Breast Implant Incision for Women with Small Bust

Around 20 million women have breast implants worldwide, a clear proof of the devices’ popularity among patients who want to improve their appearance or reconstruct their breasts following mastectomy or cancer surgery.

If used for cosmetic reasons, the common goal of patients wanting to have breast implants is to increase their bust size.

The bust size and appearance, natural tissue and fat, type of implant used, goals and expectations, and doctor’s expertise determine the appropriate incision sites in breast implant surgery.

Women with very small breasts (AA cup) should bear in mind that in breast augmentation, the “bigger the better” principle does not apply because of certain risks.  For instance, it is unreasonable and even precarious to use large implants that would give them DD cup due the higher chance of rippling and wrinkling.

And more often than not, small breasts are usually associated with small areola complex, making this incision site not ideal with the use of silicone implants, particularly large ones, because of the higher risk of visible scarring.

Silicone implants require longer incisions than saline implants because they are only available in pre-filled version.

By contrast, saline implants are filled with a sterile mixture of salt and water once inside the breast, for this reason small-breasted women may choose the areola incision if this type of implant is used.

Another good option for women with small bust is the breast crease incision, which is the easiest technique because it allows plastic surgeons to work close to the breasts unlike the armpit and navel incision sites.

However, there is one concern with the use of breast crease incision to augment a small breast.  First and foremost, women with AA cup often lacks a defined “fold” that separates the base of the breast from the chest; for this reason, there is a chance that the scar sits too high or too low that makes it visible.

But because most plastic surgeons are very adept with breast crease incision, low- or high-riding scar rarely occurs.

Meanwhile, the transaxillary or underarm incision is another good substitute for women with small breast and areola particularly if they choose saline implants.  While it is possible to use silicone implants, ideally they should come in small size so they can easily fit into the surgical slit.  

But whether a woman has small or large breast, the transaxillary technique is not used if there is an existing deformity because the distance between the incision and chest area can make the surgery extremely more challenging.  The same is true with the navel incision site. 

The First Woman Who Received Silicone Breast Implants

In the spring of 1962, Timmie Jean Lindsey from Houston, Texas received the first silicone breast implants and turned her from B to C cup.  Meanwhile, the plastic surgeons who operated on her did not realize that this would be one of the most popular cosmetic surgeries worldwide that in 2010 alone, about 1.5 million women had the procedure.

Today, 80-year-old Lindsey said she has no regrets of having breast implants, which have boosted her self-confidence.  However, what is surprising to know is that she never really intended to have a breast augmentation in the first place.

She was in a hospital for tattoo removal when one doctor came to her and asked if she would consider getting the first silicone breast implants.  At first she was reluctant because what she really wanted was a surgery to pin back her ears.

But because the surgeons Frank Gerow and Thomas Cronin offered her ear pinning surgery at no cost, she immediately volunteered for the first-of-its kind operation.

Gerow first came up with the idea of silicone breast implants when he squeezed a plastic blood bag and realized that has an uncanny resemblance to a woman’s breast.

But before the device was implanted in Lindsey’s chest, Gerow and his team first used a dog named Esmeralda as their guinea pig.  The implant was placed under the skin and stayed there for weeks until the surgeons decided to remove it after the animal incessantly chewed the stitches.

After deeming that silicone breast implants were safe, the surgeons operated on Lindsey and other women followed her footstep.

Lindsey said she experienced pain for three or four days following surgery and described her recovery “as like something had been sitting on her chest.”

At first she had no idea of the full results until she went out in public and men gave her “the look” while others would whistle at her.

While breast augmentation resulted to higher self-confidence, Lindsey said that she never revealed it to her past relationships, and her family and friends became only aware of her operation when she told them about it decades later.

Though she remains delighted with the results, she realized thatsilicone implants would not maker her “breasts forever young” and said that they began to sag over the years.

Currently, breast augmentation is the most popular cosmetic plastic surgery in the US, with about 307,000 procedures performed in 2011 alone. 

FAQs About Breast Implant Placement

The overall result of breast augmentation surgery is largely affected by implant placement.  To better understand this issue, the California Surgical Institute has provided a list of most frequently asked questions:

1.  Question:  What are the three basic types of breast implant placement?

Answer:  The implants can be placed under the tissue (subglandular or over-the-muscle placement), behind the muscle (submuscular or under-the-muscle), and behind the tissue and partially under the muscle (partial submuscular placement).

2.  Q:  What is the most ideal implant placement?

A:  The most ideal implant placement is dictated by a patient’s overall anatomical features including the amount of tissue and fat to work with, and her goals and expectations.

 3.  Q:  When is subglandular or over-the-muscle implant placement ideal?

A:  In general, this breast augmentation technique is ideal for women with ample amount of tissue and fat that provides enough “coverage” to prevent visible and palpable wrinkling.  And because the top edge of the implant has little tissue, the method provides a distinct cleavage line.

