Breast Augmentation

Breast augmentation is a very popular procedure for women and among the most commonly performed cosmetic surgery procedures. Plastic surgeons in the United States can perform this procedure by placing a saline or silicone gel filled implant under the crease in the breast, around the nipple, through the armpit, or through the belly button. The implant can be placed under the breast tissue or beneath the chest wall muscle. After surgery, breasts will appear “fuller” with an increase in volume, enhanced projection, and more shapely contour. Incision scars eventually fade over time but are permanent and can thicken in a small percentage of people.

Breast Augmentation - Before
Breast Augmentation Before

Breast Augmentation - After
Breast Augmentation After

Which incision should I use for breast augmentation?

The most common incision used for breast augmentation is the inframammary (under the breast) incision. Approximately 70% of women across the country have breast augmentation performed using this incision. It is usually well-hidden and has a low complication rate. The periareolar incision (scar around the colored part of the nipple) is also very popular. This incision typically heals well, but is located on the front of the breast. Studies are showing that the periareolar incision may result in a higher risk of complications, such as capsular contracture. The transaxillary (armpit) incision is also used, but primarily with saline implants. Some plastic surgeons place small silicone implants through the armpit as well, but this is not very common. The belly button technique (trans-umbilical breast augmentation, or TUBA) is used by a handful of plastic surgeons nationwide. It is more controversial due to the limited control and visualization the surgeon has. Dr. Youn is not an advocate of the transumbilical technique and does not practice it.

Breast Augmentation Inframammary Scar
Breast Augmentation Inframammary Scar

Breast Augmentation Inframammary Scar 2
Breast Augmentation Inframammary Scar 2

Breast Augmentation Periareolar Scar
Breast Augmentation Periareolar Scar

What is the history of silicone breast implants?

Silicone implants were used nearly exclusively in the United States in the 1980′s and early 1990′s. Unfortunately, these older silicone gel implants had many concerning factors associated with them. The outer silicone rubber shells were not very strong, and therefore the implants had a high breakage rate. In addition, the silicone on the inside of these implants was a thinner liquid. Therefore, when these implants would break, the liquid silicone would ooze out of them, causing many women to fear that the silicone would escape the breast pocket and course through their body causing various diseases, such as breast cancer, lupus, and arthritis. In reaction to these concerns, the FDA imposed a ban on silicone implants in 1992, allowing them only to be used in an FDA-approved study. For the next fourteen years, the vast majority of patients in the United States underwent their breast augmentation using saline implants. While these patients were typically very happy with their results, there was always the desire for the choice of silicone, since they are undoubtedly more natural looking and feeling. Finally, in November 2006, in reaction to the scientific studies demonstrating NO connection between silicone gel implants and any of the diseases people worried about (such as breast cancer, arthritis, and lupus), the FDA lifted the ban on silicone gel implants. We are now able to use them again.

The new silicone gel implants by the two major manufacturers (Mentor and Allergan) are much better than they were twenty years ago. The outer shell of the implant is extremely strong and resistant to breakage AND the silicone inside the implants is no longer a liquid but a cohesive gel. It’s a gel that sticks together. Now we are no longer so concerned with silicone leaking from the implant.

What is the difference between a silicone gel and saline breast implant?

There are benefits and drawbacks with each of these implant types. Saline implants are simple, less expensive, and there is never a question of whether they are broken or not. These implants are filled with sterile salt water, the same fluid that is given to a person who is in the ER being treated for dehydration. If the implant outer shell develops a break or tear, the implant will quickly deflate, often within a couple hours. The saline that leaks out of the implant is safely absorbed by the body. Because it’s typically very obvious when a saline implant breaks, there is no need for expensive tests to follow these implants. The drawback of a saline implant is the fact that it is not as natural looking or feeling as a silicone implant. Some patients complain of wrinkles and ripples, mainly on the bootom or the sides of the implants.

A silicone implant looks and feels more natural than a saline implant but is more expensive and, even though studies have shown their safety, more controversial than saline. In general, the question now is not whether or not silicone implants make people sick, but How Can We Tell If A Silicone Implant Is Broken? Because the silicone inside the new silicone implants is no longer a liquid, but a cohesive gel, it may be very difficult to tell whether an implant may have a break or tear in the outside shell. The FDA therefore recommends that all patients who undergo cosmetic breast augmentation with silicone implants undergo an MRI of the breasts 3 years after the original surgery and every other year thereafter. This is not a requirement, however. Make sure to discuss this with your board-certified plastic surgeon prior to undergoing a silicone gel breast augmentation.

What is the gummy bear breast implant, and is it an option for me?

The FDA has approved the Natrelle Style 410 shaped, form-stable silicone breast implant, otherwise known as the “gummy bear” breast implant. There are many differences between the Natrelle 410 implant and the other silicone gel implants being used. First, the silicone gel inside the Natrelle 410 is thick, firm, and resists deformation. For this reason, the implants are called “form-stable.” There is virtually no risk of silicone leakage with this implant. Second, the Natrelle 410 implants are made in a teardrop shape with a textured (sandpaper-like) surface. Unlike the smooth, round silicone implants, these implants are not made to move around inside the breast pocket, but are designed to fit snug inside the breast. Third, there are limited sizes of the Natrelle 410 available. Fourth, the Natrelle 410 must be inserted through the scar under the breast, and utilizes a slightly longer scar than the other types of breast implants.

