BREAST IMPLANTS / BREAST AUGMENTATION
IN BEVERLY HILLS, LOS ANGELES
- AESTHETIC BREAST IMPLANT SURGERY -

This page contains information which you should be aware of prior to your breast implant / augmentation surgery.
Click on the particular topic to view further information.

Table of Contents

• SHOULD I ENLARGE MY BREASTS WITH BREAST IMPLANT?
• CONDITIONS IMPROVED BY BREAST IMPLANT SURGERY
• IS THERE AN AGE RESTRICTION TO RECEIVEING BREAST IMPLANTS?
• HOW DO I CHOOSE A BREAST IMPLANT SURGEON?
• HOW DO I CHOOSE A BREAST IMPLANT SIZE?
• SILICONE OR SALINE BREAST IMPLANTS?
• TEXTURED OR SMOOTH BREAST IMPLANTS
• ROUND OR TEAR DROPPED (ANATOMICAL) BREAST IMPLANTS?
• WHICH PROFILE BREAST IMPLANT DO I CHOOSE?
• BREAST IMPLANT INCISION SITES AND SIZE?
• SHOULD THE IMPLANT BE PLACED UNDER OR OVER THE MUSCLE?
• BREAST IMPLANT COMPLICATIONS
• OTHER INFORMATIVE LINKS

SHOULD I ENLARGE MY BREASTS WITH BREAST IMPLANT?

Breast enhancement surgery with breast implants or breast augmentation is the most commonly performed surgical procedure in the United States.  Every year a total of 300,000 women choose to enlarge their breasts for a variety of reasons.  To decide if breast enhancement surgery is right for you, you have to weight the risks to the subjective benefits of the surgery.  Since breast implant surgery is elective, you will have plenty of time to research the pros and cons of the procedure and arrive at an informed decision.  Take your time, ask plenty of questions and become informed.  The aim of this section of the website is to clarify some of most important points with breast implant surgery.

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CONDITIONS IMPROVED BY BREAST IMPLANT SURGERY

There are many conditions which lead women to want larger breasts. The most common are listed below.

1. SMALL BREASTS
Most women who choose to undergo breast implant surgery feel their breasts are too small for their figure. Surprisingly, most women actually want to increase their cup size by only one size, or they wish to have enlarged breast which appear natural and proportional to their figure.

2. INVOLUTED (SHRINKING) BREASTS AFTER PREGNANCY
During pregnancy the female breasts enlarge markedly to produce enough milk to sustain the newborn baby. After months of engorgement and nursing, the skin on the breast loses some elasticity. Soon after cessation of breastfeeding, the breast tissue generally involutes or thins out to a smaller size than prior to pregnancy. Coupled with the decreased skin elasticity, the breasts become droopy to various degrees. Enlarging the breasts with breast implant can return the breasts to their original size while correcting the droopiness or ptosis.

3. DROOPY (PTOTIC) BREASTS
As we age, decreased tissue elasticity and the persistent forces of gravity lead to droopy breasts. A few pregnancies can exaggerate the droopiness. Breast implant surgery is able to lift the breasts to a more youthful position. If a more substantial lift is needed, a simultaneous breast lift or mastopexy can be performed to raise the breasts.

4. UNEVEN (ASYMMETRICAL) BREASTS
Nearly 100% of women have uneven or asymmetrical breasts. When the size difference is significant enough, insertion of a breast implant in the smaller breast can dramatically improve the asymmetry. Some women may choose to place an implant I both breasts, with a larger breast implant being placed in the smaller breast.

5. CONGENITAL DEFORMITIES
There are several congenital conditions which lead to uneven breast size and shape.

 a.POLAND′S SYNDROME
 A condition which can involve the arm along with the breast, extremely small or abnormally developed breasts can be improved with insertion of breast implants.

 b.PECTUS EXCAVATUM
 This condition is defined by abnormal development of the ribs and sternum leading to an "excavated" appearance to the chest. The ribs and sternum are depressed instead or protruding outward. As a consequence, breasts are also retracted inward with an extremely wide cleavage. Properly selected breast implants can improve the deformity associated with this deformity by simply filling-in the depression in the ribs.

6. BREAST CANCER RECONSTRUCTION
Breast implant surgery remains one of the premier options in reconstructing defects from surgery for breast cancer. Though radiation therapy after breast cancer surgery can negatively impact the softness of breast implants, some surgeons still recommend breast augmentation as the first option in reconstructing such irradiated breasts.

7. CONSTRICTED (TUBULAR) BREASTS
Some women have breasts with a narrow base and breast tissue which herniates or protrudes through their nipple-areola complexes. To correct such a deformity, it is necessary to cut the connective tissue with breast tissue thereby widening the base. A breast implant is then inserted to fill the breast and maintain the now normal base width.

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IS THERE AN AGE RESTRICTION TO RECEIVEING BREAST IMPLANTS?

While there is no maximum age limit to having breast augmentation, you must be at least 22 years-old to have silicone breast implants. To receive saline breast implants, you have to be 18 years-old.

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HOW DO I CHOOSE A BREAST IMPLANT SURGEON?

