Breast Augmentation in Seattle

Could it be that natural herbal supplements are dangerous while silicone is safe? Several products have appeared over the years claiming to enlarge breasts using “safe, all natural” herbal supplements. Yet despite the marketing claims, no clinical studies have ever been published to verify either the safety or effectiveness of these supplements. An article published in the medical journal Obstetrics & Gynecology raised serious questions about both aspects. Since the intended effect of these products is stimulation of the breast tissue in a manner similar to estrogen, there is a real possibility that the risk of breast cancer could be increased. Only large scale, long-term studies could answer this question.

There is a lot of confusion about the potential benefits of “gummy bear” implants, also known as cohesive implants, but most correctly called “form-stable” silicone implants (Allergan Style 410, Mentor CPG, and Sientra). These have been in use around the world for several years but only became available in the U.S. in 2012-2013. In order to understand the role of shaped implants, we need a little history: a while back, implants with a “teardrop” profile were introduced because that was believed to create a more natural shape. However, it was later shown that the round implants actually had the exact same profile in the upright position. Round implants, on the other hand, “behave” more like a natural breast and so become the most popular choice.

But there remained a concern about silicone gel leakage; what happens when the implant ruptures? The answer is basically nothing. That is because gel is a semi-solid, not a liquid. In scientific words, it is cohesive. The newer implants were called “gummy bear” implants, used that term to emphasize that the silicone is highly cohesive, meaning that you could slice into it like gelatin and it holds its form. (Hence the correct term “form-stable.”) But the softer gel in round implants is also cohesive, just softer, so it may very well continue to be the more natural-feeling implant. And the form-stable implants have a further disadvantage of requiring a larger incision for insertion, so there is a longer scar.

But because form-stable implants are shaped, not round, they provide an option where the foundation of the breast aren’t round. They provide a choice where the round implants may just not fit the size and projection that the patient wants. Bottom line is for a more natural result, you need to take into account your goals as well as the limitations of your existing anatomy, not make a choice based only on the features of the implant.

There are several compelling reasons to place the implants under the pectoral muscle, which is behind the breast tissue: lower risk of capsular contracture, more thorough and easier mammograms, a more natural look for many patients, less visible rippling of the implants, and less sagging of the breast over time. The downside is a high percentage of distortion of the breast with muscle flexion, called animation deformity. Using the traditional technique for submuscular placement of (dual plane), this occurs to some degree on more than 3 out of 4 cases. In order to achieve the benefits of going under the muscle without the common problems, I developed the split muscle technique.

Basically, the idea is to use the pectoral muscle to cover the upper portion of the implant, where it is most important. The difference between this and the dual-plane subpectoral method is that the split muscle technique preserves the normal attachments and function of the muscle by leaving the lower portion behind the implant. The reason for this is that the dual-plane method detaches the muscle from its attachment to the rib cage and this free edge of muscle then heals onto the scar capsule in front of the implant. When the muscle is contracted, it pulls on the capsule, causing animation deformity and often double bubble.

The subfascial (or subglandular) technique generally eliminates this, but sometimes at the expense of inadequate coverage of the upper portion of the implant. A variation of the subfascial technique called the split muscle method is often a good solution, where coverage of the upper portion of the implant is needed.

When the FDA approved silicone breast implants in 2006, they deemed them to be safe, but cautioned that they would need to be replaced every 10 years. This seemingly definitive statement is in fact misleading. Breast implants sold in the U.S. in fact have a lifetime warranty against leakage/rupture, and it seems self-evident that the manufacturers are not planning on replacing every implant for free within 10 years. The FDA points to a high re-operation rate (up to 40% over 10 years after implantation), but that is not the same as saying implants have to be replaced. Most of these re-operations are for conditions not requiring implant replacement or for simple size change request. In fact, we can expect most implants to last quite a bit longer than 10 years.

High profile, round implants have a smaller diameter but more projection compared to the standard implants. My experience is that when the implant diameter matches the natural base diameter of the breast, the result is more natural appearing and there is less rippling. With the availability of various implant profiles – high. Moderate, low – we are now able to match the diameter with a choice of different sizes.

A Keller funnel is a device that enables a breast implant to be placed with a “no touch” technique. It looks like a pastry funnel and minimizes any micro-contamination that can lead to problems such as capsular contracture (CC). We participated in a multi-center study a few years ago, demonstrating a reduction in CC to around 1% after using the funnel routinely. A Keller funnel also makes it possible in some cases to use a shorter incision. Learn more here.

Three proportions are considered to determine the right one for you. These are projection, volume, and diameter. The implant’s diameter, or width, must match the breast’s base diameter. Once that is decided on, the other two are linked; in other words, you increase implant volume (size) by using a more projected implant or decrease it by using a flatter implant. Often we use VECTRA 3D imaging to simulate results with different sizes. Learn more about VECTRA 3D imaging.

