Breast Augmentation with Silicone Gel or Saline
By Dr. Patrick Hsu
Augmentation mammaplasty, or breast augmentation, may be used to improve the size and shape of a woman’s breasts for a variety of reasons. Some women may feel their breasts are too small; some may wish to balance a difference in breast size. Women who have had children often choose breast augmentation to regain the breast size they had before pregnancy. A woman who has had a mastectomy may choose implants as a reconstructive technique following breast cancer surgery. The procedure involves the insertion of a silicone or saline implant either behind the muscle wall or within the breast itself in order to improve or restore the bust line by one or more cup sizes.
In general, women who are most suited for breast augmentation surgery are healthy individuals who are interested in improving their overall appearance. Breast augmentation can greatly improve a woman’s self-confidence and self-image, not to mention restoring or improving her satisfaction with her body. Dr. Hsu will often talk about proportionality and how many patients have a breast size that is too small for their body type. These patients can greatly improve their overall confidence by balancing the top half of the body with the bottom half. Breast augmentation with Dr. Hsu is an hour surgery from beginning to end and is associated with very few risks. Though surgery is not a cure-all and there are risks associated with any type of surgery, most women feel the benefits outweigh these potentially low risks. Dr. Hsu will highlight these risks and be sure to discuss your reasonable expectations with Dr. Hsu before agreeing to surgery.
There are two main types of breast implants used by Dr. Hsu – silicone vs. saline. Silicone implants are prefilled implants consisting of a silicone shell that is filled with silicone. The second type is a saline implant, which is filled at the time of surgery with saline (salt water). Easiest way to remember is that a silicone implant is filled with silicone and a saline implant is filled with saline. Both of these implants come in a variety of shapes, sizes and profiles. Shape can be either anatomic (teardrop shaped) or round. The different sizes will be determined by how much saline or silicone is filled into each implant, which is referred to as cc or ml (milliliters). You may hear a friend say they have 400 cc implants. That means that they are filled with 400 milliliters. As the volume goes up, the implant gets bigger. Lastly, there are generally four different profiles that mostly translate into how much projection you get. Each implant company has a different name for each profile. Dr. Hsu refers to them as low, medium, high and ultra-high profile for his patients, which is easier to remember. In general, silicone implants are softer and associated with less rippling. They feel more like breast tissue and tend to have a more natural feel when compared to saline implants. Saline implants are filled with salt water, the same salt water composition that our bodies are made of. Because they are filled with saline, they are stiffer and can have more rippling. Silicone implants will usually require a longer incision when compared to saline implants and will also have a higher capsular contracture rate. Discuss all these differences with Dr. Hsu on your consultation.
As with any operation, there are risks and complications associated with breast augmentation surgery. Dr. Hsu will discuss all possible complications with you prior to surgery to be sure you understand the risks. Although infrequent, complications that could occur specifically for breast augmentation include: bleeding, infection, poor scarring, capsular contracture, and nipple sensation changes.
Your expectations will be discussed in your initial consultation, where Dr. Hsu will evaluate your overall health and recommend the surgical techniques that are best for your breast type and skin tone. A detailed medical history will be required, including information on what types of medications and/or supplements you take in addition to whether or not you smoke. At the end of the consultation, Dr. Hsu will frankly discuss the appropriate procedure and go through your expectations in detail to ensure you understand the alternatives and risks associated with breast augmentation surgery. Dr. Hsu will also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.
Before surgery, you will be given a list of guidelines to follow, such as diet and drinking requirements, smoking, and taking or avoiding certain vitamins and medications. You will need to arrange for a ride to take you home after the procedure, and we also recommend securing someone to help you for a few days following the procedure, as you will be sore.
Your surgery will be done in a state of the art surgery center, usually located nearby. Built to provide the type of personalized care Dr. Hsu specializes in, the center is run by knowledgeable, friendly, and experienced staff with your comfort in mind. We use only the latest technology, and the facility is structured to allow you the advantages of reduced cost, easy access and a brief stay in a pleasant environment.
Because of the nature of the breast augmentation procedure, you will be under general anesthesia to minimize discomfort. Your desired results, the configuration of your breasts, and varying other factors will determine the method of insertion and placement of your implants.
The placement of your incision will be determined by what type of implant you receive, though Dr. Hsu will make every effort to ensure the resulting scar is easily concealed and as small as possible. Many surgeons will just use one incision for every single patient that they see. Dr. Hsu is trained to insert an implant in all three incisions to tailor the surgery for each patient. Dr. Hsu will usually recommend one incision which he feels is best for you, but ultimately, the decision is yours.
There are three common incision sites:
• Axillary (under the arm): This type of incision is used for both saline and silicone implants and allows for the most remote and hidden scar possible. Scars often appear to blend into the natural creases of the armpit and fade at 6 months to a year. The advantage to this incision is that there are no scars on the breast itself. Surgery will usually take an hour longer because of the increased expertise needed to perform this surgery.