4.  Q:  When is submuscular or under-the-muscle implant placement ideal?

A:  The technique is highly ideal for patients with little amounts of tissue and fats who are prone to wrinkling and rippling.  Also, many plastic surgeons believe the implant placement is recommended for women who are concerned with sagging or bottoming out since the weight of the implant is supported by the muscles rather than by tissue and skin alone.

The submuscular placement is also ideal when using large breast implants (e.g., full D cup) because it prevents visible and palpable rippling.

To further reduce the risk of rippling, doctors recommend silicone implants, which are filled with a cohesive gel notable for simulating the feel of breast tissue and fats.  By contrast, women with little tissue are often advised to stay away from saline implant due to its watery consistency, thus increasing their risk of wrinkling.

Using smaller implants when dealing with small-breasted women is another effective way to reduce the risk of rippling and wrinkling.

5.  Q:  Is it true that women with submuscular implant placement can go braless without having to worry about sagging?

A:  Technically speaking, the answer is yes.  However, many plastic surgeons believe the breasts still need a good support to prevent or at least postpone sagging.

6.  Q:  Why is it that submuscular implant placement often results to longer recovery and more postoperative pain and discomfort?

A:  In this technique, the muscle is literally compressed and pushed by the breast implants, leading to more swelling, pain, discomfort, and longer recovery than if the subglandular implant placement were used.

7.  Q:  How long does it take for the implants to settle naturally?

A:  If the submuscular implant placement were used, it would take longer (several weeks or even months) for the implants to settle down naturally than if subglandular technique were used.  But regardless of which method is used, patients should expect that their newly augmented breasts will appear unusually firm and that they will sit higher on the chest.

Within a few weeks or months, the breast implants will settle downward, leading to a natural appearance.  In some cases, a strap is wrapped around the chest area to achieve a more desirable result.

8.  Q:  Does implant placement affect the rate of capsular contracture or tissue hardening?

A:  Some plastic surgeons believe that submuscular implant placement somewhat reduces the risk of capsular contracture because it limits the contact between the implant shell and tissue where most of the bacteria live.

However, this is just an anecdotal observation rather than a scientific conclusion.  And to put it succinctly, capsular contractures are quite unpredictable and may happen to some patients, regardless of which breast augmentation technique is used.

9.  Q:  Does implant placement affect the accuracy of breast screening test?

A:  In general, breast implants—no matter what type of placement is used—make it more challenging to perform breast X-ray and mammogram.  Fortunately, many radiologists nowadays have experience screening women with these devices.

Most experts agree that the submuscular implant placement is less likely to obscure mammogram readings than the subglandular technique. 

10.  Q:  Does a certain implant placement prevent symmastia or “uniboob?”

A:  The implant placement will not affect a patient’s risk of symmastia, a condition in which the breasts settle in the middle of the chest.  This problem happens if the implants are “inappropriately” large or there is over-dissection of the muscles at the breast bone.

As with any problems caused by implant displacement, symmastia can be only treated with revision breast augmentation surgery.

Breast Anatomy—How It Affects the Breast Augmentation Technique

About 307,000 breast augmentation procedures were conducted in 2011, according to data released by the American Society of PlasticSurgeons.  But despite the growing popularity of this surgery, many patients are still not aware that their breast anatomy and even their overall body frame can affect the final outcome.

Breast Anatomy:

* Areola complex

This is the pigmented part of the skin, and at its center is the nipple which contains tiny ducts responsible for breastfeeding and are very sensitive to manual stimulation.

The edge of the areola can be used as an incision site during breast augmentation, allowing doctors to create a “pocket” and insert the implant.  And while this technique hides the scar, the tradeoff is the higher risk of temporary or permanent loss of sensation which happens if too much nerves are severed.

Fortunately, patients can choose from other breast augmentation incisions including breast crease, underarm, and navel.

* Cooper’s ligament and connective tissue

They support the entire breast and define its shape.  But after several pregnancies and weight loss, they start to become slack, leading to sagging appearance.

Breast implant alone cannot correct sagging, although this can further improve the appearance of the bust after a breast lift surgery.  Combining these two procedures are particularly ideal for women who have drooping breasts and want to add more volume in their chest.

* Inframammary fold

Also called breast crease, it separates the breast mound from the lower chest wall.  Meanwhile, this area is a great incision site because it allows plastic surgeons to work close to the chest, making it easier for them to position the implants; for this reason, the technique is ideal for patients with existing breast deformity.

However, the inframammary fold incision is more ideal for women with a defined breast crease as it can prevent them from having a high- or low-riding scar.

Most board-certified plastic surgeons are very familiar with inframammary incision technique that unsightly scars rarely happen.

* Chest width

This breast anatomy dictates the right implant profile which is the projection off the chest wall.  In general, petite women should use high-profile implant that has small base but offers more protuberance.

By contrast, patients with a wider chest width should use low-profile implants which have a broader base but offer less protrusion.

Meanwhile, patients can choose moderate-profile implants that provide projection according to their amount of filling (which is measured by cubic centimeter or cc).