So who is a good candidate for the Natrelle 410 “gummy bear” breast implant? Women who are first-time breast augmentation patients, have relatively little excess skin, and are looking for a moderate enhancement are the best candidates for this implant. The Natrelle 410 is not a good choice for women who have droopy breasts, have had surgery before, or want a larger size than is available with the Natrelle 410. It is also not a good breast implant for older patients with softer breasts. Dr. Youn can discuss with you whether you are a candidate for the Natrelle 410 form-stable “gummy bear” breast implant during a comprehensive consultation.

What is the Ideal Implant, and how is this different from a traditional saline implant?

The Ideal Implant is the newest kind of FDA-approved, saline-filled breast implant. It contains internal chambers which allow the salt water inside to move around more smoothly than a traditional saline implant. This makes the implant (and therefore the breast) look and feel more natural, sometimes approaching the natural look and feel of a silicone gel implant. The Ideal Implant also appears to have less wrinkling and rippling than traditional saline implants.

One added benefit that most doctors and patients don’t realize is that if it breaks, only one internal chamber deflates. This allows the patient more time to get the implant switched out before the pocket shrinks down in size. Typically, when a saline implant breaks the implant completely deflates, like an empty balloon. This causes the pocket it’s in to shrink down as well. Waiting too long to get the implant switched out can make it necessary for the plastic surgeon to completely reopen the pocket again. This can become an extensive, bloody operation.

With the Ideal Implant, because it has two inner shells, if one breaks the implant remains partially inflated, allowing the patient more time to switch the implant out. This can mean the difference between a simple implant exchange operation which could take 15 minutes or an operation to reopen the entire breast implant pocket which could take an hour and a half.

Dr. Youn is one of the only plastic surgeons in the state of Michigan who has exclusive access to the Ideal Implant for his patients.

Should I have my implants placed above or under the muscle?

Breast implants can be placed in a pocket either above the chest (pectoralis) muscle or below it. Traditionally implants were placed above the muscle. This allowed the implants to move with the rest of the breast tissue and provided for the shortest recovery. Unfortunately, there does appear to be a higher risk of capsular contracture (excessive scar tissue around the implant) with implants placed above the muscle. Because of this, many plastic surgeons now place the breast implants in a pocket below the pectoralis muscle. This creates a lower risk of capsular contracture and arguably allows better visualization on a mammogram.

Unfortunately, in certain patients with wide-spaced breasts it can result in a space between the breasts which some women don’t like, along with movement of the implants when the pectoralis muscle is flexed. It is also not ideal for patients whose breasts are a bit droopy. At your consultation, Dr. Youn will explain the various risks and benefits of each type of implant pocket, and determine with you which is your best approach.

How long does it take to recover from breast augmentation?

Most patients will take a handful of pain pills and should take 1-2 weeks off of work. Exercise can resume after 3 weeks.

What is the Rapid Recovery Breast Augmentation?

The Rapid Recovery Breast Augmentation is a technique that Dr. Youn utilizes in many of his patients. By combining a reasonable implant size, a non-traumatic surgical technique, and avoidance of drains, Dr. Youn’s Rapid Recovery Breast Augmentation patients are able to be off narcotic pain pills and back to nearly normal activities within 24-48 hours. Dr. Youn revealed this technique with a patient on the Rachael Ray Show. To view streaming video of this TV segment, please scroll to the bottom of the page.

How long does the surgery take?

Breast augmentation take sbetween one to two hours, and is performed under general anesthesia as an outpatient. I would exercise caution if a plastic surgeon takes less than an hour to do your breast augmentation. Speed does not necessarily equate to quality, and in fact, may be just the opposite.

How can I determine which size implant is best for me?

There are many methods to determining what breast implant size to use. First of all, all breast implants are measured in cc’s or milliliters. There is no standard A, B, C, or D size implant. Because everyone’s bodies are different and their starting breast sizes are different, an implant that could make one person a C could make another person a B. For example, a 350 cc implant may make a person who is 5’4″, and 110 lbs a C cup, whereas it may make a person who is 5’9″ and 160 lbs a B cup.

At home methods for determining breast implant size include the Rice Test (fill plastic bags with a measured amount of rice and place it in a sheer bra) and take-home inflatable sizers which can be purchased at your plastic surgeon’s office or www.MakeMeHeal.com. Allergan makes the Natrelle pre-consultation sizing kit which includes several sizing implants prefilled with mineral oil. You can order one here for $39.99 plus $5 shipping.

Some plastic surgeons prefer the “Trust Me, I’ll Make You Look Good” approach. Dr. Youn does not do this, since people have different ideas of what size will make them happy and it doesn’t give the patient enough control over her outcome. The most common method of sizing patients for breast implants is to use preoperative sizers. These are premeasured silicone implants which are placed on top of the breast with a bra to simulate what size a person will be after surgery. Dr. Youn sometimes does this with patients during the initial consultation. The newest method of determining what implant size is best for each individual patient is 3-D imaging. Dr. Youn currently utilizes the Axis 3-D system for helping predict the outcome of breast augmentation surgery. By utilizing several digital cameras and a specialized computer imaging program, the Axis 3D system can help determine which breast implant size is best for each individual patient, all using three-dimensional images of the patient’s own body. For more information, please view the video below.



View our Before & After Photo Gallery of Breast Procedures