Breast Augmentation Choices Mountain View

Options for Breast Implant Surgery

At An Enhanced You Cosmetic Surgery, Dr. Lowen offers breast implants San Jose patients rave about. Dr. Lowen wants to understand his patients’ goals and help them make educated choices about their care. This individualized treatment planning approach makes it possible to decide the best incision placement and breast implant combination for their specific goals. Contact our San Jose area center, serving the entire San Francisco Bay Area, to learn more.

Choices of Surgical Approach

Every woman will have her own specific goals in having augmentation mammoplasty and our goal is to work with you to meet those goals. Since there is no one breast implant or one way to place breast implants that is right for every woman, we will help you learn exactly what your options are and what we think is the best approach based on your own specific desires and particular anatomy.

Experienced in all three incisional approaches and various styles of breast implants, Dr. Lowen can offer the full range of options available today to patients.

There is not one “right way” to do augmentation mammoplasty. Should you be told that there is one best way to perform an augmentation or that there is one type of implant that is best, we would advise a second opinion. If the surgeon is experienced in the use of all incisional approaches and types of breast implants, it is far more likely that the operation will be tailored to your specific needs.

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Breast Implants - Quick Facts

The information below is an overview of the many options available to patients considering breast implants. These can be discussed more fully during your consultation at our Mountain View practice near San Jose.

Implants

If your goal is to achieve an aesthetically-pleasing breast shape with the least risk of capsular contracture,you may choose saline, gel or form-stable implants. Each has particular pros and cons that Dr. Lowen will discuss with you.

Incision

If you have a particular choice of incision location, it is usually possible to offer you that location. Since the choice of implant and incision location takes into account such factors as a tight or loose skin envelope, tissue coverage for the implant, and lower breast sagging or constriction, Dr. Lowen will advise you if the best result would be more predictably achieved with a different incision or breast implants.

Dr. Lowen uses all incision locations routinely, so there is no best incision. If the goal of a natural-appearing and soft breast is obtained, the resulting scar, regardless of location, fades rapidly from attention. During your consultation, all of your options for type of breast implants, implant size, and incision location are open. Only after discussing all of the factors affecting you individually, will we jointly arrive at a final decision.

We have attempted to stress that the decision to have breast augmentation is a personal decision that any woman is entitled to make. Once that decision is made it is our goal to help you achieve the results you want: a natural appearing, soft, and esthetically pleasing breast. We want you to have a choice, and we want you to be informed.

We hope that the information we have provided will help you in your educational process of breast implants. Since there is no one best implant or incision for every woman, researching breast augmentation can be a difficult task unless you are given a chance to examine and understand your choices.

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Choices of Incision Location

All incisions are precise, surgical wounds in the skin and as such must necessarily heal as a scar. The optimal outcome is healing with a thin, inconspicuous line, one that is barely noticeable except on close inspection. While this outcome is usually achieved, there is no way at present to predict which patients may heal with a less than optimal scar, despite careful surgical technique and gentle treatment of the skin.

Healing is affected by genetic factors over which we have insufficient knowledge and control to predict final appearance in any given individual. However, we do know how to create and suture incisions to minimize scar appearance, and how to place them to make the scar as favorable as possible.

Wherever the incision is placed, favorable healing usually results in scar that is thin and barely detectable after the usual six to 12 months required for scars to mature. This means that if the ultimate goal is optimal breast shape, and if that shape may be best achieved by one or two but not all three of your incision location choices, the trade-off is usually well worth it.

The Inframammary Incisional Approach: Beneath the Breast

When there is sufficient breast tissue development, the lower border of the breast can be seen distinctly to meet the chest wall along a line of attachment that is called the inframammary fold. A larger, more developed breast may have a more defined fold than a smaller breast.

If the breast hangs down over the fold, an excellent location is provided for a well-hidden incision. The incision, properly placed, will only be visible lying down, not when looking at the breast from the front, and will be only slightly visible, if at all, when viewed from the side.

Even in a woman with little breast tissue, once some time has gone by, and the lower breast skin has stretched, the breast implants scar should be well hidden at the very lowest edge of the breast, and not visible when viewed from the front.

The scar is about 1.5-2 inches in length, is initially slightly raised, and gradually softens and flattens. Scar redness is normal for several months and gradually fades. No special treatment is needed to achieve optimal healing other than avoidance of sun exposure by use of sunscreen during the first six months.