The most important decision after deciding to have breast augmentation is selecting your surgeon. Surprisingly, most of the physicians performing breast implant surgery are not plastic and reconstructive surgeons. You are advised to select a surgeon who has completed training in plastic and reconstructive surgery and is certified by the American Board of Plastic Surgery.

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HOW DO I CHOOSE A BREAST IMPLANT SIZE?

There is actually a "scientific" method for selecting your breast implant size based on the width of your breasts. You essentially cannot have an implant which looks like a small marble under your breast. Nor can you have implants which are so wide that they are touching each other at the center of your chest and extending too much into your underarms. A full breast measurement is imperative to assuring you receive the appropriate size. Of course you can select an implant larger or smaller than your breast measurements, but you would be risking looking unnatural the further away your selected implant is from your ideal size.

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SILICONE OR SALINE BREAST IMPLANTS?

With modern scientific research proving the safety of silicone implants, most women are choosing silicone breast implants over saline. But each implant type has its benefits and disadvantages. The benefit of saline is its safety in case of a rupture. Your body will simply absorb the saltwater. The disadvantage of saline implants is that they do not feel as natural as silicone breast implants. The benefit of silicone breast implants is their softness. If ruptured, it is much more difficult to remove the ruptured silicone material. If you have extremely small breasts silicone implants will feel much softer since all you are able to feel is the breast implant. In those who have moderate sized breasts prior to breast augmentation, the natural breast tissue camouflages the breast implant to a greater capacity than in those with pre-operatively small breasts. Therefore saline and silicone breast implants will both feel soft and natural in patients who start with large B-cup breasts prior to breast implant surgery. The last difference between saline and silicone breast implants is the size of incision necessary to insert the implants. Since saline implants are inserted deflated and rolled-up like a cigarette, they can be inserted through the smallest incisions (typically 2 cm long). Silicone breast implants are pre-filled and have to be inserted in their usual size. They therefore require a larger incision (3 to 4 cm long).

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TEXTURED OR SMOOTH BREAST IMPLANTS

The typical breast implant you imagine probably has a smooth silicone shell containing silicone gel or saline inside. There are also textured silicone or saline implants. The shell of these implants has a fine sandpaper texture. These textured breast implants have a lower incidence of capsular contracture. Capsular contracture is the most common complication of breast augmentation surgery. Some surgeons choose textured breast implants when implants are placed over the pectoralis muscle. One of the drawbacks of textured breast implants is the higher risk for developing ridges on the breast implant which can be visible and palpable. Another potential problem with textured implants is that they inherently develop tissue ingrowth within the sandpaper like shell. The breast implants subsequently do not move within their pocket. Normally if you lay down your breasts move to each side. A textured implant does not move to the side as you lay down and therefore lacks the natural flow of a normal breast. Smooth shelled breast implants are always moving within their loose pocket and as a result do move to the side as you lay down. Most surgeons would choose a smooth shelled breast implant if implants are placed under the pectoralis muscle. When under the muscle, there is no longer much of a reduction in capsular contracture in textured breast implants versus smooth shelled breast implants.

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ROUND OR TEAR DROPPED (ANATOMICAL) BREAST IMPLANTS?

Another variable to choose when having breast augmentation is a round breast implant versus tear dropped or "anatomical." Anatomical breast implants are shaped like a tear drop in order to give the breast a natural flow. After receiving an anatomical implant, the breast will therefore start with a gentle slope until it reaches it maximal projection or fullness towards the bottom of the breast. Anatomic or tear drop breast implants typically have a textured shell such that they do not accidentally rotate after breast augmentation. Rotation of a tear drop breast implant may still occur after breast augmentation surgery leading to breast unevenness or asymmetry while distorting the shape of the breast.
Round breast implants appear perfectly circular when placed on a table. When held upright, however, they assume a tear drop shape as gravity pulls the majority of the gel filling downwards. As mentioned in the section on textured versus smooth implants, the textured anatomic breast implants are fixed and no not change shape with changing body positions. So even if you are laying flat, your breasts with tear drop implants will stay in the exact position as when you are standing.

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WHICH PROFILE BREAST IMPLANT DO I CHOOSE (MODERATE PROFILE, MODERATE PLUS, OR HIGH PROFILE)?

The last breast implant variable to choose prior to undergoing breast augmentation is the projection of the implant. As you select larger and larger breast implants, at some point the diameter of the breast implant exceeds the diameter of your natural breast. Women with average chest diameters who desire small to moderate breast implants will typically receive a standard "moderate" profile implant. If your chest diameter is especially small or if you select a breast implant diameter which is too large, your breast implants would either touch each other at the center of the chest ("synmastia") or extend too far into the underarms, or both. In order to minimize the risk for synmastia or breast implants which extend too far into the underarms, surgeons choose a breast implant with a narrower diameter containing the same volume. For instance, standard "moderate profile" 425cc breast implant volume has a diameter of 14.2 cm and a forward projection of 4.2 cm. A "moderate plus" 420cc breast implant has a narrower the diameter of 12.9 cm and a projection of 4.8 cm. The narrowest 420cc implant called "high profile" has a diameter of 12.0cm and a projection of 5.4cm. You are encouraged to discuss your size preference with Dr. Sayah and allow him to measure your chest such that he can guide you through the selection process of an ideal breast implant based on your needs and your anatomy.

