As one of Baltimore's board-certified plastic surgeons, Dr. Markmann can enhance the size and shape of a woman's breasts with silicone or saline implants. Women tend to seek a breast augmentation after pregnancy, nursing, weight loss and aging. Some women also choose a breast augmentation if they are born with limited breast tissue. As the most common cosmetic surgery in the US, breast augmentation procedures have full, long-lasting effects on women and their self-esteem.
Saline implants have always remained a positive choice for patients when deciding what type of implant to use for breast augmentation. Because these implants are filled with a sterile salt water solution, any potential leakage does not pose any threat as the solution is safely absorbed by the body. Saline implants also cost less than the silicone type. One of the disadvantages of saline implants is that in some cases, obvious rippling can appear. This is especially something to consider for women who are thin and have low breast volume tissue. Those who opt for this type of implant must be at least 18 years old.
Silicone breast implants are very popular today and are highly recommended by surgeons for patients who are thin and desire a natural look. Since the FDA validated their safety and efficacy, safety concerns surrounding these implants are today almost no different than that of saline. The silicone shell is prefilled with silicone gel and comes in different sizes, shapes and textures. Unlike saline implants in which leakage is absorbed by the body and implant volume visibly flat, it is difficult to tell when a silicone implant ruptures. An MRI is required to detect any rupture. Patients considering silicone implants must be at least 22 years old.
For patients who desire fuller breasts but do not want an artificial implant to achieve this, there is also an option known as a fat transfer. In this procedure, the doctor will harvest fat from donor sites of the patient, such as the flank, abdomen and thighs via liposuction. The fat collected will undergo a process of refinement via a centrifuge machine. The purified fat tissues will then be gradually reinjected within the breasts with smaller syringes so the shape is evenly distributed.
There are only 3 approved manufacturers by FDA.
Breast implants come in a variety of different profiles. The selection is based on how enhanced the breasts' projection would be, as well as how wide the implant will be on the chest wall in relation to the base width. Since the silicone implants are already pre-filled, the standard profiles come in low, moderate, high and extra high. Saline implants, however, come in variants that are either prefilled; or, the silicone shell is inserted then filled with saline solution up to the patient's preferred profile. Choosing the right profile can sometimes be a difficult decision and it is up to a skilled surgeon to help guide the patient accordingly. High profile breast implants will have greater projection, but less width on each side, whereas a moderate profile, for example, will not have as much projection, but will be broader.
The standard shape of a breast implant can either be rounded or tear-shaped. Each shape serves a different aesthetic function as it pertains to the patient's goals. Rounded implants produce a shapelier curve on the top portion of the breast. The teardrop implants are shaped to copy the natural appearance of the breast, so they will not appear as high.
Implants are made with either a smooth or a textured surface. In general, smooth implants cost less and are more common. The textured implants were initially conceived out of the idea that it reduces the chances of capsular contracture (the constriction of scar tissue around the implant) although there is no valid claim to this. The textured type is more common with the teardrop shape as the rough texture adheres to tissues helping the implant stay in place.
The two most common placements are on top of the chest muscle or under it. When the implant is placed under the muscle, a pocket is created within the pectoralis major muscle. A pocket is also created if it is placed in front of the muscle, but many surgeons do prefer the submuscular approach (behind the muscle). This helps to keep the implant in place for a longer period of time and takes into consideration factors such as implant size, weight, gravity, and time. Placing the implant behind the muscle also provides a natural look and provides the implant with the long-term support it needs to stay in position.
There are several standard incision approaches for breast implants. The most common is known as an inframammary incision, which is an incision near the breast fold. Second, is an incision made under the areola, which is known as a periareolar incision. A third option is to place the incision within the armpit, known as a transaxillary approach. There is also an incision approach that takes place around the belly button, but this is the least recommended way. It is up to the patient's desires and surgeon recommendation as to what approach is best to take. Scarring is also discussed at this time with each method.
Breast augmentation is an outpatient procedure that may last from an hour to several hours. It is performed using general anesthesia in an accredited surgical facility. All activities must be limited within 48 hours after surgery. There will be bruising and swelling, and a compression support bra will also be worn to help in healing. It is normal to feel tightness around the chest area as the skin adjusts to the breast's new shape. Most patients can resume normal activities within 7 days; exercise should be avoided for 4-6 weeks. It takes approximately 6 months for the breasts to look, feel and function normally in regards to softness, sensation and final placement.
**After breast augmentation surgery, our practice asks patients to come back for multiple postoperative appointments. Initially, we see patients back one to three days following the surgery. Over the next several weeks and months, we we schedule postoperative visits as well. Additionally, at Metamorphosis, we offer complimentary follow-up visits every year for all breast implant patients for life.
This depends on the patient's breast make up. Those who opt for implants may choose between saline or silicone as each has its own advantages. Generally, patients who have low breast tissue will benefit from silicone implants; otherwise, saline implants are recommended. For fat transfer, the advantage is that it poses less risk since there is no introduction of foreign material in the body. However, the results do not last long compared to artificial implants as fat can be reabsorbed by the body.
Negative notions about silicone started back in the early 90s when there were cases of leakage and complications. With today's advancements in engineering, the silicone-based shells are made durable and safe, and have been proven so by the FDA. Today, in fact, silicone is more preferred than saline since they last longer and feel more natural. The rates of reported complications have significantly decreased in the last decade.
Breast augmentation is a cosmetic procedure designed to enlarge breasts while a breast lift is designed to tighten the loose skin of a droopy breast. Both resolve different breast issues. There are cases that the procedures are simultaneously done when it is agreed that a breast lift with augmentation is necessary.
Today's silicone implants are strong, durable and safe. Technical advancements have come so far, that even if a silicone implant does rupture, the shell of the implant will keep the silicone gel encased and protected from entering the body. In a rare case that a silicone implant does rupture, an MRI will be needed to detect the rupture. This is the main reason why MRI checks are recommended 3 years after surgery and every 2 years succeeding the first MRI.
Implants may last up to 15 years. As long as the implant shows no signs of damage or visible defects, such as breast rippling or a deformity, replacing them is not necessary. What's necessary, however, is a periodic check of the implants to make sure that they are still intact.
* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.