Breast Augmentation in Temecula

In order to maintain softness and a natural feel for the breast, implants are composed of a shell and it’s contents. The shell is a solid rubber sheet that is shaped during the implant fabrication process and has been always made up of silicone. Silicone is a polymer, like nylon and can be made into a solid, a gel or even an oil. The contents within the breast implants are either saline or silicone gel and both are used in equal numbers today by cosmetic and reconstructive surgeons. Over the past several years, different densities of the gel fill have become available with the idea that patients and doctors may further customize patient treatment. Studies on these new types of gel breast implants are still forthcoming.

Differently shaped shells have also been developed and marketed by implant manufacturers.  The commonest implant used for breast augmentation today is the round implant. This implant exhibits a round shape when a patient with implants is lying down and when the patients sits or stands, the contents of the implant “flows” downward and the implant confers a shape that is more like a natural breast. It appears more like a natural breast because the upper part of the breast sticks out less than the lower part of the breast which becomes more full.  By changing the contents of the breast implant, manufacturers can offer implants with not only a different feel but, as mentioned different flow characteristics that may make breast enhancement patients have different shapes when they are either lying down or sitting up.

The opposite of the round shell is what plastic surgeons refer to as anatomic implants. Patients refer to these implants as “tear drop implants”. They maintain the same tear drop shape whether a patient is lying down or standing up. Since anatomic implants are more complicated, for example they must be textured on their surface to maintain their position, they generally are more difficult to get the best cosmetic result and also have more complications associated with them. Despite this, anatomic implants are still in use today but are much less commonly used than round implants.

As mentioned above, contents can either be saline or silicone gel. There are equal amounts of these types of implants used today in cosmetic surgery. Both types of fills are equally safe.  What differentiates them are two issues, commonly referred to as rippling and contracture. Saline implants have a more watery feel in the hand (when they are being examined directly) than silicone gel implants which feel more “gooey” when held in one’s hand. In patients with minimal “coverage”, which means not much breast tissue, it may be possible to feel or see waves from the implant. Since saline implants can have a more watery feel to them, silicone gel breast implants may be a better option. Patients who have a significant amount of breast tissue may have a low chance for rippling. In patients with thicker tissues it may not even be able possible to feel the implant at all.

A hot area for research in plastic surgery is why some patients develop scar tissue around their breast implants after surgery. This scar formation is referred to as “capsular contracture”.  After breast implants are placed into what plastic surgeons refer to as a pocket, or space,  a scar forms around the implant. This scar is not attached to the implant but rather attached to the tissues around the implant like wallpaper is attached to the wall upon which it is placed. So the implant is free to move around the pocket and is limited only by the scar around it, which is called the capsule. The implant moves freely inside the pocket which is defined by the capsular scar that is attached to the outside tissue.  Normally, the capsular scar is quite thin and stretchy and movement of the implant in one direction cause the scar it then presses on to stretch and so the breast itself feels soft and natural, like breast tissue.

There are some patients who, for some reason that is not known yet, produce thick capsular scar that doesn’t stretch and even can contract around the implant. This contraction of the scar can make the space around the implant smaller and can even change the shape and apparent size of the breast implant itself! So there are different effects that overproduction of scar can have on the breast implant but the term used to describe the effect of excess scar production is “capsular contracture”.

Capsular contracture is an unwanted and adverse reaction to breast implant surgery. This is because contracture can change what patients and plastic surgeons wish for the shape, location and size of a patients breasts. Historically, silicone breast implants have had a higher chance for capsular contracture than saline implants. Recent studies have shown that the rate of capsular contracture is more similar between these two implants but long term data on the newer series of implants is still forthcoming. Since capsular contracture rates are relatively low for both saline and silicone implants, both remain attractive alternatives for use in cosmetic breast augmentation.

This is the most important question a breast augmentation patient should consider. It’s critical to understand two things about breast augmentation surgery. Implants make patients larger breasted and the implant also changes the shape of the breast.  There is a range of sizes  for each patient where the breast shape is the best it can possibly be. One might call that “the golden zone”. Within this range of volume, or cc’s of the implant, the shape is the best it can be because the size of the implant is doing all it can do to solve certain issues required to improve the shape. Lets discuss what those issues are.

We need volume, or size to fill out the breast to certain edges of the chest in all patients. Those edges start with the cleavage area. We need to have volume that extends the inner parts of the breast towards the center. They don’t need to be touching, but there needs to be an apparent relationship of the inner aspects of both breasts to each other. Next, the outside of the beast should form a relationship with the outer part f the chest wall. Therefore, the wider the chest, the more volume is required to fill that space. The breast implant and it’s volume should also support the upper part, or pole of the breast. This fill creates a natural and a youthful  appearance to the breast but again, volume is required to achieve this beauty. Finally, the breast also requires adequate volume to provide for projection of the breast because this also makes the breast look youthful  and natural appearing. All of these goals for breast augmentation require volume. Generally, the lowest volume that achieves most of these goals represents the lower end of the golden zone. 

There are two ways a plastic surgeon can create space to put in more volume.  One way is to place the implant only behind the breast and for the breast tissue and the muscle to stretch.  The other way is to make a space beyond the edges of the breast. Adding space by expanding past the breast is a great way to add more volume and can help patients get to their goal. It can also help improve shape. But expanding the space past a certain point can worsen the shape. The point at which adding volume to the breast no longer helps shape is the  upper limit of the golden zone.

