Breast Augmentation: FAQ
Don’t hesitate to ask questions when it comes to your body! After all, what is more valuable? Here are some common questions we hear at NuVista Plastic Surgery about breast implants and breast augmentation along with clear explanations.
Should I Get Saline or Silicone Breast Implants?
Saline and silicone implants are both great implants for breast augmentation and understanding your options will help you make a choice you feel comfortable with. Both types of breast implants have an outer shell made of silicone—the difference is in the filling of the breast implants. Silicone breast implants are filled with a gel form of silicone and saline implants are filled with saline (salt water). Both kinds of implants have their advantages and disadvantages. The main advantage of silicone breast implants is that they tend to feel more like “natural” breast tissue. They also tend to have less “rippling” or wrinkling that can be seen or felt through the breast tissue and skin surrounding the breast implant. This can be important for a woman who has less breast tissue to start with. The difference in feel between silicone and saline implants is diminished when the implants are actually inside the body behind skin, breast tissue, and muscle. In my practice, I find that many women decide that the difference in feel is not the main factor in choosing the type of breast implant they want.
The main advantage of saline breast implants is less of what I call “maintenance.” That is to say that if a breast implant was to leak or rupture it is very easy to identify with a saline implant. It requires no testing to detect, the breast will simply deflate noticeably. On the other hand, detecting a leak or rupture in a silicone breast implant may require imaging tests. Even a mammogram may not detect a silicone breast implant leak. Periodic MRI’s are recommended for women with silicone breast implants. Additionally, the salt water of a saline breast implant is easily absorbed by the body and poses no problems to the surrounding tissues if it escapes its shell. Silicone leakage can be much more difficult to remove. Although silicone from breast implants has been shown not to cause the diseases and health concerns feared in the past, silicone leakage into the body tissues is difficult to remove completely.
In my practice another important consideration in choosing saline or silicone breast implants has to do with where a woman prefers to have the breast implants inserted. I have many patients who want an axillary approach—that means that the breast implant is inserted through a small incision in the arm pit and the saline breast implant is filled once inside the body. This allows for a small incision and for a breast augmentation with no scars on the breast itself. This approach is impractical with a silicone breast implant because the incision would have to be much larger to accommodate a pre-filled implant. But for women who do not mind insertion of the implant from under the breast fold or crease, silicone is a more viable option. See below for more about possible approaches to implant insertion.
What Are Gummy Bear Breast Implants?
This term can be confusing—mostly because it’s a slang term and not a name brand or specific implant type. Different people mean different things when they refer to “Gummy Bear” breast implants. When some people use the term gummy bear breast implant they are referring to the 4th generation of silicone implants that were approved in 2006. They are termed “highly cohesive” silicone implants. This means that the silicone that makes up the gel is less liquid-like than previous generations and is bonded to itself so that if the shell is penetrated, the silicone inside the breast implant is not supposed to leak out into the body. The gel is sort of a semi solid—like a gummy bear.
When others use the term Gummy Bear Breast Implants they are referring to the 5th generation of silicone implants which are a type of highly cohesive breast implants but are also “form stable” or “shaped” breast implants. Rather than being round, these are teardrop shaped breast implants that are supposed to more closely match the natural shape of a breast. These breast implants have more volume in the lower part of the implant and thus the breast will have more volume at the bottom. These breast implants retain their shape regardless of their environment—inside or outside of the body—just like a gummy bear retains the shape of a bear.
Shaped implants offer a new option for women, but are not right for everyone. Some women feel that their breasts already have too much of their volume at the bottom and are looking to restore a more uniform fullness. I have heard women joke that these implants give you the option of buying saggy breasts. But there are many women who feel that the shaped implant disguises the fact that they have had work done at all because the shaped implant follows the more natural contour of a breast. Shaped implants are also more expensive. Careful analysis of your own anatomy with the help of a skilled surgeon, and clear communication about the kind of results you are looking for, will lead you to the kind of implant that is right for you.
Where Are Breast Augmentation Incisions or Scars?
There are four incisions that are commonly used to place breast implants. The most common type by plastic surgeons in the United States is the “Inframammary” incision, which is the incision in the crease under the breast. The resulting scar hides itself in the fold under the breast and heals very well. The incision is typically a few centimeters long, depending on the size and type of implant.