Thinking About Having Bigger Breast Implants?

As its name suggests, breast augmentation surgery aims to increase the bust size and a fuller appearance especially in the upper and medial cleavage.  However, it does not necessarily mean that you can go as large as you want because several factors can play a role in your ability to accommodate larger implants.

Currently, the biggest implants available are filled with 800 cubic centimeter or cc of saline or silicone gel.  Going larger than this size means you will need a customized implant, which means additional fees.

But common sense suggests that implants larger than 800cc do no guaranty better results or more beautiful appearance.  In fact, most self-respecting plastic surgeons would likely decline a patient whose aesthetic goals are too extreme that these will push the body’s limits.

While breast implants are reasonably safe, this may not be the case if yours would be too large for your tissue and fat to accommodate.  Imagine that an implant shell needs “enough coverage” to prevent palpable rippling and visible wrinkling, and using extreme sizes can lead to this kind of problems.

And if you are leading an active lifestyle, unreasonably large breast implants will definitely not work for you.

A “reasonable” size should not just depend on what you want to achieve with breast augmentation.  First and foremost, you should also consider certain anatomical features such as chest width, waistline, and natural breast tissue and fat.  Always bear in mind that the less tissue you have, the more ideal it is for you to choose small- to moderate-sized implants.

By considering your anatomical features—including your body frame (e.g., petite, athletic, big-boned)—it would be easier to achieve a more natural appearance.  Take note that the “heavy top look” which is arguably popularized by Pamela Anderson is no longer the in thing; in fact, the star has been rumored to undergo a revision breast augmentation to downsize her implants.

Even Dolly Parton and Denise Richards were reported to have had breast augmentation to downsize their implants and achieve a more natural look.

Even before consulting with a plastic surgeon, you should be 100 percent sure on the bust size you want to achieve; in this way, you will most likely be satisfied after the surgery.  Always bear in mind that a significant number of revisions happened because the patients thought they have gone too big or too small, so making it right the first time is crucial. 

Silicone Breast Implants Do Not Increase the Risk of Cancer

In the early 1990s, silicone breast implants were pulled out of the market due to concerns that they might increase the risk of breast cancer and systemic diseases.  But in 2006, the US Food and Drug Administration has lifted the moratorium after extensive studies found no link between using the devices and serious illnesses.

The FDA’s decision to lift the moratorium is supported by many oncologists; in fact, silicone breast implants are increasingly becoming popular among post-cancer patients who have breast deformity following their mastectomy (partial or complete removal of their breasts).

Meanwhile, leading LosAngeles plastic surgeon Dr. Tarick Smaili believes that silicone breast implants are reasonably safe both for cosmetic and reconstructive surgeries.

“Silicone breast implants have been subjected to the most rigorous examinations which have proven that they are reasonably safe.  Another bonus is that they can provide a very natural appearance since they are filled with a cohesive silicone gel that replicates the feel and look of breast tissue and fats,” Smaili said.

Because post-cancer patients who had mastectomy often have a limited amount of tissue, silicone breast implants are usually more ideal than saline implants which have a watery consistent (because it is only filled with a sterile mixture of salt and water).

The mastectomized breast has a very low risk of cancer recurrence so placing implants during reconstructive surgery has become a common practice.

However, Smaili warns that breast implants can make it difficult to conduct mammogram and “physical” breast examinations.

“A breast augmentation patient should go to a technician who has an extensive experience in conducting mammogram screening on women with breast implants.  Also, more views are necessary to get a more accurate and clearer result,” Smaili said.

But despite more difficulty to do mammography, the plastic surgeon advised women with breast implants aged 40 years and older to undergo screening at least every year.

“In this way, their doctors can immediately diagnose any cancerous lumps even before the condition gets worse,” he added.

Meanwhile, mammography is not only performed on older women (with or without implants) but also on younger patients with silicone breast implants that are prone to “silent leak,” a condition in which the cohesive gel drips out of a damaged or ruptured shell without causing any visible signs.

But in the long run, silent leak can lead to inflammation of the tissue, pain, and visible breast deformity.

The FDA recommends mammography every two years for patients with silicone breast implants; on the other hand, this is not a requirement for younger women with saline version because a rupture would immediately show visible signs. 

FAQs About Breast Lift or Mastopexy

Breast ptosis or sagging is one of the most common problems associated with aging; however, pregnancy and significant weight loss are also known to contribute to the problem because these may stretch the ligament, tissue, and skin.

Fortunately, breast ptosis can be corrected by mastopexy or more commonly referred to as breast lift surgery.  To better understand the procedure, these are the most frequently asked questions of patients:

1.     Question:  How is breast lift performed?

Answer:  Plastic surgeons tighten and sometimes remove the loose skin and tissue using incisions placed directly in the breasts.  In most cases, the surgery also involves changing the position of the areola and nipple to achieve the most desired result.

