implants rupture, an MRI prior to your 10-year implant anniversary is probably a good idea. Better to have the manufacturer pay the cost of replacing a ruptured implant than pay it on your own.
So is silicone gel safe? If the implants are intact, the FDA says “Yes.” If they’re ruptured, the FDA says “We’re not really sure.” I personally do not think that silicone gel is an evil substance. As long as you understand that there is still some residual controversy surrounding silicone gel, I think it’s very reasonable to use. If silicone gel implants scare you, then saline breast implants remain an excellent alternative in most women.
For more information about breast implants, please visit http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
April 16th, 2010
Welcome to the inaugural issue of the CosmeticSurgeryPlano blog! Our first series of blog entries will concern everyone’s favorite cosmetic surgery topic: breast implants.
Silicone gel advantages:
1. Softer to touch, feel more like breast tissue.
2. Reduced rippling relative to saline implants.
Saline advantages:
1. Smaller incisions (3 cm—about 1.25 inches versus around 5 cm for silicone gel)
2. Lower risk of capsular contracture (hardening of the implants due to scar tissue)
3. Lower cost (around $1200 to $1500 lower).
4. Less controversy (I’ll address this in the next blog).
There is no perfect implant. If there were, we’d only be discussing one kind of implant type (rather than two).
Silicone gel breast implants are probably better from a purely cosmetic standpoint: they feel very similar to breast tissue.
Saline breast implants are probably better from a purely safety standpoint: it’s hard to argue with the safety of a bag of saltwater.
In general, if you have a reasonable amount of breast tissue, subcutaneous fat, and breast tone, saline implants will be reasonably well-camouflaged and may be a good choice.
On the other hand, if your breasts are very small (A minus), you are extremely thin, and/or have poor breast tone (i.e. you don’t have much tissue to cover your implants), you may want to consider silicone gel.
Click here to watch a video about breast augmentation and a patient’s experience with the procedure.
For more information about breast implants, please visit our webiste.
More about breast implant safety considerations in the next blog…
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | 1 Comment »
