The Premier Advantage Limited Warranty

The procedure of Breast augmentation has been performed since the early 1960's. Since its origination at that time it has been one of the most popular cosmetic surgery procedures. When the procedure was first initiated, it was pretty rudimentary. Today, the variety of implants and, insertion options as well as modern surgical techniques all combine to provide for women the appearance they want, both safely and naturally with minimal scars. Whether you are seeking a subtle enhancement of your figure to fill out a dress or a dramatic change, the variety of implant shapes and dimensions available today, can help you achieve this and still maintain a natural appearance.

Women undergo breast enhancement surgery for a variety of reasons. Many times, genetics and puberty are not as generous as one would desire resulting in a breast of little volume or shape. Other women who are blessed with their ideal breast volume frequently lose some of this volume with pregnancy, (with or without breast feeding,) as well as with weight loss and the progression of time. Still others choose breast augmentation for the benefit of enhancing or accentuating the moderate breast volume they already have.

In most cases there are no limitations as to what size your breasts can be. It is a personal choice and a decision to be made by a combination of your desires and your surgeon's experience. Dr. Markmann will help you in choosing the right implant size to give you the appearance you desire.

The Process: Step by Step

The first step is to make an appointment for a consultation with Dr. Markmann. Your consultation will be scheduled for approximately one hour's time during which Dr. Markmann will discuss with you your desires in regard to size and shape of your breasts and you ultimate goals. He will also explain to you how the procedure is performed including the different insertion sites or scars and the pros and cons of each. Also during this consultation you will be examined and measurements taken to help determine the best implant dimensions to fit your breasts. Dr. Markmann will also discuss the implant options including the pros and cons of saline vs. silicone.

At the end of the consultation you will be given a quote as to the estimated total cost of the procedure, including operating room and anesthesia fees, surgeon's fee as well as the cost of the different implant options. You may also schedule your surgical date at this time if you desire. This will require a 10% deposit. Once your surgical date is scheduled, Dr. Markmann will see you for a second consultation approximately two weeks prior to your surgery date. You are also required to have a physical examination and blood work performed within thirty (30) days prior to your date of surgery. This should be performed by your medical doctor. Further details will be given to you during your consultation with Dr. Markmann. It is also helpful to provide photographs (unclothed) of someone with approximately the size breasts you are seeking. Everyone's idea of a B, C or D cup is not exactly the same. Also during the second consultation you will be asked to bring in a bra with the cup size that you wish to be able to fill out. During this second consultation you will be able to try various sizes of implants in this bra and see which size provides for you the appearance you are seeking.

The Details

Anesthesia Options - Most breast augmentation procedures are performed under general anesthesia which means you are totally asleep throughout the procedure and will wake up once the procedure is completed. A second and much less used option includes injection of local anesthetic to numb your breasts, along with sedation to keep you relaxed or groggy during surgery. This is sometimes called "twilight" anesthesia.

Incision Options - The most commonly performed technique is placement of the implant through a scar in the crease beneath your breast called the "Inframammary" incision. The second option is called the "Trans-Axillary" incision. This incision is placed in the underarm area. The third option is called "Peri-Areolar," placing the scar at the junction of the pigmented skin surrounding your nipple and normal skin. There is also a fourth option which is much more rarely used called the "Trans Umbilical Breast Augmentation" incision commonly referred to as the TUBA technique. In this technique, a saline implant is placed through a scar in the belly button. Each of these techniques has pros and cons. The final decision as to which approach is used for you is a combination of your desires as well as your surgeon's recommendations. Some of these techniques have limitations as to which implants can be inserted through them as well as in regard to what size implants can be inserted through them. Further details regarding these options will be discussed at the time of your consultation.

Implant Options

There are two main categories of implants available today, Saline and Silicone. Each of these implant types has several sub-categories including that of textured or smooth as well as several different dimension options including high, intermediate, moderate, or low profiles.

Saline Implants: Saline implants are basically a silicone balloon filled with a salt water solution called saline. The volume of saline placed into any given implant can vary depending upon manufacturer's recommendations. All saline implants have an approved fill range. Higher fill ranges tend to minimize folds in the implant. However, this does tend to make the implants feel more firm. If a saline implant should rupture at any time the saline will leak from the balloon and be absorbed by your body. Being that the majority of your body weight is saline, this fluid will be absorbed and urinated out. Your breast will progressively decrease in volume and you will therefore know that your implant is ruptured and needs to be replaced.

