Preparation for Breast Augmentation Los Angeles Breast Surgery Recovery

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  2. Preparation for Breast Augmentation
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1. Questions & Answers

What Types of Breast Implants Are Available for Breast Augmentation?

There have been varying viewpoints throughout the years about the best kind of implant to use for Breast Augmentation, and health controversies about one kind of implant that dominated news reports in the 1990's. Many women who were interested in having fuller breasts were fearful to do so because of these reports. The following describes the different kinds of implants that are available, and addresses some of the concerns regarding differences between breast implant fill material, shape, surface texture, size, manufacture, and use of implants.

  1. Breast Implant Fill Material: Although all breast implants do have a solid silicone shell (bag), they are filled with different substances such as:
  2. Saline Breast Implant: While there are a number of implants available for Breast Augmentation, currently the most commonly used is the saline breast implant.
The saline implant has an exterior sack made of solid silicone, which is filled with a sterile saline solution — like the salt-water solution that is administered for intravenous fluids. One of the advantages of this solution is its safety. Should the implant for some reason leak, the saline just gets absorbed by your body, as would the intravenous fluids used during, and after surgery. Yet another advantage of the saline implants is a very low infection rate, which is usually less than one to two percent.

Another advantage of the saline implant is that it is filled with fluid after being inserted in the breast, therefore requiring only a small incision. This is in contrast to silicone implants which are pre-filled. Also, because saline implants are filled after insertion, their final volume can be adjusted making it easier to correct for existing breast asymmetry.

  1. Silicone Breast Implants: These are implants that are filled with a silicone gel. More than 1.5 million American women currently have silicone breast implants. Some people feel that the silicone implant results in a more natural appearing breast. However, about 15 years ago, the safety of these implants was questioned in numerous media reports, and through the filing of numerous lawsuits again the implant manufacturers. Numerous afflictions, including autoimmune diseases and hardening of the breasts, were attributed to the leakage of silicone into the bodies of women who had these implants

  2. Cohesive Gel Implants: Cohesive gel implants are silicone implants that are filled with a thicker silicone gel that holds its shape and form like a "gummy bear." If you cut into a standard gel implant, the liquid silicone gel escapes from the implant shell. In contrast, when you cut into a cohesive gel implant, the implant itself maintains its shape and integrity. These shaped implants are designed with a focus upon a natural look, rather than for enlargement. Furthermore, gummy bear implants maintain their shape in an upright position that decreases the incidence of folding of the implant shell or rippling. If a cohesive gel implant ruptures, it maintains both its shape and integrity.

    One disadvantage of cohesive gel implants is that they require a slightly larger incision for insertion. Because of this, insertion is usually performed through an incision in the fold under the breast, or occasionally through an incision around the areola. Cohesive gel implants are very difficult to insert through an incision in the armpit. Finally, gummy bear implants were approved in late 2006 by the FDA for use in the United States, but their use is limited to certain age, and patient require strict follow-up with MRI to look for silent rupture.

  3. PIP Implants: PIP implants are breast implants manufactured in France by Poly Implant Prostheses, and, until recently, imported by PIP/USA. PIP implants are saline but, unlike other saline implants, they are pre-filled. They are not currently approved by the FDA for use in the United States.

  4. Expandable Implants: The Spectrum implants introduced by Mentor Corporation are expandable and can be filled anywhere from 25cc to 140cc depending on the initial size of the implant itself. They come with a small remote port that is placed over the outer chest rib cage. They can be filled over weeks to months to let the patient decide exactly on the size. The advantages are the flexibility and range of fill size and the ability to change it after surgery. The disadvantages are that it requires a second surgery to remove the port from the chest wall. There is also a higher infection rate with a remote port and that these implants are costlier than standard implants.

Another advantage of the saline implant is that it is filled with fluid after being inserted in the breast, therefore requiring only a small incision. This is in contrast to silicone implants which are pre-filled. Also, because saline implants are filled after insertion, their final volume can be adjusted making it easier to correct for existing breast asymmetry.

How will I know what size to choose?

Many women don't have a clear idea of how different cup sizes actually look. They often say that they "don't want to become too big and only want to be about a size C," At the same time, they will show their cosmetic surgeon their "ideal" photo of a woman with a Size D cup.

To make the right choice for you, you should not only consider breast size. The most important factor is how does that breast size appears on a particular frame and a particular height. Proportionality is the final arbiter of the overall appearance of the breasts. This being said, first consider the factors that should not be a part of your decision. These include basing your decision on the proportions of models and celebrities who have body proportions very different from your own. Do not do so by comparing yourself to your friends. And don't leave it all up to your cosmetic surgeon. This is a joint decision that you will make with his or her expert input about your particular physique.

Some surgeons or web sites suggest that you fill your bra with different size bags of sand, grain, or water in order to find the right size. It is actually more effective to have patients try on actual implants in a special bra during their consultation. This gives them a more realistic estimate of the final result, while also giving the cosmetic surgeon a clearer understanding of their goals.

Who would benefit most from high profile breast implants?

Standard breast implants are round and have low to moderate profile. Women who want very large and protruding breasts, but have small and narrow chests, would benefit from high profile implants because they have a relatively small diameter but a much higher profile than standard implants. In certain types of cases, when breast augmentation is combined with a breast lift or reconstruction, high profile implants might also be of advantage.

How small or how big of a breast implant can I get?

You can have a saline-filled breast implant as little as 120 cc or as big as 850 cc. If you are a small size, the 120 cc implant would make you a size A, and the 850 cc implant would make you DD. The size of the breast implant is not the only determining factor in your bra size; obviously it also depends on the size of your existing breast tissue. As the size of breast implants increase, their width increases relatively faster than their projection. Therefore, the larger the implant size you choose, the wider the breast implants will be. While larger or wider implants create a strong cleaveage, there is a limit on how large of an implant can fit on your chest. Your plastic surgeon will make a chest wall measurement and most likely recommend a range of breast implant sizes that you can choose from. In my practice, I have the patients try on different size breast implants in order to see how it looks on their figure.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.

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