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. 

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. 

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 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.

Study Shows the Benefits of Reconstructive Breast Augmentation to Cancer Survivors

When breast augmentation is mentioned, the first thing that comes to mind is a cosmetic procedure to improve one’s figure.  While it is true that a significant number of patients seek this to increase their bust size, the surgery is also a way to reconstruct the breasts of cancer survivors who had mastectomy.

In 2010, approximately 93,000 breast reconstructive surgeries were performed in the country.  Most of the patients were cancer survivors who wanted to regain their normal appearance.

According to the American Cancer Society, female patients who have undergone breast reconstruction via breast implants, tissue-based method, or combination of both procedures, have experienced dramatic improvement in their social and sexual wellbeing after their traumatic experience with cancer and disfiguring surgical treatment.

A recent study, which is conducted by researchers from Memorial Sloan Kettering Cancer Center and The University of Toronto, examined the wellbeing of post-cancer patients who had DIEP flap breast reconstruction, a procedure in which their own abdominal tissue was used to create new breast mound.

Before and after breast reconstruction, the respondents were required to answer questionnaires that would determine the status of their wellbeing and self-esteem.  According to the findings, majority had experienced significant improvements in terms of their emotional health just three weeks after the reconstructive plastic surgery.

But as with any tissue-based breast reconstruction in which the patients will likely experience muscle weakness in the donor site, most patients had reported weakened abdominal wall three months after surgery.  However, the symptom is usually tolerated well by many.

While muscle weakness is one of the tradeoffs of breast reconstruction via tissue-based technique, plastic surgeons can prevent this by placing surgical mesh or support over the donor site.

Apart from using a person’s own tissue, plastic surgeons also use breast implants, either filled with silicone gel or saline solution.  But in case that there is little tissue left after mastectomy, they will first insert temporary implants that is inflated with saline solution every two weeks; once there is enough room, they remove the tissue expander and replace this with a permanent implant.

The appropriate breast reconstruction technique largely depends on the amount of tissue left—or the lack of it.  And in general, patients who had invasive cancer surgery will likely need tissue-based surgeries.

On the other hand, women who are left with more amounts of glandular tissue and skin after their cancer surgery will often have the opportunity to choose breast implant surgery, which is less invasive and results to less scarring than the tissue-based reconstruction.

Breast Implants with Lift for saggy boobs

Even small breasts can sag due to the natural effects of aging, weight fluctuations, and previous pregnancies.  Fortunately, plastic surgeons have come up with a new technique which combines the benefits of mastopexy (or breast lift) and breast augmentation in one operation.

The sagging of the breasts primarily happens when the amount of tissue decreases and the skin becomes lax.  Contrary to popular belief, breast augmentation surgery alone is less likely to provide a lifting effect especially if there is a severe case of ptosis (drooping).

Mastopexy with breasti mplants starts by making incisions to remove a small amount of skin, which in turn corrects the sagging appearance.  With this technique, less tissue is excised than if breast lift is performed alone; for this reason, patients will enjoy less scarring on their chest.

Because less skin is removed, plastic surgeons need shorter incisions to perform mastopexy-augmentation surgery.  In most cases, they use the crescent-shaped incision around the areola complex, although patients with severe breast ptosis may need the lollipop incision in which the surgical cut is made around the areola and vertically down the breast crease.

The good thing with mastopexy-augmentation is that most patients can get more cleavage, although they should bear in mind that the final result also depends on their chest width and rib cage.  For example, women with a concave chest are likely to enjoy more medial cleavage and upper pole fullness as the implants tend to settle toward the center.

On the other hand, patients with convex chest will achieve less cleavage because their implants will likely settle opposite with each other.  However, there is a solution to the problem: use breast implants that offer more projection off the chest wall.

While some surgeons prefer simultaneously performing breast augmentation and mastopexy, others would rather wait for three months before another surgery (augmentation) is conducted.

Some doctors argue that breast augmentation with mastopexy—if performed on the same day—can lead to higher risk of asymmetrical breasts and complications since the skin is being removed and tightened while at the same time the implants stretch it even further.  Another concern is the tension on the incision site can adversely affect the blood supply.

They also argue that it is challenging to position the nipple and breast crease if mastopexy and breast augmentation are performed simultaneously.

Regardless if breast augmentation is performed on the same day of mastopexy or at a later date, most plastic surgeons recommend placing the implants totally under the pec muscle which can provide good coverage and strong “support.”

Teardrop-Shaped or Anatomical Breast Implants

Anatomical breastimplants—also referred to as dimensional, teardrop, and contoured implants—were first used to reconstruct the breasts of post-cancer patients.  But in later years, some plastic surgeons have started using these devices in cosmetic breastaugmentation surgery.