2.     Q:  Where do plastic surgeons perform mastopexy?

A:  Mastopexy—or any type of cosmetic surgery—should be only conducted in an accredited surgical center or hospital.

3.     Q:  What are the techniques used in breast lift?

A:  Because the degree of sagging is different from each patient, plastic surgeons have come up with several techniques.  In severe cases, they use anchor lift which uses an incision around the edge of areola, within the breast crease, and another one that travels from the nipple down to the crease.

For women who need less correction, the vertical incision from the areola to the breast crease would be removed.  But for those who have a very small breast, even the donut lift—in which only the incision around the areola is maintained—would be enough to raise the bust.

4.     Q:  Who should postpone the procedure?

A:  Women who are planning to lose weight, nursing a child, and wanting to have more children should postpone breast lift because pregnancy and weight fluctuations can reverse the result of the surgery.

5.     Q:  What are the risks?

A:  As with any cosmetic breast surgery, mastopexy has its own set of risks including increased bleeding, infection, asymmetric appearance, and adverse reaction to medicines.  With this consideration, patients should only consult with a board-certified plasticsurgeon specializing in the procedure.  

6.     Q:  What are the preparations before breast lift surgery?

A:  Plastic surgeons require their patients to undergo physical and laboratory examinations (e.g., mammograms or breast x-rays) to determine any underlying health problems that may lead to more risks. 

And days or weeks before the surgery, patients should avoid aspirin, ibuprofen, warfin, and other drugs that can affect blood clotting; certain types of herbal supplements; alcohol; caffeine; and tobacco.

7.     Q:  Is there any visible scars?

A:  Within a year after surgery, the scars will remain very visible but over time they will fade.  While the incision lines are permanent, they are hidden from view that even if a woman would wear a plunging neckline, they cannot be seen.

8.     Q:  Can breast lift provide fullness?

A:  Breast lift can only raise the sagging breasts but cannot create fullness especially in the upper poles; for this reason, some doctors recommend breast implant surgery as a complementary procedure.

Breast Contour After Augmentation Mammaplasty

When discussing breast implants, the size is not the only issue patients should focus upon.  They should also bear in mind that the shape and profile of the device, in addition to the appearance of their chest and amount of tissue and fat, can have a significant impact on the final result of breast augmentation surgery.

Breast implants come in two shapes: round in which all the sides are symmetric, almost resembling the contour of an M&M candy; and anatomical in which the lower portion has more volume than the upper part, leading to a teardrop appearance.

To date, round breast implants are more popular than the anatomical version not only because they are cheaper but also they are less likely to cause “aesthetic” problems.  In fact, they can rotate inside the breast pocket and the shape of the chest will still not appear distorted.

By contrast, contoured or anatomical breast implants can lead to deformity in case that they rotate inside the pocket.  And because of this risk, they only come in textured surface which aims to prevent gross movement; however, the same design that prevents implant rotation has its own downside including higher risk of rippling, traction wrinkling, and failure.

As mentioned earlier, implant profile—or its projection off the chest wall—also has an impact on the breast contour after the implant surgery. 

Patients should take note that by using the right implant profile, they can avoid having breasts that appear too pointy or “unusually round.”  Fortunately, most board-certified plastic surgeons today can tell which one can provide the most desirable and natural result by simply looking at the patients’ body-frame.

For instance, high profile implants, which offer more projection but come with a smaller base, can result to a pointy appearance if they are used by women with a wide upper body, thereby leading to a very unflattering appearance.  On the other hand, the design provides a natural outcome if used by patients with a narrow frame.

For patients with a broad torso, it has been sacrosanct to use low profile implants, which offer less projection but come with a wider base so they can fill up more space.

Aside from the implant type, the appearance of the breasts and amount of tissue and fat also affect the outcome of breast augmentation surgery. 

Patients with a fair amount of tissue and fat tend to enjoy a more natural result with the use of saline implant, which has a watery consistency.  By contrast, women with limited tissue and fat would likely end up having a dome-shaped breast if this implant type is used.

Fortunately, a dome-shaped breast can be avoided with the use of silicone implants particularly when dealing with patients whose tissue and fat are quite limited.  This is because the implants are filled with a cohesive gel designed to simulate the consistency of the natural glandular tissue.

Also, the breast contour after surgery is affected by the structure of the chest.  For instance, women who have a pigeon chest, which is associated with the protrusion of both the sternum and ribcage, should expect that it would be more difficult for them to achieve a prominent cleavage (both upper and medial cleavage) than patients in the general population.

Hottest Celebrity Breast Implants

Breast implant surgery is arguably the most popular cosmetic procedure among female celebrities, although not all of them are willing to spill out their secrets.  Meanwhile, these are the stars who made it to the list of hottest breast augmentation results.

1.     Hilary Swank

After her breakout film “Boys Don’t Cry,” some people have noticed that the actress bust size has increased, however, others just speculated that she might have hidden her “assets” earlier in her career.  But whether she is naturally busty or has sought the help of a plastic surgeon, she looks sultry and beautiful these days.

