By Dr. Patrick Hsu
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 associated with less rippling. They feel more like breast tissue and tend to have a more natural look 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.
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.