The second type of breast augmentation incision is the “Axillary” incision, which is in the armpit. The axillary breast augmentation incision leaves no scars on the breast. The axillary incision is made in a natural crease in the armpit and the implant is placed through the incision. The scars fade very nicely and are nearly indistinguishable from the natural creases in the arm pit. Generally this incision is used with saline implants because the implants can be placed into the body through a small cut and then filled once in their proper place.
The next approach to breast augmentation insertion is the “Peri-areolar” incision. the peri-areolar incision is made at the junction of the areola and the skin. The scar is hidden where the two types of skin meet and a change in color and texture already exists. Some surgeons feel that there is an increased risk of capsular contracture with this approach because of the incision’s proximity to the bacteria in the milk ducts. Capsular contracture is the growth of scar tissue around the implant and can result in hardening and deformity of the breast. But data is inconclusive. If this is the approach you desire, talk to your surgeon about his or her perspective on these risks.
The final breast augmentation incision is called “Transumbilical Breast Augmentation” or “TUBA.” Endoscopic instruments and cameras are used to tunnel from the belly button to the breast area. The implants are then pushed through this tunnel. This is probably the least common incision in the United States. Like the axillary approach, this approach to breast augmentation also results in no scares on the breast itself.
In my clinic I use inframammary and axillary incisions for most breast augmentation surgeries.
Will Breast Augmentation Make My Breasts Perkier or Do I Need a Breast Lift?
Breast implants can create more youthful breast appearance or return volume to the breast that was lost through pregnancy, breast feeding, or weight loss. However, if the nipples or breast tissue are too low on the chest wall, or if there is an excess of breast skin, a breast lift might be needed or recommended in conjunction with the placement of the implants. Breast lift procedures add scars to the breasts. These scars vary depending how much lifting effect is needed.
Do I Need to Wait Until I’m Done Having Children to get a Breast Augmentation?
That depends. Time and pregnancy will change your breasts whether you have an augmentation before your pregnancies or after. If you have an augmentation and then have children, it is possible that you will need a lift later. But you would need that lift whether you had had your augmentation before or not. The question is, do you want to enjoy fuller breasts now, or wait and take care of any issue and changes you experience with pregnancy all at once? And pregnancy or no pregnancy, as we age women’s breasts will lose some of their support. To wait or not to wait? There is no right or wrong answer.
Breast implants usually do not interfere with pregnancy or breast feeding. Some breast lift procedures may lessen lactation to varying degrees depending on the procedure and how much tissue needs to be removed during your lift. There is no harm to the infant from nursing when implants are in place.
How Often do I Have to Replace My Breast Implants?
The average lifespan of a breast implant is between 12-15 years. That being said, I have seen breast implants last 30 years and I have seen them need replacement after just a few years. The bottom line is that you must consider them NOT to be a lifelong device and should plan on replacing them at some time in the future. The manufacturers do provide warranty options for the implants. Those warranties help support the cost of replacement if the implants rupture or leak.
Will My Breast Implants Pop from Exercise (or Sexual Activity)?
While breast implants can occasionally rupture, it is extremely unlikely that breast implants will rupture from normal activities such as exercise or sexual activity. It usually requires a great degree of force to rupture an implant, such as a high speed motor vehicle crash or being kicked in the chest by a horse (both of which have happened to patients of mine.) So a fall, a tight hug, or the wrong bra should not pop your implants. However, the vast majority of implant ruptures cannot be linked to any sort of trauma.
What is the “Down Time” or Recovery Time for a Breast Augmentation?
Everyone is a little different, but in general you can expect to be off of work for just 3-4 days. You may not need that long depending on how well you react to anesthesia. If you have surgery on Thursday and recover over a weekend, then most people can expect to go back to work by Monday. The “down time” is less of an issue than the post-surgery restrictions. I tell my patients no heavy lifting, strenuous exercise, or heavy housework for 6 weeks. No baths, hot tubs, swimming, or tanning for 6 weeks either. These restrictions may take some advanced planning on your part. Don’t have surgery 2 weeks before a cruise you want to go on. And wouldn’t it be great if you could get surgery you’ve been wanting for a long time AND a temporary housekeeper? Careful adherence to your post-surgery instructions will help you to have the best surgical outcome possible. It will make all your preparations well worth it.
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