Breast Augmentation

The Procedure

Breast augmentation plastic surgery is one of the most common aesthetic procedures. Women may choose to under go breast enlargement surgery for various reasons. These personal reasons may center around breasts that are perceived to be under developed, or because of differences in the sizes of the breasts.

Significant changes in the appearance of a woman’s breasts frequently occur after pregnancy, with or without breast feeding or with weight loss. Some women simply want their breasts fuller. Breast enhancement using breast implants can give a woman more proportional shape and may improve self esteem.

Breast augmentation is performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

If you are a smoker, you may be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Dr. Simon utilizes several medications during the surgery that will lead to increased comfort in the postoperative period. A long acting local anesthetic will be placed in the area under the muscle along with the implant which will significantly decrease postoperative pain. Dr. Simon makes a special effort to ensure the most comfortable surgical experience possible for Miami plastic surgery patients.

Before & After Gallery

Good Candidates for Breast Augmentation

You are bothered by the feeling that your breasts are too small

Clothes that fit well around your hips are often too large at the bustline

A feeling of self-conscious wearing a swimsuit or form-fitting top

You have lost weight or had children and the breasts have lost their volume

There is significant asymmetry between the breasts (difference in size)

Implant and Surgery Options

Dr. Simon offers both saline and the FDA approved silicone gel implants. The silicone gel implants are preferred by some patients secondary to their more natural look and feel and for secondary cases. Dr. Simon is certified by both Mentor and Allergan, the two breast implant companies in the U.S. for placement of silicone gel implants.

The incisions that are utilized for gel implants include periareolar (under the nipple) and inframammary (under the breast); saline implants may also be placed through an axillary incision (under the arm). The implants are typically placed under the pectoralis muscle as this is generally considered the safest location and the most natural appearance.

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The Consultation Process

Dr. Simon will listen to your concerns and goals regarding breast augmentation surgery. Throughout the process, multiple factors will be considered to determine the best surgical procedure for you and breast implant size. Dr. Simon will spend as much time as necessary to make you feel comfortable. The risks and benefits of the various types of procedures and implants will be discussed as well to aid you in making the most informed decision possible.

What to Expect After Surgery

You will see Dr. Simon for a follow up appointment 1-2 days after the surgery. The surgical bra will be removed at that time and further instructions will be given. You will be permitted to shower after this visit. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month

Post-op Activity Restrictions

Dr. Simon’s patients typically return to their normal daily activities the day after surgery. However, you will need to restrict any strenuous activity for a week and there will be no lifting anything over 5-10 lbs for the first 2 weeks. Activities and exercise that involve the chest muscles, running, and jumping is restricted for 4-6 weeks.

Risks

During the consultation process you will have the opportunity to discuss the potential risks of breast augmentation surgery, in addition you will be given material for review at home that will further detail these issues.

Potential complications that may be discussed with you include reactions to anesthesia, bleeding and infection. Although rare, an infection that does not subside with appropriate treatment may require temporary removal of the implant. Changes in nipple or breast sensation are uncommon and when they occur are usually temporary.

When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may sometimes tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in the breast’s appearance. In such cases, more surgery may be needed to modify or remove the scar tissue, or perhaps remove or replace the implant. Dr. Simon does everything possible to minimize the incidence of this particular problem

Breast implants are not lifetime devices and cannot be expected to last forever. If a saline-filled implant breaks, the salt water content is harmlessly absorbed. A definite change in the size of the breast is clearly noticed. Rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause. Surgery will be required to replace the implant, if desired. As a patient of Dr. Simon’s, after the initial few postoperative visits you will be followed annually.

Mammographic examinations are performed regularly on women with breast implants. There are several additional views that are required, however most breast imaging centers today are quite familiar with dealing with patients with implants.

Long Term Results

Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long-lasting. However, gravity and the effects of aging will continue to affect the breasts and may alter their size, shape, and position. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift to restore their more youthful contour.

FAQ’s Breast Augmentation and Implants

Do breast implants need to be changed every 10 years?

No. This is a common question propagated by an old mentality first stirred up by a 1970s article. Before saline implants, silicone gel implants didn’t last as long as they do today. So after 10 years, the implants had a high chance of rupture. That’s no longer the case. The chance of a silicone gel implant rupturing over 10 years is less than 1%. I recommend regular self-examinations. Feel for any change in size or placement. If the area feels different or uncomfortable, schedule a visit with your doctor. Otherwise, there’s no reason to change a silicone gel implant after an arbitrary amount of time.

Are silicone gel breast implants safe?

