Charlotte Breast Augmentation

Breast Augmentation (Augmentation Mammaplasty)
Breast augmentation is among the most commonly performed cosmetic surgery procedures in the world today. Either silicone or saline-filled implants are inserted either under the crease of the breast, around the nipple, or through the armpit.  The implants can be placed under the breast tissue or beneath the main chest (pectoral) muscle.  After surgery, breasts will appear fuller and shapelier. Incision scars will fade over time.  We have listed frequently asked questions in order to provide you with information regarding breast augmentation.
 
WHAT MAKES PREMIER PLASTIC SURGERY CENTER’S “QUICK RECOVERY BREAST AUGMENTATION SO DIFFERENT? 
Under ideal circumstances, any elective surgery would result in minimal discomfort and a speedy recovery.  Though it is not really possible to have absolutely no discomfort after surgery, the techniques utilized by Dr. Ferrari at Premier Plastic Surgery Center now make it possible to minimize the discomfort after procedures and return to normal activities sooner.  Over the years after thousands of cases, he has perfected the breast augmentation procedure and so we now call it our “Quick Recovery Breast Augmentation”. 
 
When most surgeons perform breast augmentations, they typically utilize blunt trauma techniques to create the pocket which will accommodate the implant.  As a result, there is bleeding and bruising of the tissues which causes more inflammation and therefore more pain.  Dr. Ferrari’s techniques start weeks before the surgery ever begins.  First, we EDUCATE patients as to the NUTRITIONAL SUPPLEMENTS they can begin taking preoperatively to help their bodies heal faster.  Second, LOCAL ANESTHETICS are injected after the patient is put to sleep, but before the surgery begins.  This allows the surgery to be done with less intravenous medications which results in a decreased inflammatory response to the surgery which again, leads to less discomfort.  Third, Dr. Ferrari performs the surgery without blunt trauma, but rather CAREFUL AND PRECISE creation of the pockets for the implants with meticulous attention to stop any bleeding.  Excess blood left in the pockets will cause more irritation of the tissues and lead to more inflammation and more soreness.  At the end of the procedure, LOCAL ANESTHESIA is either sprayed into the pocket to assist with post-op discomfort or, if the patient chooses, a PAIN CONTROL PUMP is placed which slowly and continuously drips local anesthesia into the breast implant pockets for 3-4 days.  For those patients who elected to have the pain control pumps placed, they experience almost complete breast numbness while the pump is in place and take minimal, if any, oral pain medication.  We also encourage LIGHT ACTIVITY to keep the muscles from becoming stiff and uncomfortable.  A light, compressive ACE WRAP and BRA are placed at the end of the case to further reduce post-operative swelling and tenderness.  We encourage our patients to return to non-strenuous activity within 24 hours of their surgery.  Most of our patients typically say that the procedure was much easier than they ever thought it would be and highly recommend it to other women.  They only regret is that they didn’t do it sooner so they could enjoy the benefits of their appearance longer!
 
SHOULD I HAVE MY IMPLANTS PLACED OVER OR UNDER THE PECTORAL MUSCLE? 
One of the decisions you must make is whether to have your implant placed under or over the pectoral muscle. All patients are given information to assist them in making a decision that best suits their aesthetic goals and lifestyles. 
 
The BENEFITS of having the implant UNDER THE MUSCLE (“submuscular”) include:

