by David Newman, MD | Oct 23, 2019 | Blog, breast-surgery
You have just decided to take the plunge and have a breast augmentation. There has been the back and forth deciding and listening to your friends and relatives telling you what to do but now you have finally decided. You have consulted with several good plastic surgeons but you still don’t know exactly how big you want to go or which implant is the best. Dr David Newman recommends that patients think more like a doctor when looking at breast implant alternatives. And there are two secrets that doctors know about breast implants.
Size Matters but Not Like You Think
Your Right Breast Implant Size is the Size That Will Make You Look Your Best
Plastic surgeons use volume to create shape. So when the volume of the implant is too small, there is not enough size to get to the best shape. For example, the implant needs to extend horizontally from the cleavage area to the outside of the breast in order that the cleavage will be the best it can be. If the implant is smaller than this, the cleavage will suffer. This is also true from the vertical perspective. The implant needs to have sufficient volume so that it can extend from the bottom of the breast to the upper pole or the upper part of the breast won’t be full and again, the overall shape will not be its best. These are both examples of the minimum volume required to achieve the best shape.
But shape will suffer when the implant goes beyond a maximum volume. In other words, when the implant is too large, the shape won’t be as good as it was with a lesser size. This is mostly because the doctor has to make a larger pocket to hold the larger implant and the space required may extend beyond the natural edge of the breast tissue. When this is done, the breast starts to lose its “breast shape” and become more “blobby”. Some patient might be willing to sacrifice some loss of shape to get to the size they wish but more often patients wish the best shape. But patients should know that there is a “best shape range of implant sizes” that will lend the best shape. There are some other issues that relate to creating a pocket that extends past the natural edge of the breast tissue. The breast tissue provides natural cover for the implant and hides the ability to feel or see edges of the implant (rippling). So when the implant goes beyond the edge of the natural breast tissue, it may be possible to feel the implant.
Another issue relates to the support of the implant by the patient’s tissues. The implant is being supported by the pectoralis muscle which acts like an internal bra to push the implant up and that creates fullness of the upper part of the breast. We need good volume to have the implant “get to the top” of the breast to create this fullness but when the implant pocket is made too large or especially when the muscle is released at the bottom to put in a large implant, the muscle is no longer able to support the large implant and, over time, the implant that lacks support will fall and “bottom out”. This also results in loss of fullness of the upper part of the breast. Most patients can get to their goal size wishes without having to go beyond this point. But it is interesting and helpful to discuss the fact that there is a “best size” or at least “best size range” for each patient and this is generally in the C to full C range though it can vary widely with different chest widths, different anatomy and different breast shapes. To find your best size range it is important to discuss your wishes with a plastic surgeon, both in terms of the size and the shape.
A Plethora of Possibilities
While you are on the road to your best shape, it’s also important to know that there are several kinds of breast implants and not only one type. Breast implants can be round or tear drop shaped, have differing amounts of projection (sticking out from the chest), can be saline or silicone gel and even are offered with differing thicknesses of gel. This reveals something very important: there is no one best implant but rather different implants that each have pluses and minuses. Each patient must weigh the benefits of these different implants as they relate to their goals and go through the process of this decision. It’s a very enjoyable process to go through and find what is best for you! So don’t let anything hold you back.
by David Newman, MD | Oct 7, 2019 | Blog, breast-surgery
Breast Augmentation
A frequent discussion by plastic surgeons centers on why patients are so pleased after breast augmentation surgery. Because it’s not only the change in breast size but rather something about shape and functionality, how a woman feels, moves and relates that changes after the procedure. The ideal breast has projection, i.e. it sticks out, at least to some degree from the body. Some women don’t develop the projection they wish or with the passage of time there is a loss of projection. Implant surgery provides a base upon which the tissue sits to provide good projection. And when the implant is placed under the pectoralis muscle, there is sufficient support of the breast implant so the upper part of the breast is fuller. This upper pole is the part of the breast seen by others because it extends beyond the shirt or bathing suit. But it’s not even the youthful improvement in the upper pole that makes breast augmentation so gratifying.
Breast Augmentation is Back in Fashion
It’s more about the freedom and confidence women feel when they know they appear healthy and beautiful to others that boosts their self confidence. Suddenly, it’s easier to wear different clothing and even explore bathing suits that don’t hide as much skin. As the implant gives fullness and size, it’s no longer necessary to use padding which immediately makes wearing clothes a lot more easy and with much less fuss. Some patients don’t need to wear a bra after breast augmentation because the tissue around the implant supports it. That less restricts what a woman can wear because some clothing is more functionally worn without a bra.
So when one considers a patient’s gain in shape and beauty and the confidence breast enlargement brings, how it makes a woman feel and the years implants provide this improvement, the price is there but seems to fade in importance.
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by David Newman, MD | Oct 7, 2019 | Blog, breast-surgery
To schedule a free consultation with Dr. Newman, call 951-698-3344.
