Newport Beach & Orange County, CA
As mentioned in the Breast Enhancement Overview, the four clinical conditions of the breasts are:
- Heredity
- Acquired
- Asymmetry
- Mild Ptosis
In all of these conditions, there can be a significant improvement in using breast implants. The Newport Beach and Orange County breast implant patient is educated about implants during the consultation. It should be noted that breast implants are extremely safe, will not cause disease, will not affect nursing, and will not prevent the detection or treatment of any breast disease.
The breast implant patient is asked to make four significant decisions before undergoing breast augmentation. These four patient decisions are:
- Site of the surgical incision
- The size of the implant
- The type of the implant
- The anatomical plane that the implant is to be inserted
The breast implant patient is given a choice of four incision sites but is warned that regardless of where the incision is placed, the manner in which the incision heals is out of control of the physician. Regardless of where the incision is placed, the incision may heal with a significant, visible scar and the patient must take this into consideration in making an informed decision as to where the incision site should be.
The four breast implant incision sites are:
- In the armpit
- At the region of the naval
- At the conjunction of the pigmented and non pigmented area of the front of the breast which is called a periarelar incision.
- An incision that is made just under the breast in the natural crease which is what we refer to as infra mammary incision.
An example of a post-surgical scaring of periarelar area is shown and it should be obvious that scaring of this nature is first, unpredictable, but when it occurs it is nearly impossible to correct. Because of that, we advise patients that if they elect to have the incisions made inside the armpit or around the navel or in the periarelar and they should happen to scar, then they have to accept that as a possibility and live with the consequences. If an incision is placed in the inflammatory crease, it usually is well hidden and usually heals with little or no scar and most of our patients prefer that site for the incision.
The next decision that the patient must make is the size of the breast implant to be used. We advise patients during their consultation to have a non padded “dream bra”. We then show the patients a variety of implants. there are a variety of sizes and there are also a choice of profile shape of the implant so that the implant can either be a high profile, a medium profile, or a low profile implant. The patient then puts on the non padded dream bra and uses a variety of sizer implants to determine the size of the implant that she desires. It is our philosophical approach that the patient should decide for herself how large a implant she should use. We do not feel that it should be our decision to advise a patient the size of the implant because after all, it is her body, they are her breasts, and we philosophically don’t feel it should be up to us to impose upon a patient to have a certain breast size.
The next decision a patient must make that of the implant type. Basically, at our Newport Beach facility, there are two types of breast implants:
- There is an inflatable implant that is filled with salt water that has been referred to as a saline or inflatable implant
- Next there is a silicone implant which is pre-filled with a silicone gel.
It should be noted that both of these implant shells are in fact silicone. But in one instance, the implant is filled with salt water and the other is pre-filled with a silicone gel. The patient is also educated that implants are either smooth, or what is referred to as textured. The patient is able to actually feel and touch the implants and it is immediately apparent that the textured implants are thicker, more firm, and in our opinion not as ideal as the smooth implant. Also, the patient must decide if they want a high profile, moderate profile, or a low profile implant. The patient is shown a variety of implants. Some are inflatable, some are pre-filled. They come in a variety of sizes and profile shapes and are either smooth or textured. The patient then is able to ask questions about any of the implants in the attempt to make an intelligent decision as to the type of implant and the size that she prefers.
A very important issue in placing breast implants is which anatomic plane the implant should be placed in. The patient has a choice of either putting it in under the pectoralis muscle or putting it over the pectoralis muscle and under the breast itself. This is called a sub glandular as compared to a sub muscular implant. The patient is educated regarding the pectoralis muscle and is shown diagrams of the muscle and is shown that the muscle is attached to the breast bone. The patient is educated that the implant, if placed under the pectoralis muscle, cannot go directly to the midline to create ideal cleavage because the attachment of the muscle to the breast bone prevents the implant from getting to the midline. It should also be noted that the lower part of the implant, even if placed under the muscle, is not under the muscle and it hangs below the muscle. So there is a general misconception that the muscle in affect acts as a support for the implant when in fact the lower portion of the implant is not supported at all by the muscle. The patient is then shown a variety of examples of patients who have had sub muscular implants and the following are examples of sub muscular implants which can result in sub muscular deformity especially when the patient contracts the pectoralis muscle. If a patient places their hand on their own breast, and contracts the pectoralis muscle it becomes obvious that by nature the breast tissue is in fact over the muscle, not under the muscle. So that putting the implant under the muscle, is not in keeping with the natural position of the breast tissue. The patient is shown the following examples of patients who have had implants placed under the muscle and we can clearly see excessive cleavage and displacement of the nipple. Nipples ideally should be located in the front of the breast. These patient examples also reflect the distortion that may occur on contraction of the pectoralis muscle. We can see that there are a variety of abnormal configurations as a result of placing the implant under the muscle not the least of which is an excessive amount of cleavage. Because of the anatomic structure of the pectoralis muscle, another very common condition is what we refer to as the “double bubble” affect. When the patient contracts the pectoralis muscle, the lower edge of the pectoralis muscle then creates a indentation in the implant creating the obvious double bubble affect.