• Periareolar (around the nipple): One of the most common incision sites, this method creates a circular cut around the natural edge of the areola. Scars are concealed by the natural lines and ridges of the nipple, so are far less noticeable. Breast feeding can be hindered by this type of incision so be sure to ask Dr. Hsu about this incision.
• Inframammary (in the fold under the breast): The inframmary fold incision is a small incision along the base of the breast. It is perhaps the easiest to perform however scars in this area can be particularly good or particularly bad depending on the shape and size of the breast. Breastfeeding is generally unaffected and the scar is well concealed if the patient has enough breast tissue to drop over the incision. The surgery usually takes one hour to complete with Dr. Hsu.
Stitches are used to close all incisions and additionally taped for greater support. A gauze bandage may be applied over your breasts to help with healing and then you will be placed in a surgical bra. Dr. Hsu uses only dissolvable sutures and there will be no drains placed to make the whole experience less anxiety provoking.
Though there are different methods of implantation, all procedures involve lifting the skin and breast tissue to create a pocket centered under the nipple, which is where the implant will ultimately be placed. Surgery lengths and recovery times depend on the incision and placement method, so consider carefully.
Women preferring a more “natural” look to their breast augmentation should consider submuscular placement, especially smaller breasted patients. This procedure places the implant behind the pectoral muscle rather than within the breast tissue. There is a longer surgery and recovery associated with this type of surgery, but most women appreciate the benefits of a more natural look. Patients who have more breast tissue can have the implant placed above or below the muscle with little difference. Dr. Hsu will let you know which placement may be best for you. Your needs and desired results will determine if this is the procedure for you.
Before and After for Breast Augmentation
Subglandular means the implant is placed above the muscle just under the breast tissue. Since only skin and fat are disturbed during the procedure, there is less recovery time and pain associated with it. There is higher likelihood that the implants will be palpable and edges more visible, and there is an increased risk of capsular contracture (thick scarring around the implant). Dr. Hsu will discuss with you the pros and cons of the two possible implant placement sites, and recommend the site that best meets your needs. Also, you should be aware that breast implants don’t last forever. They often require a future operation to remove and replace the original implant.
After Breast Augmentation Surgery
Fatigue and soreness are common immediately after surgery, though these symptoms often dissipate within the first week. Dr. Hsu uses a lot of local anesthesia with his breast augmentation surgeries that helps provide more pain relief. Most patients will feel sore like they did a hundred push-ups but sharp excruciating pain is very very uncommon. Medications will be prescribed to help control the pain and discomfort, helping your overall comfort levels. Some women report either some numbness or hypersensitivity in the nipples post-surgery and this usually takes weeks to months to resolve. You will be given a surgical bra, which Dr. Hsu will instruct you on the proper way to wear. The swelling may take 3 to 6 weeks to completely dissipate.
You will not have to return to remove any stitches since Dr. Hsu uses absorbable sutures, which your body’s enzymes will dissolve naturally in 30 to 60 days.
Dr. Hsu’s followup is routine and he sees all of his own followups at scheduled intervals. You will be seen one week, two weeks, one month, three months, six months and one year.
Dr. Hsu will give you a timeline to follow for resuming physical activity. How soon you return to your normal activity level depends on the type of surgery and the amount of physical activity you typically experience. Most women are able to return to work within a few days, though it depends on the amount of physical exertion required by your job. We recommend avoiding direct contact with your breasts for the first few weeks, as they will be extremely sensitive. Once that sensitivity fades, normal contact may be resumed. Heavy lifting should also be avoided for 4 weeks. In general, nothing heavier than 10 pounds. Mammograms should be continued after breast augmentation for women who are in the appropriate age group. Your mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.
The amount of noticeable scar tissue will depend on the placement of your incision. Though scars will never fade entirely, they will eventually become less noticeable. Depending on your ethnicity, firm, pink scars are expected usually around the first year and will begin to fade in around one year. Dr. Hsu is very aggressive on scars and tries to keep the incision as short and concealed as possible. You will be aggressively started on scar therapy at two to three weeks after surgery.
Whether you chose breast augmentation to enhance your appearance or correct a problem, the results are often exhilarating for most women. An improved self-image is only one of the benefits of this amazing procedure. Dr. Hsu recommends routine mammograms at intervals throughout the recovery process and afterward to ensure complications (if any) are caught and corrected early.
Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.
What causes breast implants to rupture?
The most common cause of an implant bursting is usually from trauma. This is usually associated with high impacts such as car accidents. Normal trauma that is usually experienced from falling or tripping should not, under normal circumstances, cause implants to rupture. As a manufacturer’s note, implants should be replaced every 10-15 years. This is necessary because, even if the implants are made with stronger shells, they are not designed to last forever.
Do I have to pay for fees if my implants burst?