2.     Salma Hayek

Considered as one of the sexiest Hollywood actresses, Hayek’s mother once told her that the only roles she could get in movies was a servant due to her “weird accent.”  But apparently, she proved her mom dead wrong.

Aside from her exotic beauty and acting skills, perhaps the star’s curvy body, which is rumored to be partly the result of breast augmentation, has also helped her to be always on the limelight.  But in the last few years, some people have noticed her breasts seem to be growing larger.

However, there are some people who believe the actress is naturally busty and the seemingly larger breasts may be the cause of weight gain, but then again, this claim may not be too convincing since only breast implants can create such a dramatic change.

3.     Halle Berry

While the beauty denies going under the knife, not all people believe her claims.  According to rumors, she has gotten breast implants (resulting to a full 36C cup) earlier in her career.

In previous interviews, Berry was quoted saying that she may consider plastic surgery in the future, however, not all were convinced with this statement especially with rumors of nose job and breast augmentation surgery.

4.     Beyonce Knowles

While the singer-dancer is naturally curvy, photos taken between 2002 and 2005 show that there was a considerable increase in her bust size, which is rumored to be the works of breast implants.

While Beyonce denies having any cosmetic surgery, not all people are convinced especially when one photo with her arms raised revealed a small incision in her armpit—a possible proof that she had breast augmentation.

Underarm incision technique is particularly ideal for dark-skinned patients who are prone to keloids.  According to some studies, the armpit is less likely to develop raised scars.

5.     Carmen Electra

Former Baywatch star Carmen Electra’s breast implants probably catapulted her career and made her into a Hollywood sex goddess.  In fact, she has been featured in Playboy magazine four times.

Should I Have Mastopexy to Treat My Sagging Breasts?

Mastopexy, or more commonly known as breast lift, is usually the first one that comes to mind for those with breast ptosis or sagging.  However, you should bear in mind that the exact appearance of your chest determines if this procedure is the right one for you.

A board-certified plastic surgeon can help you determine the extent of the sagging and choose the surgical technique which can provide the most desirable result.

But take note that having a flaccid breast does not automatically qualify you for breast lift surgery.  To know if you can benefit from this procedure, first you should understand the three types of breast sag:

* Ptosis

This condition warrants a breast lift.  It is manifested by having nipples that fall within the breast crease (Grade I); nipples falling below the breast fold (Grade II); and nipples reaching below the crease and pointing downward.

The degree of the problem determines the type of breast lift technique is used.  But the rule of thumb is that the more sagging you have, the more extensive the incisions will be.

If your breasts are very large and/or your breast ptosis falls under the category of Grade III, you would likely need the anchor lift technique which places incision around the areola complex, within the breast crease, and vertically between the areola and crease.

But if your ptosis falls under the category of Grade I and/or if you have a small- to medium-sized breast, the incision within the breast crease can be removed, thereby leading to quicker recovery. 

If you have a small sagging breast that lack volume in the upper cleavage, you may benefit from breast augmentation performed at the same time of your breast lift surgery.  Take note that be combining these two procedures, your plastic surgeon will use fewer incisions, leading to lower risk of visible scarring.

* Empty Sac Syndrome

The condition happens when the breasts have lost their fullness and roundness, giving an impression of sagging.  But if you will look closely, the nipples have not yet reached the breast crease.

For empty sac syndrome, the best approach is breast augmentation surgery particularly with the use of round implants to create fullness.

* Pseudo-ptosis

This is almost the same with empty sac syndrome, although the difference is that the upper cleavage is the only area which lacks fullness and roundness.  For this reason, placing round breast implants can correct the flaccid appearance. 

Octavia Spencer Planning Her Plastic Surgery

After winning the Best Supporting Actress at the 84^th Annual Academy Awards, The Help star Octavia Spencer said that she is planning to undergo plastic surgery, particularly with a procedure called breast lift.  It is surprising that while many celebrities tend to deny going under the knife, she admitted her plans without batting an eyelash.

In an interview with Parade magazine, the 39-year-old actress said she wants breast lift surgery which she views as her first gift to herself.

“I want my boobs where they were when I was 17,” Spencer quipped.  

The star said her breast lift surgery would likely take place in November since she will be busy working out of the country to shoot a movie until early fall.  In this way, she said that she can enjoy a long vacation until January next year.

Meanwhile, breast lift surgery is the only permanent solution for women with a real case of breast ptosis or sagging.  This aesthetic problem is manifested by a nipple falling below the breast crease while the areola complex is pointing downward.

One of the most common reasons why breast ptosis happens is pregnancy.  As the body prepares itself from childbirth, the ligaments, tissue, and skin are stretched, sometimes to the point that they can no longer retract to their original position, thereby leading to the sagging and flaccid appearance. 