It is also important to understand that patients are shaped differently and they have different wishes. Some patients wish to have an increase in their cup size but also the best shape possible and would therefore be described as wanting to be within the golden zone and perhaps at it’s upper end. Other patients don’t want to be much large but want the shape improving effects that breast augmentation can provide. These patients would be in the lower range of the golden zone.  Finally, there are patients who want improvement in their size more than they want improvement in their shape. These patients want implant sizes beyond the golden zone.  Controlling breast size with implants is something that can be controlled prior to surgery and so it is very important for patients to thoroughly discuss what  size they wish as well as the effect of that specific size on their shape.

Silicone breast implants

Silicone implants consist of silicone gel filling with an outer silicone shell. These implants have several advantages in terms of appearance and feel. The silicone gel has a thick flowing  texture, similar to that of breast tissue. Many patients prefer silicone implants because they provide a more natural look and feel, closely mimicking the characteristics of firm breast tissue.

Saline breast implants

Saline breast implants are filled with sterile salt water with an outer silicone shell. Unlike silicone implants, which are pre-filled, saline implants are filled with saline after they have been inserted through a small hidden incision. This allows for more customization in achieving the desired size and volume. Filling the implant after insertion allows for the use of a smaller incision which leads to less scarring. 

Despite the fact that saline implants are water filled, the deflation (rupture) rate is exactly the same as for gel filled breast implants. Some patients like the fact that if there is a deflation with saline implants, they will always see that there is a deflation because the breast will appear smaller. That is not the case with gel implants because the gel will remain in the breast implant pocket and there will be no external change to breast shape. It is important for patients to understand that even ruptured gel implants are safe. Dr. Newman can discuss this in detail with you at your consultation and spend time with you, listen to your concerns and needs and make recommendations for treatment.

Choosing the best implant size is a personal decision because patients have differing body shapes and desire different looks for their breast. During your comprehensive consultation, Dr. Newman will listen to your desired goals and vision for the procedure. He will consider several factors including your body size, weight, current breast shape, measurement, and breast tissue characteristics. While you may have a specific size in mind, it is also important to select the ideal implant size with breast support structure and body proportions in mind. Ultimately, it is your choice what breast implant size you desire.

What to do:

• DO follow Dr. Newman’s post-operative instructions carefully.  In addition to your initial consultation with Dr. Newman, you will have a detailed pre-op appointment with Dr. Newman and his nursing team to review the post-operative paperwork prepared specifically for you. These instructions are essential for promoting healing and minimizing the risk of complications. It’s important to keep this information handy at all times after your surgery so you can easily refer to it as needed. Trust these guidelines for a successful recovery.
• DO wear a bra. A supportive bra will be provided by Dr. Newman to be worn home from surgery and during the weeks following your breast augmentation. He will discuss the frequency and length of time needed to wear your bra to achieve the best success of your results.   
• DO eat a balanced and nutritional diet. It’s important to remember that your body has undergone a major transformation. Providing your body with the essential nutrients is crucial for a successful recovery. Avoid fast food and unhealthy snacks; instead, focus on incorporating lean meats, fruits, vegetables, and whole grains into your diet. The right foods can fuel your body and encourage healing. 
• Do rest when your body needs it, but do get up and do light activity to promote blood circulation and reduce the risk of blood clots. 

What not to do:

• DON’T forget your follow-up appointments! Every appointment Dr. Newman schedules with you is just as important as the one prior. Healing is a journey that extends past the first few weeks after surgery. At these appointments, Dr. Newman evaluates your progress and healing. He is there to answer any questions you may have and ensure you are on the road to recovery for your desired results and expectations. 
• DON’T use any tobacco products. Not only is it required to quit any tobacco products before surgery, it is also advised to avoid nicotine during your breast augmentation recovery as well. Nicotine narrows your blood vessels which reduces blood circulation. And reduced blood flow can lead to poor healing.
• DON’T submerge your body into water until your wounds are fully healed and Dr. Newman gives you clearance to swim or take a bath. There are risks of bacteria in the water which may increase the risk of infection and delay healing. 

It’s really important to allow your body time to fully develop before considering a breast augmentation. During puberty, estrogen promotes breast tissue growth, and for some women, this growth will continue into their late teens and even early twenties. If you get a breast augmentation too soon, it may affect your results because your breast size and shape are still developing. Having a solid foundation of soft tissue and muscle is key for the best implant placement. Taking the time to wait until you’ve finished puberty can lead to better surgical outcomes and ensure that the implants remain in the proper position long term. There are women who achieve full growth of their breasts in younger years. Discuss that with Dr. Newman at consultation.

Newer implants have an extremely low deflation (rupture) rate and that rate is the same every year for the life of the implant. Many patients never have to have repeat surgery but the FDA has instructed us to tell patients there is a likelihood that they will need more surgery. The reason that the deflation rate is the same every year is that its not wear and tear so much as an imperfection in the shell of the implant during its formation. That’s why there is a warranty the implant manufacturer provides for the life of the implant.

After surgery, some pain is expected. Dr. Newman prioritizes your comfort and pain management throughout the entire recovery process and has designed the procedure to decrease the chance for pain. He offers effective pain management solutions including a laddered pain medication protocol. Each patient has a different response to surgery but most patients take pain medications for about 3 to 4 days after surgery. After this period, most are able to taper off the stronger pain medications and manage their pain with Tylenol.

It’s completely understandable to be excited and eager to see your final results soon after surgery! However, keep in mind that implants need some time to settle in and find their perfect position. Right after the surgery, your breasts may look compressed and slightly higher in position and after about two to three weeks descend and expand into the new beautiful shape and size. Most patients expect to see their final results within 6 to 8 weeks after the procedure. Healing takes longer when breast lift surgery is added to breast augmentation. Dr. Newman will likely continue follow-up appointments up to a year post-op to ensure everything looks great and that the implants have settled.