Patients are also educated that any implant placed inside the body will by nature develop a scar tissue protective barrier around the implant. This is true whether it is a facial implant, breast implant, hip implant, or any other type of implant. The scar tissue is what we call a capsule and usually the scar tissue is paper thin and is a natural protective mechanism of the body to surround the implant material. The scar tissue, or capsule, is unpredictable and at any point in this patients life, that scar tissue can get thick or hard. Being that a patient has two breast implants, the future of the capsule of each of those implants is unpredictable. One may remain soft for the patients entire life and the other one may get thick or hard at any point in that patients life. That could be three months after surgery, 8 years after surgery, but probably never. The patient has to understand that it is an unpredictable phenomenon and that in the even that it occurs, the breast can either feel hard, be tender, or change shape including develop surface rippling. If that occurs, then the solution is to take the patient back into surgery and to release the scar tissue so as to create a “bigger house” for the implant. Opening the capsule is a relatively simple procedure and it is a clinical condition that we call a capsular contractor of the breast tissue. The photograph shows an example of a patient who first has an under the muscle deformity as well as a deformity of the left breast which is a result of a scar tissue contracture or capsular contracture of the left breast. The comparative photograph is the same patient in which her treatment consisted of converting the implant from under the muscle, to over the muscle so you can see the patient in a relaxed state has a much more natural appearing breast with better cleavage and when she contracts her pectoralis muscle, she doesn’t have that abnormal cleavage that she has before the surgery and her breasts are far more symmetrical. The idea of the consultation with this breast patient is to educate and allow the patient to make an informed decision. The staff and the physician is not to attempt to influence the patients decision. The goal is to educate the patient, tell them the pros and cons on each of these decisions they must make, and then follow the desires of the patient. This, in affect, insures that the patient gets exactly what they want, not necessarily what the doctor and his staff wants.
Sometimes we see patients that have multiple defects. The following photograph is a patient who had implants placed under the muscle and it was performed through an incision that is on the right side. A periarealar incision on the top portion of the breast, and on the left side, a pariarelar incision on the bottom part of the breast. Close attention to the incision on the right side shows significant visual rippling and when the patient is contracting her pectoralis muscle, we see a significant increase in the cleavage, and a typical under the muscle deformity. This is a patient who had surgery in which the implant was converted from under to over the muscle. She previously had saline implants and elected to have silicone implants. The ripple affect at the site of the right incision was supported by using a filler material called “stratis” that was placed between the patients breast tissue and the implant to create a smoother affect of that area of the breast. Post-operatively the patient has had improvement in a multitude of deformities that were a result of incision placement and self muscular placement of the implant.
The patient is also advised that breast implants can leak. The leakage can occur at any time in the future of the patient. The leakage can occur in a year, or five years, or eight years, but probably never. The significance of leakage, is if the patient has an inflatable saline implant, and there happens to be a leak, the saline will leak out of the implant and their will be a deflation of the breast and there will be a significant change in the size of the breast so that the breast implant that leaks will completely deflate and the patient will return to the pre-operative size and shape. The photograph shown is one where the left implant has remained intact but the right implant has deflated creating a smaller sized breast. The solution for this condition is one where a small incision is made, the deflated implant is removed, and a new implant is placed and in this case the patient was very pleased with the size, shape, and position of the left breast so that the exact volume was used to create symmetry.
If a patient elects to have a silicone implant, and develops a leak, once again it is unpredictable whether and when the leak can occur. Usually, if a silicone implant leaks, the silicone will stay within the protective tissue capsule and it will remain intra capsular.