1. Saline implants typically look better under the muscle (“submuscular”) because there is more coverage of the upper part of the implant which tends to hide the edge of the implant.  Also, saline implants have a higher tendency to show visible rippling and the pectoral muscle can minimize the visibility of the rippling in the cleavage area.  The muscle does not cover the lateral or inferior aspects of the implant (i.e. technically called “partial submuscular”) and therefore rippling may be visible in these areas.  Silicone implants can be put under or over the muscle and look good in either position.
2. Mammograms are slightly better with submuscular implants.
3. The capsular contracture rate is slightly lower for submuscular implants when compared to implants put under the breast gland (“subglandular”).  However, if the implants are placed in the SUBFASCIAL plane over the muscle, then the capsular contracture rate is almost the same as under the muscle placement.  (Dissection into the subfascial plane is achieved by lifting the tough fibrous fascia layer off the pectoral muscle along with the breast gland.)  At Premier Plastic Surgery Center, we have a very low capsular contracture rate (less than 5%).  In addition, we purchased a laser in 2007 which can soften the capsular contractures without performing surgery.  Of the few patients that have developed capsular contractures and received laser therapy, over half of them did not need surgical revision because the laser was able to soften the scar tissue capsules.
4. The pectoral muscle helps hold the weight of the implant so the tendency to sag should be less.  However, if a woman does a lot of chest exercises, this can actually cause the implants to drift laterally and inferiorly over time (see # 4 below).

 

The DISADVANTAGES of having the implants placed UNDER THE MUSCLE include:

1. The post-op recovery is more painful because the muscle gets stretched.  As a result, we recommend patients consider getting a PAIN PUMP placed at the time of surgery.  The pain pump will slowly drip local anesthesia into the breast to numb up the entire breast and greatly alleviate the discomfort associated with the stretched muscle.  The pain pump does not cause sedation so you can be alert and have her pain controlled.  Also, there is no scarring from the tiny pain pump catheter (tube). As a result, many of our patients do not need to use any narcotic pain medications, thus avoiding the potential side effects of those drugs, and enjoying a quicker and more pleasant recovery.
2. The implants get pulled up by the pectoral muscle and ride high for up to three months.
3. Whenever the pectoral muscle is flexed (even in daily activities such as lifting grocery bags), the breasts will move with the muscle.  Some women find this breast animation disturbing and unnatural.  In addition, it sometimes brings unwanted attention and questions regarding why their breasts move in that manner.
4. For women that like to do upper body exercises such as weight lifting, resistance training, Yoga, Pilates, push ups, bench press, chest flyes, etc., the pectoral muscle can stretch out the implant pocket over time and cause the implants to drift laterally and downward.  To repair this, the implants must be removed, the implant pocket adjusted with multiple internal stitches, and a new pocket created above the muscle in the subfascial plane.  In addition, some women also need removal of excessive breast skin (i.e. breast lift) at the same time in order to regain a normal shape.  This would lead to breast scarring.  Therefore, for athletic women who want to continue doing chest exercises, we typically recommend that the implants be placed above the muscle in the subfascial plane.  We also recommend silicone implants for above-the-muscle subfascial placement because they have a more natural look and feel with less tendency than saline implants to show visible rippling.  For those who choose subfascial augmentation, we do not recommend the pain pump because it is not necessary.

 
The BENEFITS of having implants placed ABOVE THE MUSCLE (subfascial placement) include:

1. Less pain.  For this procedure, it is not necessary to get the pain pump option mentioned above.  Patients typically go back to work in a few days verses about a week for submuscular augmentation patients.
2. Quicker recovery.  When the implants are placed above the muscle, the muscle does not lift the implant as is the case with submuscular placement.  Therefore, the implants have “settled” into their natural position soon after surgery.
3. With implants above the muscle, there is minimal (if any) animation of the breasts with flexion of the pectoral muscle. 
4. With implants above the muscle, a woman can perform heavy chest exercises without dislodging the implants. 
5. Breast implants above the muscle tend to be somewhat softer than below the muscle because in the submuscular position, the pectoral muscle tone can exert constant tension on the implant making it feel firmer.