Yes. Patients assume they’re relatively new. But silicone breast implants have been in use since the 1960s. In fact, they were the original breast implants – long before saline breast implants arrived in the 1990s. A news story incorrectly made a link between silicone breast implants and connective tissue diseases, lupus and autoimmune disease. The products were removed from the market for two months. Then from 1992 to 2005, thousands of women with silicone gel breast implants went through an extensive study. Over the course of study, no correlation was found between the implants and health issues. In 2006, the U.S. Food and Drug Administration closed the book on this issue. So silicone gel breast implants are safe. In fact, they’re as safe as saline – and have lower overall complication rates than saline. Additional information about the safety of silicone breast implants can be obtained through the breast implant companies’ websites (Mentor [www.LoveYourLook.com] and Allergan [www.Natrelle.com]

What is the difference between silicone gel and saline breast implants?

Both use implant shells made of silicone. The difference is in the contents. The saline used to fill the breast implants is a sterile saltwater solution. Saline implants come from the manufacturer empty with a one-way valve allowing the implant to be filled at time of surgery. Therefore, the surgeon determines the final fill volume during surgery. Silicone gel breast implants are sealed at the manufacturer, coming in a variety of sizes and profiles. For these reasons, a silicone gel breast implant requires a slightly larger incision for insertion. Also, the plastic surgeon might use a “sizer” or temporary implant filled with saline to approximate the resulting breast size once the silicone gel implant is inserted. Patients like silicone gel breast implants because their shape, appearance, consistency and feel are more natural and similar to natural breast tissue than those of saline breast implants. Patients can see and feel the edge of a saline implant, especially in thin patients. As always, discuss the pros and cons of any implant option with your plastic surgeon.

What are the different options and pros and cons for breast implant position?

Breast implant placement often boils down to two locations: above or below the pectoralis major muscle. In my Miami plastic surgery practice, the majority of breast implants – whether silicone gel or saline – are placed beneath or under the muscle. This provides a more stable position for the implant. With more skin, natural breast and muscle tissue above the implant, the implant is better hidden and pushes natural tissue to the forefront. Sub-muscular placement also reduces the chances of the patient developing capsular contracture (see below).In a few cases, especially with surgeons in Latin America, implants will be placed on top of the muscle. This can be switched in a secondary surgery, as must U.S. surgeons – and patients – agree that sub-muscular is better. There are circumstances where an implant placement above the pectoralis muscle is better, and this is also determined and discussed at the time of consultation.

What is capsular contracture with a breast implant?

A capsular contracture occurs when the scar tissue capsule around the implant shrinks and tightens, causing a deformation of the implant and discomfort (regardless of whether it’s a silicone gel or saline breast implant). Every breast implant has a thin layer of soft layer of scar tissue around it called a capsule. It only becomes noticeable or problematic if it shrinks or tightens around the implant. Capsular contracture is an inherent risk of getting breast implants. In about 5% of cases, the capsule shrinks, tightens up and causes a deformity. This could require corrective surgery. Sub-muscular implantation has helped reduce the rate of capsular contracture. The capsule naturally forms about six to eight weeks after surgery; if a problem were to occur, most patients see it within the first year, though it can occur years later. Corrective surgery becomes more difficult as the plastic surgeon must remove scar tissue; the breast implant might also need to be changed. The goal is the prevent the capsular contracture from occurring in the first place. Dr. Simon will irrigate the site during surgery with three different antibiotics and use the Keller Funnel (insert link to blog once posted) to help reduce chance of infection or foreign body being introduced during insertion of a silicone gel breast implant.

Are massages required after breast augmentation?

Possibly, depending on the patient. In the post-operative visit about a week after surgery, Dr. Simon will examine the patient and may instruct specific patients to start breast massages. Some don’t require massages, and there’s no scientific, proven benefit for random prophylactic breast massage. Yet, for certain patients who may get a benefit, massages may loosen tight muscles or improve asymmetry where one breast is higher than the other.

What cup size are the implants?

This varies and is determined by patient’s desire and physique. But implant volume is not measured in cup size, and different implants can deliver a different cup size. Sizers are used for the consultation to demonstrate and simulate how certain sized implants will look after implantation.

When can I wear an underwire bra?

For the first six weeks after breast augmentation with silicone gel or saline breast implantation, patients must wear a special surgical bra or a sports bra. From six to 12 weeks, they can wear a bra without wire. After three months, patients can wear any bra.

Is it safe to breastfeed with implants in place?

Is it safe to breastfeed with implants in place? The real question should be, can breast augmentation affect one’s ability to breastfeed? In most cases, the answer is no. But the real answer exists in the statistics. Some 75% of all women who have never had breast surgery can successfully breastfeed, meaning 25% of all women who never have had breast implants will experience some difficulty. For those who may seek to breastfeed in the future, this Miami plastic surgery practice recommends the implant go inframammary, or where the breast and chest meet. This may decrease the likelihood of breastfeeding issues, by avoiding the need to cut through any breast tissue while creating the sub-muscular space for the implant. Moreover, a simple breast augmentation won’t change these numbers. But a breast reduction or lift tends to reduce the number of women who can successfully breast feed to around 50%. Regardless of whether the implants are silicone gel or saline, the numbers are the same.