Unlike round implants in which all the sides are symmetrical, anatomicalimplants have more volume at the bottom than on top, leading to a teardrop appearance.  But because of their shape, there is a risk of flipping over, which in turn leads to visible distortion of the breast contour.

To prevent the anatomical implants from flipping over, they always come in textured shell, which can prevent them from rotating.

The anatomical implants are available in different sizes and profiles (outward projection off the chest wall).  However, patients should bear in mind that these implants are only filled with saline or saltwater solution.

Anatomical implants filled with silicone gel are not available in the US because the “gooey” material cannot be molded into a teardrop shape.

However, there is a new type of breast implant called gummy bear implant (available in some European countries and Canada) which uses a gel more cohesive than the currently available silicone implant’s.  And with its form-stable characteristic, anatomical implants can now be filled with silicone.

It is important to know that gummy bear implants are not yet available in the US market, although some patients may have these new devices if their breast augmentation surgery is conducted by a surgeon involved in a nationwide, FDA-approved study.

While anatomical implants are used in cosmetic breastaugmentation, they are not as popular as the round implants because they are more expensive and can expose patients to higher risk of visible and palpable rippling (because they are always available in textured shell), particularly those with a limited amount of fats and tissue in their breasts.

Another consideration is that the anatomical implants can rotate inside the breast pocket, which in turn can disfigure the shape of the bust.  On the other hand, round implants can be subjected to gross movement and they will still not result to distorted appearance because all their sides are symmetrical.

Contrary to popular belief, there is really no significant difference between anatomical and round implants when it comes to the breast contour after surgery.  In fact, round implants will form a teardrop shape if these are held against the chest wall as the gravity works its wonder.

Patient Options in Breast Augmentation Surgery

The primary goal of breastaugmentation is not just about increasing the bust size but also making the result as natural as possible.  Fortunately, this is easier nowadays as breast implants come in different sizes, shapes, shell, filling, and projection, in addition to a wide range of surgical techniques used by plasticsurgeons.

Nowadays, three options in breast implant placement are available for patients: complete submuscular (under the muscle), partial submuscular (partially under the muscle), and subglandular (behind the tissue).  These surgical techniques have their own pros and cons which are carefully explained to women so they can decide for themselves.

The complete submuscular implant placement results to longer recovery and more pain during healing period because the pec muscles are stretched and pushed.  However, the technique provides countless of benefits such as more coverage to reduce the risk of implant wrinkling; more lifting effect; better mammogram reading; and lower risk of capsular contracture, which is a condition resulting to hardening of the scar tissue around the implants.

On the other hand, the subglandular implant placement results to shorter recovery because the pec muscle remains intact.  But since no muscle covers the implant shell, the technique is only ideal for patients with enough glandular tissue, fats, and skin.  Another consideration to make is that an ongoing ptosis (drooping) may be further aggravated because of the lack of strong “support.”

Meanwhile, the partial submuscular combines the benefits of subglandular and complete submuscular implant placements.

Aside from the implant placement, the type of implants can also have a significant impact on the final result.  For instance, women who want to achieve more cleavage are advised to choose round implant rather than the teardrop-shaped version, although the latter is more notable for simulating the natural contour of the breast.

Breast implants are either filled with saline or silicone gel.  For those who want to achieve a more natural “feel” and “look,” and women with a limited glandular tissue, the silicone implant is a better option; however, one downside is that the patients are required to undergo MRI screening every two years to detect any asymptomatic or “silent” leak.

On the other hand, women with saline implants are not required to have a regular MRI screening because a leak is easily manifested by deflated-looking breasts, making it possible to immediately seek revision breast augmentation.

Regardless if saline or siliconeimplants are used, their size should not only be based on one’s goal but also on her body-frame, amount of tissue and skin, and chest width.  It is important to note that a good plastic surgeon will not push the body’s limit by introducing implants that are too large for it.

Breast implants can be inserted via four incision sites: axillary (armpit), TUBA (navel), breast crease, and areola complex.  Patients should remember that the best surgical technique largely depends on their goals, acceptable risk level, and type and size of implants.

The axillary and TUBA incision sites require the use of an endoscope, which is a fiber optic camera attached to a large monitor.  Through this instrument, plastic surgeons can insert an empty saline shell inside the breast pocket and then fill this with a sterile saltwater solution.

But because the axillary and TUBA incisions work farther away from the bust area, there is a greater margin of error.  By contrast, the breast crease and areola incision sites provide surgeons with greater control over the final result of the surgery, making them a more popular choice.

Since there are many surgical options and type of implants available for women, breast augmentation typically involves lengthy consultation between patients and plastic surgeons.  In this way, doctors can also determine if the goals and expectations of a person with the surgery are plausible and achievable.