SHOULD I GET SALINE OR SILICONE GEL IMPLANTS? 
In the 1990’s, there was some controversy as to the safety of silicone gel implants.  The media portrayed silicone implants as toxic substances that were ruining women’s lives.  Dow Corning decided on a $4 billion settlement instead of trying to fight the lawsuits.  The FDA restricted first-time augmentation patients from getting silicone gel.  However, what most people don’t realize is that the FDA did not completely ban silicone gel implants from the market.  For example, if a woman had saline implants that rippled, she could get them exchanged for silicone implants; if a woman needed a breast lift along with augmentation, she could opt for silicone implants; and if a woman had breast cancer and needed reconstruction after mastectomy, she could choose silicone implants.  So, you must ask yourself, if the FDA thought silicone implants were dangerous, then why would they allow them in cancer patients?  You should also ask yourself why the United States was the only country in the world to put a ban on silicone implants.  The story is long and convoluted involving political and financial gain, but suffice to say that the implant companies repeated all their safety studies and in 2006, the FDA re-approved silicone gel implants for women over 22 years old. 
The BIGGEST BENEFITS of SILICONE implants over saline is that they look and feel more natural.  Even though the implants are round, they take on more of a teardrop shape when compared to the saline implants. For small breasted women, this is particularly important.  In addition, silicone implants look good under or over the pectoral muscle (see above for details). 
The main BENEFITS of the SALINE implants is that the cost is lower and if they ever leak, your body absorbs the fluid making it obvious that you need to have a replacement.  If the silicone implant ruptures, it is difficult to diagnose because the breasts look and feel the same due to the new cohesive gel used to fill the implants.  You would need the help of a radiologist to detect a leaky silicone implant.  For that reason, the FDA has recommended (but not required) that women with silicone implants undergo an MRI scan three years after surgery and every two years after that.  The good news is that the new silicone implants have a cohesive gel that tends to stick together and not migrate like the old silicone implants.  Migration of the gel could cause the breasts or underarm lymph nodes to become lumpy, but there is no evidence that this caused disease or cancer.
The DISADVANTAGES of SALINE implants are that they tend to show rippling (and therefore typically should be placed under to pectoral muscle); feel more like a bag of water and not a natural breast; and tend to have more of a round look instead of a teardrop appearance.
 
DO THE IMPLANTS HAVE ANY TYPE OF WARRANTY? 
Yes, the implants companies we use (Mentor and Allergan) both have LIFETIME WARRANTIES on the implants for no additional charge.  In addition, if they leak in the first ten years, the implant company will also pay you a certain amount of money to help offset the fees you incur to have them replaced.  You may purchase an upgraded warranty that will increase the reimbursement level in the first ten years if desired.  Ask our staff for details.
 
WILL THE IMPLANTS AFFECT NIPPLE SENSATION?  
Most women have a temporary change in nipple sensation (either more or less sensitive) after augmentation because the sensory nerves have been stretched.  The nerves may take 3-12 months to fully recover from the stretch injury.  A small percentage (1-2%) of women do not recover sensation because either the nerves were stretched so far they ruptured, or the nerves anatomically were not in the right place and were damaged at the time of surgery.  There is no way to tell in advance if you are at risk for losing nipple sensation.
 
WILL I BE ABLE TO BREAST FEED AFTER AUGMENTATION?  
Yes.  If you choose to have your access incision in the underarm or at the bottom of the breast, then the breast should function normally.  If you choose to have the incision around the nipple, then some of the ducts will get divided and there will be some decreased milk production, but that will not prevent you from being able to breast feed.
 