Contrary to popular belief, breastfeeding does not cause sagging.  In fact, several studies have suggested that pregnancy alone—even if a mother will breastfeed her baby or not—can cause the problem.  Meanwhile, the drooping appearance can be further aggravated by weight fluctuations.

Going back to Spencer, she may be a good candidate for breast lift as long as she is no longer considering getting pregnant.  But to further ensure that the result will be long lasting, it is important that she is near her ideal weight at the time of surgery.

(Being near the ideal weight means that a person should not be more than 25-30 lbs. heavier than her recommended weight.)

Some breast lift patients need implants to create fullness particularly in the upper poles, however, women with large a bust size like Spencer may forego the additional surgery. 

But the good thing about combining breast lift and breast implants is the fact that plastic surgeons use less and shorter incisions, thereby reducing the risk of visible scarring, and potentially shortening the recovery period.

Saline Breast Implants—Pros and Cons

Saline breast implants are filled with a sterile saltwater, for this reason, a leak will not result to serious health problems although patients will need revision breast augmentation to correct the deflated-looking bust.

Saline implants are not superior to silicone version, and vice versa.  Patients should realize that the most ideal option largely depends on their anatomical features (e.g., amount of breast tissue) and goals and expectations.

Meanwhile, these are the advantages of saline breast implants:

*  Shorter scar.  In the US, only saline implants filled at the time of surgery are available (currently there is no pre-filled saline implant).  Once the shell is inside the breast pocket, plastic surgeons inject this with a sterile saltwater before closing the incisions.

Because an empty shell can fit in a small incision, patients who will use saline implants should not be concerned with visible scars.

* Lower cost.  Saline implants cost less than the silicone version (around $900 to $1300 cheaper).  The difference in price is due to the reason that the cost of production for these implants is lower.

* No risk of silent leak.  In case of rupture, patients will immediately know it right away.  By contrast, women with silicone implants have to undergo regular MRI screening to detect silent leak.

* Slightly lower risk of capsular contracture.  This complication happens when the scar tissue surrounding the breast implants becomes too thick that it squeezes the devices.  Some studies suggest that women with saline implants are at lower risk of having this problem than patients with silicone version.  While the difference is just 1 percent per year, it can be as high as 10 percent after a decade of having the silicone implants.

On the other hand, saline implants have their own disadvantages such as:

* Less favorable cosmetic result.  Because saline implants are filled with only saltwater, women with little amount of breast tissue cannot achieve a natural result.  However, this is usually not a concern of patients with a moderate to significant amount of tissue and fat.

For patients with little breast tissue, silicone implants are the best option.

* Prone to sloshing

Unlike the silicone implants which are notable for simulating the natural “feel” of tissue, the saline version is prone to sloshing because it is only filled with water.  For this reason, some plastic surgeons intentionally overfill the shell to make the implants firmer.

* Natural deflation

One study has suggested that saline implants have a natural deflation rate of 1 percent per year due to evaporation and other factors.  By contrast, silicone implants maintain their for volume for years except in the event of rupture

Preventing Breast Implant Rupture

While there is no guaranty that breast implants will last a lifetime, plastic surgeons have come up with different techniques to at least prolong the devices’ lifespan and lower the risk of implant rupture.

In the event of implant rupture, the only solution is a revision breast augmentation; this procedure may involve replacing the implants with new ones or removing them without any replacement.

Meanwhile, these are some of the basic rules which can help patients prevent or at least lower the risk of implant failure.

* Choosing silicone implants over the saline version

Currently available silicone breast implants are less likely to rupture than saline because they are not prone to sloshing and wrinkling which are known to affect the shell’s stability.  Another advantage is that the silicone gel does not evaporate (unlike the saline) which means the patients can maintain their breast volume unless in the event of rupture.

The latest version of silicone implants—which have a more cohesive silicone gel than the one currently used—is almost immune to implant failure.  However, these breast implants, called the gummy bear implants, are not yet approved in the US although these are already used in Europe and Canada.

* When using salinei mplants

Rippling, which can compromise the shell’s stability, can be prevented in saline implants by slightly overfilling them.  However, this should be carefully done because too much filler can cause abnormal pressure on the device.

On the other hand, underfilling saline implants only has negative results because it can cause creases, leading to weak areas in the shell.

* Avoiding high trauma to the breast

Modern breast implants are very strong although they are still subjected to the effects of physical force.  Impact from car collision, sports injuries, and accidental falls may compromise the shell’s stability or may even lead to rupture.

* Consider the implant placement

Some doctors say that submuscular implant placement (placing the device under the pec muscle) poses a slightly higher chance of shell damage than the subglandular technique (positioning the implants over the muscle).  A good compromise might be the subpectoral placement.

* Use of Keller Funnel technique

In this technique, plastic surgeons place the breastimplants in a cone-shaped device and then squeeze it so the implants are transferred into the breast pockets.  Doctors use less force in this method than if they push the devices using their fingers.