If an x-ray is taken, the x-ray may reveal the implant and may reveal evidence of a slight leak of the silicone gel but it will also usually reveal that the leak remains within the capsule. This type of condition then is discussed with the patient and the patient is educated as to the pros and cons of replacing that implant. Many patients prefer to just have periodic examinations to make sure that the leak stays intra capsular, but some patients who have a basic silicone leak anxiety prefer to have a surgical expiration with removal of the leaking implant and replacement with a new implant. Anytime that revision surgery is performed, the patient has some choices to make. Such as, should they convert from a saline to a silicone, or vise-versa. Should they change the size of the implant either going smaller or larger. There is no better time to accomplish that change that the patient desires. We can show a variety of examples of patients who are ideal candidates for breast augmentation and we can begin with one of the four conditions that make for ideal breast implant candidates.
The first is a hereditary condition where the patient didn’t develop completely to her liking and wanted to have larger breasts. In this case, we use an incision in the crease underneath her breasts and as we can see that incision is very inconspicuous and that patient has a very natural appearance.
The second clinical condition is one where the patient has an acquired loss of breast tissue either through general weight loss or because of nursing. But in each instance, there is a significant improvement in the clinical condition simply by using a breast implant. Another example of an acquired condition is one where just by nature the patient looses breast tissue but it can be replenished using an implant and in this case, an incision in the crease underneath the breast.
The next condition that lends itself well to breast augmentation is one of asymmetry where the patient has a significant difference between one breast and the other either in size, shape, or configuration. A variety of examples are shown where that condition is improved simply by using breast implants of different size and location so as to create a far more symmetrical appearing breast.
The final example of an ideal candidate for breast augmentation is one where the breast, over the years, begins to sag and loose volume. This is a condition we refer to ptosis. We can see an example of a patient who had a significant improvement simply by using a breast implant which not only created a better contour to the breast, but also elevated the breast both in actuality and by illusion, we see that the nipple is centered in the normal anatomic position of the breast and the incision is hiding in the crease underneath the breast. This is an example of correction of a sagging breast.
In summary, breast augmentation is an extremely common procedure performed for a variety of different clinical conditions. It is extremely important for the patient to make the selection regarding the sight of the incision, the type of implant, the size of the implant, and whether the implant should be placed beneath or above the muscle. It is also very important for patients to also have informed consents so that there is a complete disclosure as to all of the possible downsides of breast surgery. The ultimate goal of breast implant surgery is to have soft, supple, symmetrical breasts, all of which result in the ultimate goal in complete patient satisfaction.
Breast augmentation is performed at Newport Beach Center for Surgery usually under a very light, general anesthetic. The anesthesia statistically is safer than the patient driving to or from the clinic. The surgery is performed in such a way where a limited incision is made, usually in the infra mammary crease. A pocket is created under the breast tissue and over the muscle and an implant is then inserted. At the patient’s request, either an inflatable implant or a pre-filled implant is inserted. On completion of the procedure, a light compression support dressing is applied and the patient is transferred to the recovery room where after a very short recovery period is then discharged to the care of a responsible adult who then takes the patient home. Typically, the patient has no pain, feels fine, and even the day of the surgery, is up and around, is able to use the bathroom facilities, is able to have dinner, and have a comfortable night’s sleep.
The following morning, the patient is given two options. One is to remove the support dressing at home, and then to report back to the office. Then the patient is advised to use some type of sports support compression bra for the next three or four days. The patient also has the option of coming into the office where the staff removes the dressings and checks the breast. Then the patient uses a compression bra over the next four or five days. The patient is advised the very next day after surgery to get into a shower, do all of her personal hygiene, engage in normal activities, regular diet, and regular sleep habits. The vast majority of patients, the most that patients need is extra strength Tylenol. The vast majority of patients breeze through the surgery with minimal discomfort and can resume their normal lifestyle beginning the day after surgery as well as extremely gratified and happy with the surgery.
A common misconception is that breast implants must be replaced approximately every ten years. That is simply a general misconception because unless the patient has a capsular contraction which creates discomfort, or if a patient has a leakage and there is a clinical indication and necessity for replacement of the implant. The implants have a lifelong expectancy. There is no need to replace the implant unless there is a clinical indication or desire on the patient’s part to change the implant.
For more information about Orange County breast implants and beast augmentation surgery, contact our Newport Beach Breast Implants surgeon for a personal consultation.