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BREAST IMPLANT INCISION SITES AND SIZE?

1. Areola
A small 2 to 3 cm incision at the areola border is the most common method of inserting breast implants. The transition in skin color between regular breast skin and the darker areola skin color is the perfect place to hide a scar.

2. Under the breast
Another common site to insert breast implants is the fold under the breasts. As the breasts are enlarged, the breast tissue will typically fold over at the bottom, thereby covering any visible scars as you are standing. When laying down the scars may be visible.

3. Underarm
Using modern endoscopic equipment which involve pencil thin lenses and camera systems, a newer site to insert breast implants is through the underarms. The scar is well hidden in the natural folds of the underarm creases. The advantage of the underarm approach is the absence of any scars on the breasts. But if you experience an atypically bad scar, your underarm will likely be more visible than your breasts. Since it is currently not easily possible to revise or re-operate on the brast thorugh the same underarm scars, the disadvantage to this approach is the possible need for another scar on the breast should another surgery be necessary in the future.

4. Naval / Belly button
The least common location for inserting breast implants is the belly button or naval. This approach is only possible with saline implants.
Implant manufacturers do not approve this approach and void their warranty should you have your breast implants inserted through the belly button.

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SHOULD THE IMPLANT BE PLACED UNDER OR OVER THE MUSCLE?

Many research studies have demonstrated that a breast implant placed under the pectoralis muscle has a lower risk of becoming hard or developing capsular contracture than one placed over the muscle. The extra layer of tissue or muscle covering the breast implant will further camouflage any rippling of the breast implants. The disadvantage is the weakness associated with the cut pectoralis muscle. Another potential problem with placing a breast implant under the muscle is termed "animation deformity." In such cases the breast implant shape is distorted every time you tighten the pectoralis.
If you have droopy breasts, a breast implant placed over the muscle is better able to lift the breasts versus one placed under the muscle.

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BREAST IMPLANT COMPLICATIONS

As with any surgery, there are certain risks associated with breast augmentation. Some of the risks are as follows:
1. Scars
The incision necessary to insert the breast implants will lead to scars. In some cases you may develop poor scarring which may be visible and require further procedures to improve.

2. Infection
Any time you have a scratch or cut on your skin bacteria can enter the body leading to infections. Breast augmentation surgery is no exception. You will be started on antibiotics prior to your surgery and thereby minimize the risk for any infections. Unfortunately breast implants have no blood supply. So if your breast implant is infected, it will have to be removed until the infection resolves. The breast implant can then be reinserted.

3. Bleeding
Any cuts will obviously lead to bleeding or oozing. Dr. Sayah will perform your breast augmentation surgery meticulously paying close attention to stop all bleeding as he proceeds. Occasionally, you can develop unforeseen bleeding or oozing after surgery. This may necessitate another surgery to drain the blood or ooze.

4. Asymmetry / Uneven breasts
Practically all of us have uneven breasts. Breast implant surgery can enlarge or highlight your existing asymmetry. The breast implants themselves may lad to further unevenness or asymmetry which may necessitate another surgery.

5. Implant displacement
Breast implants may shift in position after breast augmentation surgery. One may go down or another may go up. We will provide you with a compression garment which will hold your breasts in position after your breast implant surgery. In this manner, any risk for implant displacement will be minimized.

6. Rippling
All implants have a risk for rippling. This is particularly so with large breast implants placed in small pre-operative breasts. Saline breast implants also have a higher chance of rippling relative to silicone breast implants.

7. Rupture
The rupture or leak rate for breast implants is actually quite low. It ranges from 3 to 5% over ten years. If ruptured the breast implants will have to be replaced. A ruptured saline implant is easily diagnosed as the breast soon deflates. Rupture of a new generation cohesive silicone breast implant is only possible by an MRI or physical examination.

8. Capsular Contracture
The most common risk associated with breast implant surgery is capsular contracture. After an implant is placed inside your breast, your body elicits an immune reaction with scar formation around the breast implants. In some individuals, for yet unknown reasons, the scar formation or capsule around the breast implant thickens and deforms the breast implant. If severe, the capsule or scar tissue will have to be removed (capsulectomy) and a new breast implant inserted.

9. Need for additional surgery
You may require another surgery on your breasts sometime during your long life. Whether it is to enlarge or reduce your breast implant size, or to correct droopy breasts after breastfeeding, we will be following you closely at least annually to assure the best results.

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OTHER INFORMATIVE LINKS

FDA REGULATION AND GUIDELINES
FDA - Breast Implant Consumer Information
FDA - Breast Implant Questions and Answers

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Other plastic surgery related pages: Glossary – Procedures – Surgical Guide – Procedure FAQ's – Before & After Gallery

Dr. David Sayah is a plastic surgeon in Beverly Hills - board certified - and offers all aspects of plastic and cosmetic surgery incuding non surgical procedures and treatments.