Breast Surgery—Combining Fat Grafting and Breast Implants

Breast reconstruction via implants for cancer patients who had undergone radiation therapy is often not an ideal procedure due to the high risk of complications for the reason that radiation has toxic effects on tissues, which can impede natural healing for many women.

Because breast implants are not ideal for cancer patients who had radiation therapy, tissue-based reconstruction is the only viable treatment in which their own tissue from buttocks, abdomen, or back is used to create a new breast mound.  However, the tradeoff is longer recovery and muscle weakness and scarring in the donor site.

Fortunately, doctors have found ways minimize the radiation-induced complications, making it possible to use breast implants for post-cancer patients who received radiation therapy.  The staged procedure involves injecting a person’s own fats to her breast so the area will receive a “bed of healthy tissue” in the chest wall.

A recent study published in the February issue of Plastic and Reconstructive Surgery medical journal has proven the promising advantage of combining fat grafting and implants for breast reconstruction.

The three-year study involved 16 patients who underwent the new breast reconstruction technique after receiving radiation therapy to fight off cancer cells.  Eleven respondents had mastectomy (partial or complete removal of breasts) while five had lumpectomy and other types of breast-conserving surgery.

Breast reconstruction began three to six months after the respondents received radiation therapy.

All patients have received two to three fat grafts to place healthy tissue in the chest wall, allowing it to accommodate the breast implants and to lower the risk of radiation-induced complications.

The collected fats from the donor site must be subjected to a purification method to separate biomaterials such as blood and connective tissue; in this way, the survival rate of the grafted fats will be high.

After the staged breast reconstruction, the results were highly encouraging in terms of aesthetic improvements, the researchers concluded.  Also, patient satisfaction was rated high to very high.

Meanwhile, an average follow-up of 15 months did not show any complications as all patients have experienced good healing in their tissue surrounding the breast implants.

Performing radiation therapy after breast cancer surgery significantly reduces the risk of recurrence, although the downside is that the treatment can affect the body’s healing because of its toxic effects.

While the new study revealed the promising benefits of fat grafting with breast implant for reconstruction surgery, the researchers said more comprehensive surveys and trials with longer follow-up are still needed to confirm their findings.

Traditional Breast Lift Surgery Vs Surgical Mesh

Traditional breastlift surgery is conducted by making incisions around the areola, across the breast crease, and vertically down from the nipple to the fold, thus allowing plastic surgeons to excise some of the loose skin and tighten the tissue.  However, one tradeoff a patient should remember is that while it can raise and reshape the bust for a period of time, it cannot stop the effects of gravity and skin laxity.

But recently, plastic surgeons from South Africa have developed a new technique called Internal Bra System which uses a “support” to prevent future sagging.  This method is now also used in Europe.

The new breast lift technique uses a mesh-like device called Breform which is similar to the one used in hernia repairs.  Meanwhile, plastic surgeons who developed the method said the material can take the strain off the scars and skin, preventing the breasts from sagging.

While Breform has not yet been approved in the US, experts believe that it will be introduced to the market within the next coming years.

Breform is a cone-shaped polyester mesh that is placed underneath the breast skin and is attached to the fascia using internal sutures.  The procedure is conducted under general anesthesia that puts a patient to sleep.

Plastic surgeons in Europe who are using Breform said the device is incorporated into the breasts over time, with the body naturally producing fibrous tissue holding the new structure in place.  With this technique, they believe the result is like a permanent support bra under the skin.

However, patients should remember that the new technique also involves the same incision sites used by the traditional breast lift surgery.  This means that the risk of scar and the length of recovery of these two methods are almost the same.

While Breform is approved in Europe, it has not been permitted by the US Food and Drug Administration, which is noted for its strict regulations on medical instruments.  And because the breast surgical mesh is quite new, there is no long-term study proving its effectiveness and safety.

Some US plastic surgeons are also concerned if the mesh-like device may affect the accuracy of screening tests for breast cancer or if it may lead to serious complications.

However, a four-year study involving 170 patients in Holland found no serious complications following the procedure.  The trial also revealed that breast X-ray examinations were still possible after the internal bra surgery.

Can Silicone Breast Implants Correct Mild Drooping?

Silicone breast implants are increasingly becoming popular these days as they provide a more natural result than saline implants.  This is not surprising because they are filled with a cohesive silicone gel designed to replicate the “feel” and move of glandular tissue and fats; another bonus is that the filling does not evaporate—unlike the saline solution—which means the patients can maintain their breast volume unless in the event of leak or rupture.

The good news is that breast implants—particularly the silicone-filled versions—can correct mild or pseudo ptosis (sagging) which is caused by breastfeeding.  It happens when the mammary glands put pressure on some glandular fats, but after the enlargement resolves, the breasts somewhat “deflate.”

On the other hand, true ptosis is caused by stretched and damaged suspensory ligaments in the breasts.  Oftentimes, the problems can only be addressed by mastopexy or more commonly referred to as breast lift; this can be performed as a standalone procedure or as a complementary to breast implantsurgery.

