Breast Augmentation

Above, the gel implant (left) has less rippling than the saline (right).
Saline or silicone gel? Many people still view saline as “safer” than gel implants, despite FDA approval of several brands of gel implants for use in breast augmentation.
The lifetime of a saline implant is generally quite a bit shorter (7-10 years) than a cohesive ‘gummy-bear’ gel implants (20-25 years barring trauma).

When viewed from the side, you can see that the saline implant (right) tends to “bottom out”, with the volume gravitating downwards. This tendency leaves the upper pole hollow. Gel implants (left) tend to retain more volume in the upper pole.
Gel implants tend to migrate down and out into the armpit less than saline implants. Saline implants tend to deflate suddenly, causing an urgent need for repair. Cohesive gel implants do not suddenly lose volume. A significant injury would be needed to cause the gel to leak out of the shell. Since gels last longer, hold a better shape and need less frequent replacement, I tend to use cohesive gel implants for my patients.

Smooth or textured? 

Smooth gel implant

Textured gel implant

Textured or smooth implants? Textured implants were popular for a while as they were supposed to reduce the incidence of capsular contracture. However, my experience has been that contracture is actually more common with these implants. They feel a bit more firm than smooth implants, and they don’t tend to shift naturally as smooth gel implants do. They are good for patients with recurrent migration. Otherwise, most of my patients prefer the smooth cohesive gel implants for a top long-term result.

What about Profile?

Question: “I went to another doctor who only uses high profile implants. Why won’t you put in implants with a high profile?”

Answer: See the photo below. She went to a doctor who only uses high profile implants. Her outcome was not satisfactory. Because the high profile implants have a very narrow base and a lot of projection, using them is like stuffing a grapefruit into a breast. The look is very unnatural as there is an upper hump and no lower pole fullness.

1. The ideal proportion of a breast is 40% of the volume above the nipple; 60% below the nipple.
2. The nipples should point forward, not up nor down.
3. The lower breast has a pretty round curve and a well defined infra-mammary crease.
4. The upper pole of the breast should be full, without a defined ridge or “hump.”
5. Fill out the entire breast without a flat spot on top nor a big gap between the breasts.
6. The décolleté should have a gentle swell, not a flat spot, then a bump.
7. The key to a good outcome is using the broadest implant that fits each individual’s frame. I use smooth, round, moderate implants for most of my patients. As you can see, this does not result in a flat silhouette. The higher profile implants tend to have a base that is too narrow to give the desired contour.
8. Never go too large. Big implants make people look overweight, matronly, or trashy. I recommend thinking about this as a lifetime choice; classy and tasteful will last much longer than a dramatic overstatement!

This patient’s before (left) and after (right) results show all of my criteria for a good breast augmentation outcome (rules number 1 through 8, above).

Surgery
After making an incision under the breast, Dr. Duncan carefully opens the pocket underneath your pectoral muscle. She then inserts a ‘sizer’ implant and lifts the back of the table to see if that size gives the desired aesthetic result. If not, she’ll try on another sizer. Once it passes her standards, she replaces the sizer with the implant that will stay with you, and closes the incision.