Placing implants beneath the pectoral muscle provides coverage that can create a more natural look but also has drawbacks. There are 4 options: subglandular or under the breast in front of the muscle; subfascial, which is in front of the muscle but with the thin fascia layer adding support; under the muscle with dual plane, which is the most common; and under the muscle with the split muscle technique, which Dr. Baxter pioneered and is our preferred method. Dual plane can cause a problem known as animation deformity, a distortion of the breast when using the pectoral muscle because the muscle is partially detached. This is avoided by using the split muscle method, which still covers the upper and inner parts of the implant but without detaching the muscle. Athletic women may do best with the subfascial method or the split muscle, which preserve muscle function and strength.

Related Blogs:

• Over or under the muscle? The four options for breast augmentation and how to decide
• Breast augmentation in athletic women: update
• Subfascial breast implant placement: still fashionable after all these years

An internal bra is considered when the breast, implant, or both need extra support. Primary augmentation would be done for large implants in a patient with loose, sagging breasts.

While there are different concepts of ideal cleavage, most agree that implants too far apart are unnatural and implants too close together are not everyone’s cup of tea. For implants under the muscle, the attachment of the muscle along the sides of the breast bone (sternum) limits how close the implants can be. Subfascial placement may allow for closer and higher placement. Another important consideration is nipple position; if they are naturally more lateral, then implants close together may leave the nipples pointing to the side. Implant diameter is also important. Learn More

Breast implants restore volume and a breast lift restores shape and nipple position. After breastfeeding or weight loss, breasts may have a deflated appearance that looks like sagging but can be corrected by adding back the lost volume with implants. Breasts that have sagged will need a lift (mastopexy.) A rule of thumb is that if the nipple position is lower than the inframammary fold or bottom edge of the breast, then a lift is the way to go.

Most patients can resume exercising after a week and resume most activities before that.

Several things contribute to how natural a breast implant feels: size, profile, placement, and the firmness of the gel or saline. Very large and high-profile implants will usually look and feel less natural than a moderate profile in proportionate size. More breast tissue to conceal the implant and under the muscle for more coverage can help. There are different options for gel firmness, also known as cohesivity. More cohesive silicone gel implants are more resistant to rippling but may be too firm for some patients.

It is not common to lose nipple sensation after breast augmentation, but the risk is higher with larger implants.

No, you will not have drains. We use buried dissolvable sutures, so there are no external stitches to remove.

Overall, complications are uncommon. In the early days after surgery, there is the potential for bleeding, which could require a return to the operating room, though this is rare. The long-term risks of concern are capsular contracture, in which the scar capsule squeezes and distorts the implant, causing it to feel firm and implant rupture. Our rate of capsular contracture is around 1%, far lower than published statistics. Implant rupture is typically a silent event and could go unknown for a long time. Therefore, they should be evaluated every few years, which we do here in the office with ultrasound. Learn More

Implant size is determined by both the patient’s desires and anatomical constraints such as breast diameter. After doing measurements, we will recommend a range of sizes and profiles. You can try sample sizers in a bra and/or VECTRA 3D simulations. We do this at the consultation and then confirm at the pre-op visit, so there is no pressure to make a decision too quickly. Learn More

It is impossible to place implants without a scar somewhere, but we make it as short and inconspicuous as possible.

Although all breast implants have a lifetime warranty for rupture, it can happen. When it does, it is usually a silent event because the silicone gel is a semi-solid material, so it doesn’t go anywhere. (Saline implants, on the other hand, will show obvious signs of deflation when that occurs.) We recommend having the implants screened with ultrasound every few years, which we are happy to do here in the office.

You should not avoid having mammograms because of implants. Damage to the implants is very unlikely to occur because of mammography.

We do usually recommend wearing a bra after having breast augmentation. This helps support the implants while the scar capsule forms, and we believe that it helps prevent the implants from sagging out of position.

A smooth experience with anesthesia means selecting the type that is both safest and the most comfortable. Most often, this is general anesthesia. Learn More

You should have someone with you for 24 hours after any surgical procedure.

FDA guidelines require us to tell you that breast implants are not considered lifetime devices. In the past, implants needed to be replaced every ten years or so, but now the manufacturing standards and implant designs have improved. All implants now have a lifetime warranty for rupture. The way I see it, it is unlikely that the implant companies are operating under a business model where they replace them for free every 10 years, or even that all of them will need to be replaced sometime during a patient’s life.

There is no substitute for long experience with breast augmentation, where the surgeon can see how patients do over several years. Also, because Dr. Baxter has earned a national reputation for correcting difficult problems such as animation deformity, he has a better understanding of why those problems occur and how to avoid them. His background as a formally trained artist makes Dr. Baxter and the PHASE Plastic Surgery team uniquely qualified.