WHICH INCISION OPTION IS BEST FOR ME? 
As plastic surgeons, we always try to hide scars as well as minimize them.  The UNDERARM incision is a great way to hide the scar for those who want implants placed UNDER THE MUSCLE.  When a lot of surgeons use the underarm approach, they take a blunt instrument and rip and tear to create a pocket for the implant.  This can cause excessive pain, bruising, slower recovery, increased risk of internal breast bleeding after surgery, and higher risk of capsular contracture.  At Premier Plastic Surgery Center, we have never used this blunt trauma technique.  We have always used endoscopic (or “fiberoptic”) scopes with sterile cameras so we can see inside the breast and precisely make the pocket exactly where we want the implant to be placed.  We also stop every bleeding blood vessel along the way.  Typically, patients lose less than a teaspoon of blood during the procedure.  The scars are well-hidden along a natural fold in the underarm.  A year after surgery, most patients cannot find their own scars.  We can put any size saline implant through this access, but because silicone gel implants are pre-filled, we usually limit the size of silicone implant that we put through the underarm to approximately 350cc.  For those who want their implants above the muscle or silicone implants larger than 350cc, then next option we recommend would be at the BOTTOM OF THE BREAST (inframammary crease).  This incision is placed just off the crease and slightly on to the breast in order to avoid scar irritation by the bra.  For silicone implants, we routinely use the KELLER FUNNEL (see below) in order to reduce the scar length, reduce the risk of infection, and minimize the chance of getting a capsular contracture.  You would also have the option to have the incision made AROUND THE AREOLA.  This scar typically forms a fine line and is placed at the junction of the pigmented areola and lighter-colored breast skin in order to try to hide it.  Unfortunately, this access has the disadvantage of having the highest chance of losing nipple sensation, highest infection rate, highest capsular contracture rate, and leads to some decreased milk production.

WHAT IS A KELLER FUNNEL? 
The Keller Funnel is a soft, nylon, disposable triangular “sleeve” (similar to an icing bag) that allows us to insert the silicone gel implants in through a smaller opening and minimize any chance of damaging the implant during its’ placement.  In addition, the implant never touches the skin during this process.  Preliminary data on this device indicate that it may also be effective in reducing the likelihood of developing a capsular contracture.

WHAT IS A CAPSULAR CONTRACTURE AND HOW CAN IT BE PREVENTED? 
Whenever any synthetic device is implanted in someone, the body will form a scar tissue capsule around the object.  The good news is that this scar tissue capsule can help hold the weight of the breast implant and thereby reduce the tendency to droop over time.  However, in some women (for reasons we don’t fully understand), the scar tissue capsule can shrink and squeeze the implant.  We call this a “capsular contracture”.  If this occurs, the breast will feel firmer and the implant typically takes on the form of a sphere.  The capsular contracture can also change the shape or position of the breast implant.  Typically, the implants are displaced upward.  Factors that increase the risk of capsular contracture include trauma, bacterial infection, excessive blood or fluid (i.e. “hematoma” or “seroma”) in the breast pocket, smoking, and radiation. To prevent capsular contractures, we use meticulous surgical technique to assure complete sterility and insure that there is no bleeding at the end of the case.  We also use powder-free gloves, antibiotic irrigation, and a “no touch” technique (the implant never touches the skin or surgical drapes.  It is either in its’ sterile container or we are inserting it in the patient.  Only the surgeon touches the implant; never the scrub tech or nurse.)  The “cleaner” the implant, the less likely a capsular contracture will form. Also, patients are instructed on how to do proper breast massages to further minimize the chance of contracture.  Vitamin E along with multivitamins has also been shown to be beneficial.  Anti-asthma medicines such as Accolate or Singulair have been used with limited success. This would be an “off label” use of these medications which means the FDA does not recommend these medications for capsular contracture.  Therefore, we at Premier Plastic Surgery Center also do not recommend Accolate or Singulair because they offer limited benefit and have multiple side-effects associated with them. Finally, textured implants may reduce the likelihood of capsular contractures, but some studies failed to show any benefit. 
 
We hope this information has been helpful.  For more information, please feel free to CONTACT US at Premier Plastic Surgery Center.  Call us at 704-844-8344. 
 
In addition, you can click here to download our free report “THE BIGGEST MISTAKES PATIENTS MAKE IN PLASTIC SURGERY AND HOW TO AVOID THEM”. 
 
You can also click here to see BEFORE AND AFTER PHOTOS.

Dr. Victor Ferrari, a Breast Implants Charlotte specialist, will answer any questions you may have about Breast Augmentation surgery. Click here to contact Dr. Ferrari and setup a consultation today!