To correct mild or pseudo ptosis, it is highly recommend to use small implants (300 to 350 cubic centimeters would be the right range) because introducing large ones can aggravate the problem as the tissue is forced to carry the extra weight.  And over time, the stretched tissues will worsen.

By using large implants, there is a higher chance that the patients will need breast lift sooner rather than later.

It is important to note that even small implants can provide upper pole fullness in the breast, the area which is often affected by childbirth and breastfeeding.  But as mentioned earlier, silicone implants are better than the saline versions because they do not have a natural deflation rate.

By contrast, saline implants have been found to lose about 10 percent of their volume after a decade because of evaporation and other factors.  This simply means that patients with these devices are more likely to need revisions sooner than those who have silicone implants.

Meanwhile, there is still a debate whether the subglandular or submuscular implant placement provides more lift.

In the subglandular implant placement, the device is positioned above the muscle which is believed to provide a more lifting effect.  But one downside is that only the tissue and skin support the implant, something which may aggravate the ongoing ptosis.

On the other hand, the submuscular implant placement is said to prevent future ptosis because the device, which is positioned under the pec muscle, is being supported not only by the tissue and skin but also by a thick amount of muscle.

Too Young for Breast Augmentation?

In the US, the legal age requirement for breast implant surgery is 18—and that is if you are going to have saline implants which are filled with a sterile saline (saltwater solution).  But if you want to use the silicone implants, you should be at least 22 years old.

The main reason why silicone breast implants require a higher age limit is that they pose risk in the event of rupture or leak.  For this reason, you have to undergo regular MRI screening to detect any “silent leak.”

By contrast, the examination is not necessary if you will choose the saline implants because in the event of implant failure, your breasts will deflate within hours after the rupture, thus allowing you to seek revisions right away.

Generally speaking, female patients under the age of 18 cannot have breast augmentation surgery unless there is an issue of breast deformity.  The problem with younger people is that their body is still maturing and they may not yet fully understand the ramifications of cosmetic plasticsurgery.

It is important to note that even if you are flat-chested at the age of 15, there is still a chance that your breasts will enlarge as years pass by.  And with large implants and ongoing breast development, you may end up having oversized busts that look unnatural and asymmetric to the rest of your body.

Another concern is that patients below the age of 18 are not emotionally mature.  In fact, a study has suggested that teenagers see cosmetic surgery as a way to fit into their crowd.  By contrast, adults seek the procedure to stand out from the rest.

As mentioned earlier, your plastic surgeon may allow you to have breast augmentation at a younger age if you are suffering from certain types of deformity including tuberous breasts in which they appear too pointy because of the unusual structure of their base.

Breast augmentation performed at a younger age may also be necessary if you develop a very large breast on one side while the other is too small or even “absent.”  In general, age is not an issue in reconstructive plastic surgery.

While the US is quite strict when it comes to cosmetic breast augmentation, certain countries allow the procedure on patients as young as 16.  This lower age limit is not acceptable to many American surgeons who believe that the body should be allowed to mature first before any aesthetic or elective surgery is conducted.

Breast Implant Size and Things to Consider Before hand

The size of breast implants is measured via cubic centimeter or cc instead of “cup” since every bra manufacturer follows its own standard.  Meanwhile, it is important to note that the volume is not the only thing that affects the final results as there are other contributing factors such as implant profile, shape, and placement.

During the previous years, a significant number of women who asked for breast augmentation wanted larger implants even if it meant having a “heavy” top look.  However, plastic surgeons today see a shifting trend toward smaller sizes to achieve the natural look.

The growing trend can be seen on some Hollywood celebrities who replaced their breast implants with smaller ones.  For instance, Denise Richards and Pamela Anderson have been reported to have undergone revision plastic surgery to downsize their implants.

Another good example is Kate Hudson who has been reported to receive small breast implants in 2010.  And because of the subtle changes in her bust size, no one would even know that she had the procedure if not only for her previous photos and videos showing how flat-chested she was back then.

As a general rule, very large implants will obviously look “fake” in addition to higher risk of complications as the body, especially the back and upper torso, has to carry more extra weight.  For this reason, a good plastic surgeon will make every effort to convince his patient that inappropriate implant sizes can lead to many problems.

The problem with inordinately large implants is that they may lead to premature sagging and tissue thinning as the breasts are forced to carry more weight.  To correct such complications, a revision plastic surgery—which may involve implant replacement or permanent removal of the device—is the only effective solution.

For thin patients, particularly those with limited amounts of glandular fats and tissue, very large implants can significantly predispose them to visible and palpable rippling, or sometimes even traction wrinkling especially if they will receive the textured implants with large size “graininess.”

Another consideration to make is that large breast implants can upset the center of gravity of women, which can affect the way they move.  With this consideration, athletes and patients who live an active lifestyle are generally advised to choose smaller implants to maintain their performance and good posture.

Because of the risk of excessively large bust size, implant manufacturers in the US do not sell silicone breast implants that are over 800cc.