Breast enhancement is one of the most gratifying procedures offered in Plastic Surgery and more than twenty million women have had the procedure. Breast implants not only enlarge but even more importantly enhance a patient’s shape to make the breast more natural appearing, more youthful and gives a sense of vibrancy and energy. That is no truer than in Temecula where Temecula breast augmentation surgeons seek to gain the best shape possible for every patient but also understand that it’s important to get back to normal daily activities as soon as possible and to get back to exercise and outdoor activities.
Size and Shape are Married
Preoperative planning is of utmost importance in getting patients to their goals and at the top of the list in that department is a discussion about size: what patients wish and the effect of size on a patient’s shape. Many think that different sized implants will keep the shape the same but it’s the opposite. Going larger affects the shape and there comes to be a “sweet spot” in the sizing where breast shape is the best it can be. Going larger is good but “too large” doesn’t mean big but rather that there are negative effects on shape, both initially and over the long term. So it’s important to understand what the implant is doing to improve shape in order to understand how going beyond the sweet spot can detract from breast shape.
What Breast Implants Really Do
When the implant is placed under the pectoralis (pec) muscle, the muscle acts like an internal bra and pushes the implant upwards. This creates fullness in the upper part of the breast and gives a natural and youthful appearance. The skin of the breast doesn’t give this support and that’s why plastic surgeons use the muscle to gain support and to protect the implant. A space for a moderately large implant can be made under the muscle at surgery but in order to place a larger implant, space must be made past the muscle. Sometimes that space is made beneath the muscle and this requires muscle release with a resultant loss of support. The muscle is no longer acting as an internal bra and the pressure of the implant is brought to bear on the skin. A space can also be made to the side beyond the outside edge of the pec muscle but this also results in a loss of support of the implant. In the short term patients see that there breast is large and there can even be fullness in the upper pole of the breast but over time the implant can fall downward. When that happens, the upper pole becomes empty and the breasts take on an aged appearance.
More is Better But Not A Lot More
So it behooves patients to work to achieve their “best size” and this is done in discussion with a plastic surgeon. Patients should feel free to say what size they wish. In turn, the doctor can discuss how the breast might look on them and what effect that size might have on the shape of the breast. Patients should also “try on” different sizes of implants which doesn’t inform one much about the shape but can give a lot on information about the ultimate size and whether the patient likes the size on them.
Breast augmentation is a very gratifying procedure and the process of surgery and experience of going through the surgery should also be enjoyable too.
by David Newman, MD | Sep 26, 2019 | Blog, breast-surgery, Featured
Among the most exciting changes in plastic surgery have been the development and widespread use of different types of implants used in breast augmentation. These additions have helped plastic surgeons achieve excellent cosmetic results in nearly all patients. Today, there are more implant choices available than ever and so more to talk about with your plastic surgeon!
A recent survey of plastic surgeons in the US and in Europe has revealed that saline, or salt water filled breast implants are the implant most commonly used in the United States and in Europe, silicone gel breast implants are more commonly used for cosmetic breast surgery. The commonest shape of implant used both in the US and Europe is the round implant by an overwhelming majority and few surgeons still use breast shaped, or “anatomical” implants. Anatomical implants were more frequently used in the past as they were thought to provide a better shape for patients but over time, these implants have been associated with more complications than the simple round breast implant. Anatomical breast implants had also been textured on their surface to keep them in proper position and this textured surface has been implicate in the very rare BIAL, or breast implant associated lymphoma. To date, there has never been a case of BIAL associated with a smooth surfaced breast implant.
Breast Implant Shapes
Along the way in the development of different shapes of breast implants, manufacturers have varied the width and projection of implants to solve issues some patients have in terms of the width of their chest. The ideal shaped breasts create a space in the center of the chest where the breasts come together near the midline. They don’t need to touch but there should be some relation to each other. The ideal breast shape also includes fullness on the side where the breast comes to fall at the edge of the chest but no further. Additionally, the ideal breast shape includes fullness of the upper portion of the breast because this is the part of the breast that is exposed. Breasts should also have good projection, where the breasts stick out from the chest. Both projection and fullness of the upper pole create a sense of youth and vitality.
For round shaped implants, manufacturers have varied the width and the projection of the implants. For example, there are wider implants with less projection and on the other end of the spectrum, narrower implants with more projection. Some patients with wider chests can have a better and more natural breast shape with a wider breast implant that has less projection. And some patients with a narrower chest night also have a better shape with a narrower breast implant that has more projection.
Most patients are best served with an implant that’s in the middle of these extremes. These are round shaped implants with good projection that also have enough width so that the extend towards the middle and the sides of the chest. That way patients have the best of both worlds.
It’s What’s Inside
Implants are constructed as a shell of solid silicone rubber on the outside and the shell is filled with either saline (salt water) or silicone gel. The shell is similar, in concept to a balloon in terms of its flexibility but the shell is very strong and can withstand very high pressures and not deflate. But it is what is inside that can affect how the implant feels and appears. In patients with smaller breasts that have less tissue covering the implant, there is a higher chance to be able to feel the implant or to feel or see waves. This is termed “rippling” and is more common with saline filled breast implants. Silicone gel filled implants have a lower chance for this rippling effect.