If the implants are ruptured, the manufacturing company of said implants will usually cover the required operation costs. There are criteria that the manufacturers have put into place to warranty the device and each incident is evaluated on a case-by-case basis. If the rupture is deemed a manufacturer’s defect, the implants and associated breast augmentation repair fees for replacement are typically covered.
Breast augmentation restrictions after surgery?
For the first four weeks, it is recommended that patients avoid any heavy lifting of objects weighing more than 10 pounds, which can result in bleeding or additional pain in the early postoperative period. Patients can start easing back into their normal activities and routine gym exercises starting the second month. As a test, patients should start with a lighter weight the first few days and if no pain and/or discomfort is experienced, the can slowly increase the weight and intensity.
Eventually, implants should naturally become a part of a patient’s body. Dr. Hsu recommends permanently avoiding isolated chest exercises since these exercises focus on the pectoralis muscle and can lead to chronic pain and soreness. Additionally, they may also push your implants down and outward, causing a disfigured or abnormal shape. Isolated chest exercises include pushups, bench presses, dumbbell fly exercises, etc.
Will skin color affect how obvious a scar’s color is?
Scarring as a result of breast augmentation varies from individual to individual. All scars look red and raised for the first year before they mature. Scars will usually start to fade after the first year and improve in appearance as the years pass. Darker skinned patients usually scar worse than lighter skinned patients. Dr. Hsu is very aggressive with scar therapy and recommends that patients start with scar therapy within two to three weeks depending on the procedure.
What are some breast augmentation complications that could arise?
There are not many complications that could arise from breast augmentation surgery. In general, the most common complications with any type of surgery include bleeding, infection, and scarring. However, infection and bleeding are extremely rare because of the precautions that Dr. Hsu takes inside the operating room. Amongst other things, all implants are soaked in a solution that contains three different antibiotics while the pocket where the implants will be placed are likewise washed out with the same solutions. Moreover, Dr. Hsu uses a funnel to deliver the implant direct from a sterile container into the pocket so it does not come into contact with your skin. All of these precautions lower the risks of any complications.
How to pick from the best breast augmentation incision types?
There are many factors that come into play when deciding on incision sites. Dr. Hsu, who is adeptly skilled in utilizing all three incision sites (armpit, nipple, fold) will personally evaluate each patient before recommending the most suitable location inline with the patient’s body type and desired final look.
Will an implant move after surgery?
If the implant is designed and dissected out correctly, the implants should not move around too much and should sit evenly on the chest. Implants will begin to drop into place once the skin and soft tissues slowly stretch out. It usually takes 2-3 months before an implant is finally settled.
Will having breast implants affect an active lifestyle?
Implants should not affect an active lifestyle. There are considerations for placing the implant above the muscle in patients who are competitive athletes. Please let Dr. Hsu know what specific lifestyle you live and he can guide you through the process.
Is there a specific body type/breast type that is prescribed for saline or silicone implants?
No, saline and silicone implants can be placed in everyone. They are filled with different materials and therefore result in a different feel. Any body type can get a saline or silicone implant.
Breastfeeding after breast augmentation?
Most patients will be able to breast feed after breast augmentation surgery because not much of the breast tissue is disturbed, especially if the implant is placed under the muscle. However, Dr. Hsu cannot guarantee breastfeeding since most women who cannot breastfeed are those who have smaller breasts, which usually do not produce enough milk. Furthermore, incisions around the nipple may also slightly lower your risk of being able to breastfeed. Ability to breast feed post-breast augmentation will vary from patient to patient so it is recommended that patients ready questions they can ask during the initial consultation.
How long should I wait after breastfeeding before I can have breast augmentation surgery?
If a patient has just had a child, it is recommended that she wait at least 3-6 months before undergoing breast augmentation surgery to ensure lactation is complete. This will help reduce the risk of infection and also produce a more accurate final result.
What are the implications of a ruptured silicone implant and how does that differ from saline implants?
Ruptured saline implants will just deflate and the body will absorb the water the implant was filled with. There are no complications when saline implants rupture except for cosmetic deformity. Silicone implants are harder to detect because the majority of the silicone will typically stay within the shell because of its cohesive bear (sort of like a gummy bear’s consistency). When ruptured, the silicone gel is first contained in the implant shell and if it travels outside the shell, it is usually contained in the capsule or scar tissue surrounding the implant. Although silicone is a relatively inert substance in your body, it is always recommended that it be removed immediately to minimize the risk of infection, capsular contracture or additional migration of silicone into the breast tissue itself.
How will I know what size implants to get?
All patients who consult with Dr. Hsu will have their measurements taken and will be asked to try on implants during their initial consultation. Dr. Hsu feels that this is the best way for a patient to gauge how large they want to go while still remaining proportional to their body. Dr. Hsu stresses proportionality and will not place implants that he feels are too big and will cause long term body pains in the future.