Silicone Implants: These implants are made of basically the same silicone balloon as saline implants. The difference is, that in this case the implant balloon is filled with silicone gel. Being that silicone gel has a density very similar to a woman's natural breast tissue, it tends to feel much more like a breast than saline implants do. This similar density also helps the implant to blend in visually as well, minimizing the risk of seeing ripples in the implant. Silicone also tends to provide a more natural movement to a woman's breast than saline does.

In general, silicone implants create a more natural result.

Silicone implants, just like saline, can also rupture or break. One major difference is that unlike saline, an extremely small amount of the silicone will ever be absorbed by your body and therefore you will not notice a change in the size of your breasts. Dr. Markmann therefore recommends that you follow-up at his office for a yearly checkup at no charge. He may order additional testing where indicated and as recommended by the FDA to evaluate your implants.

The silicone implants being used today are not the same as those used in the 1960's. Since that time the implants have changed dramatically as far as the viscosity or cohesive nature of the silicone gel used in them as well as in regard to the way the implants are made. This has resulted in a significantly lower rupture rate as well as a reduction of potential complications or concerns about silicone leakage. The newest of the silicone implants are all cohesive gel implants, meaning that they are filled with a more sticky or semi-solid gel with much less free silicone oil to potentially leak from them. These implants have all undergone rigorous testing, have an excellent track record and have been deemed safe by the FDA which placed them back on the market in November 2006. When the implants were released at that time, they were made available for women age 22 or older. However, saline implants still remain available for women of age 18 or older. The FDA recommendations also include obtaining routine MRI follow-ups to evaluate for implant ruptures. There is however significant debate over this recommendation of routine MRI evaluation.

Implant Positioning:

The implant may be positioned either above or beneath the pectoralis muscle. When they are positioned above the muscle, it is frequently referred to as sub-glandular. When positioned beneath the pectoralis muscle it is commonly referred to as sub-pectoral or sub-muscular. There are many benefits to placing the implant under the muscle including a more natural look and feel, less palpability of ripples or folds in the implant and less risk of the implants coming too close together called Synmastia (more commonly known as the dreaded uniboob). However, I believe the most important benefit of placing the implants under the muscle is much less risk of the implant interfering with cancer detection on mammograms.

There are few benefits of placing the implants over top of the muscle with the most notable being that of a quicker recovery with less pain after surgery.

Recovery/Return to Work:

This will vary depending upon what type of work you perform as well as your own tolerance of pain. With implants above the muscle patients are frequently back to work within a few days, whereas with implants beneath the muscle, Dr. Markmann usually recommends one to two weeks off work. This will vary depending upon your type of job.

Other Important Things to Know:

Breast implants are not guaranteed to last your entire lifetime, but most implant companies offer a lifetime warranty on the implants. Pregnancy, weight loss, gravity and the effects of aging also have an impact on breast implant positioning and the size and shape of your breasts.

There are potential risks with this and any surgery including that of bleeding, infection, unfavorable scarring, malpositioning of the implants or migration of the implants as you heal, capsular contracture (tightening of scar tissue around the implants making them feel hard or changing their shape), loss of nipple, areola or breast skin sensation which can be temporary or permanent as well as the potential need for additional surgery in order to correct any of the above. There are also medical or potentially life threatening risks associated with this and any surgery including that of blood clots, anesthesia risks or death.

Breast implants have never been shown to impair breast health, ability to breast feed, cause cancer or any auto immune diseases.

Final Results:

Depending upon your skin and muscle tone as well as the size of the implant being used, it can take several weeks and even several months to see your final results in regard to size and shape of your breasts. This is referred to as the Settling Period. During this time you may be required to wear a special compression garment to maintain or improve the position of the implants.

It is also recommended that you massage your implants on at least a daily basis to keep them soft and minimize the risk of capsular contracture. This also helps to keep you in tune with the feel of your breast tissue and implants and therefore if there are any changes such as the development of cysts or lumps you will be aware of this at an earlier stage. Monthly self examination is still recommended for early cancer detection. One out nine American women (with or without breast implants) develop breast cancer.

All women, including those with implants need to have mammograms performed on at least a yearly basis after the age of 40 for early detection of breast cancer. Breast implants have not been shown to increase the risk of breast cancer in any way! However, there have been several studies which have shown a lower incidence of breast cancer in women who have breast implants in comparison to those who do not. It has also been shown that women with breast implants tend to find their cancers at an earlier stage. This however does not alleviate the need for self examination or mammograms. To the contrary, it may be the increased attention that women with implants give their breasts that has lead to this earlier detection than women with out implants.

For further information regarding your breast enhancement surgery, please contact

Dr. Markmann's office to schedule your free consultation.