Recent Developments
The basic silicone gel breast implant that is still in use today was one of the first implants to be placed on the market 65 years ago. There are three breast implant manufacturers that produce FDA approved gel implants in the US today. They use different names for their products but the implants are basically the same product. The last two years have seen the release of silicone gel breast implants that have a denser gel fill and each company also has their own names for these more dense gel products. The manufacturers state that these thicker gel filled implants have more fullness in the upper part of the breast and that there is a lower chance for rippling than with the basic gel fill. Both of these claims still await independent scientific proof.
The choice of implants is best discussed thoroughly with a plastic surgeon that can listen to a patient’s needs, both in terms of shape and size and is open to discuss the pluses and minuses of each type of implant.
by David Newman, MD | Sep 26, 2019 | Blog, breast-surgery
Breast Augmentation is one of the most gratifying cosmetic procedures offered by plastic surgeons today, and in fact, studies show a 95% satisfaction rate with this surgery which is one the highest rates among all procedures. A large number of patients have breast augmentation when they are in their younger years where they are just joining the work force, are in school or otherwise find it difficult to fund surgery. It may still make sense to have this surgery both because of the high satisfaction rate and because the beneficial effects of the surgery are so long lasting. Breast implants provide for a permanent size that never changes during a patient’s life time. Implants also affect shape, and make the breast appear natural and youthful, even when patients are in their older years. Breast implants also allow for greater ease in the wearing of different styles of clothing. In a way, breast augmentation surgery might be considered a worthwhile investment.
Breast implant surgery is generally performed under anesthesia and so support personnel are required to provide the safest and most pleasant experience. Staffing for surgery involves not only the physician performing the procedure but also an anesthesiologist and nursing staff, as well as other operating room personnel. The surgery must also be performed in an accredited surgery center and all materials and procedures must comply with the best standards and practices. Despite the high cost for providing this high level of medical care, competition has made breast augmentation surgery affordable for almost every patient. One factor has put an upward pressure on the cost of breast augmentation surgery.
Breast Implant Cost
In the 1980’s, there were two types of implants available: saline and silicone filled breast implants. The cost of the implants was so low that they represented approximately 4% of the total cost of the surgery and so breast augmentation prices remained low. More recently, breast implant manufacturers have brought different types of breast implants to the market and at higher prices. Most significantly, “gummy bear implants” were introduced and these breast implants have a thicker silicone gel fill than previous gel breast implants. When gummy bear implants are used, they drive implant cost to account for 30% of the total cost of surgery.
Higher Cost But are they Better?
The breast implant manufacturers state in their sales literature that gummy bear implants support the upper part of the breast more than saline implants and more than their other silicone gel breast implants. They also state that it is more difficult to “feel” the implant and that therefore the results of breast augmentation surgery are more natural with the gummy bear implants. These claims have not been confirmed yet by independent scientific study.
As mentioned above, breast implants are quite durable when one considers that they move with the patient’s movements and appear totally natural and part of the patient’s natural anatomy for many years. Patients, in consultation are encouraged to feel the different types of implants, to “try on” the implants in a specially designed bra and also to look at breast implants before and after photos.
One issue that might affect a patient’s shape with gummy implants is that, with time, and as normal breast tissue is lost, the more solid shape of these implants may become more noticeable. Gummy bear implants are relatively new and although they are FDA approved, it may take some years of actual patient experience to determine what the long term effects are on the shape of the breast as compared with the current saline and silicone gel alternatives.
Fat Transfer Breast Augmentation
Recent innovations in the field of liposuction and fat transfer have made the use of fat an alternative to enlarge the breast. Benefits of the use of fat are that no foreign object (i.e. a breast implant) is required. The greatest negatives regarding the use of fat to enlarge the breast are the degree to which the breast can be enlarged, which is a fraction of one cup size and that multiple treatments may be required. The average increase in cup size when patients opt for breast implants to enlarge the breast is between one to two cup sizes. Additionally, with time the fat that has been transferred may be lost, whereas breast implant volume never changes, with the exception of the occurrence of a deflation which is uncommon. Thus, for now fat transfer breast augmentation is probably not the best option for patients seeking breast augmentation but technological advancement may change that.
Breast Lift with Implants
Some patients may develop loosening of their breasts, especially after childbirth and with breast feeding and this can cause the breast to droop. The other issue with drooping is that, at the same time, there is a loss of tissue in the upper part of the breast and so the breast can appear less full.
Patients who develop drooping of their breast and also note loss of fullness in the upper part of the breast usually require a breast augmentation with a breast lift. Since this surgery takes at least twice as long to perform, the cost is more. There may be alternatives and so it is important to discuss these with your plastic surgeon.