The inframammary fold approach offers the most versatility in achieving specific improvement in breast shape. It allows direct surgical access underneath the breast and/or muscle, facilitating the correction of difficult breast problems including drooping, stretched out breasts, or breasts which are tightly constricted at their lower border.

When larger cup sizes are desired, the inframammary approach also offers more accuracy in pocket dissection to achieve optimum breast implant placement.

When there is no particular desire to change breast shape, and the desire for volume is moderate, any incisional approach can be used.

For those women who have a strong desire to achieve a specific shape using textured breast implants, those who want larger implants, or those who have difficult pre-existing problems to correct, the need for precise pocket dissection and implant placement influences the decision to choose the inframammary incision.

The Periareolar Incisional Approach: Around the Areola

The periareolar incision goes along the natural boundary between the pigmented areola and breast skin for half the circumference of the areola. In this position it usually heals as a thin, inconspicuous scar.

This incision technique requires that a tunnel be made through breast tissue to place the implant below the breast or pectoralis muscle. The width of the areola affects the length of the incision and thus the size of implant that can be placed through this approach.

The degree of injury to fine terminal branches of sensory nerves going to the nipple and lower breast skin is greater using the periareolar approach, so the risk of some degree of nipple or skin numbness is slightly increased. The sensation usually recovers as the nerves regenerate.

When the areola is large, or when there is a pre-existing periareolar scar, the periareolar incision is a suitable approach to breast augmentation and allows the precise pocket dissection and implant positioning needed to use larger breast implants or implants specifically designed to affect breast shape.

There is some evidence that the presence of bacteria in the breast pocket may be linked to hardening of the capsule surrounding the breast, also called capsular contracture. Since the periareolar incision goes through the breast tissue, and it is known that bacteria such as staph epidermidis are present in breast ducts, it is possible that there may be a slightly increased risk of infection or capsular contracture using the periareolar approach.

The Axillary Incisional Approach: Deepest Hollow of the Armpit

In the axillary approach the incision is placed high in the armpit off of the esthetic unit of the breast. There is no scar on the breast. A tunnel is made from the incision to the pectoralis muscle and a pocket is then made underneath the muscle.

Saline or gel implants may be placed through the axillary incision. Form-stable implants are placed through the inframammary incision. Larger implants with an increase of two cup sizes may also be placed.

The axillary incision has a lower risk of sensation loss than the periareolar incision. The pocket is made entirely under breast tissue and muscle so there is no contact with breast ducts that may harbor bacteria.

Certain problems with breast shape, such as sagging of the breast and skin envelope below the inframammary fold or constriction of the lower half of the breast cannot be addressed well through the axillary incision, and are best approached by one of the other two incisions.

The axillary incision serves the needs of those women who want no visible scar on the breast and whose desires for changes in breast shape is within the range that can be achieved with this incision.

The final choice of incision will depend on your personal preference and an analysis of breast anatomy and specific needs and desires for changes in shape and size. We do not prefer any particular incision, but attempt to help you understand what can and cannot be achieved most predictably in our goal of creating the most natural-looking and attractive breast.

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Implant Shape

There are two shapes of breast implants patients can choose from: the round implant, either textured or smooth, and the textured “anatomical” or form-stable implant. The form-stable implant is teardrop shaped and designed to maintain its shape when a woman is in the upright position. It therefore does not collapse downward on itself, and does not fall to the bottom of the pocket as does the round implant. Although it provides control of upper pole fullness, unless the implant is chosen carefully to match the patient’s anatomy, it may appear too full in the upper part of the breast. This is more likely with larger implants and smaller initial breast sizes. In the United States, experience with textured anatomical implants for initial augmentation had been limited to saline implants until April of 2012. At that time Sientra and then Mentor and Allergan introduced form-stable ”gummy bear” implants that were FDA approved and are now available.

In addition to round and shaped implants, round implants come in three different profiles, low, moderate (or moderate plus as Mentor calls their moderate implants), and high profiles. The most commonly used are moderate profile implants. They are designed to fill the width of the breast while providing a natural anterior projection. Form-stable implants come in a matrix of tear drop shapes; available choices include the classic higher than wide, the round base, and the oval base which is wider than high. They are used according to the patients chest wall anatomy and patient preferences. They also come in varying projections.

High-profile implants are used when the volume a woman desires is larger than would fit appropriately in her breast base width if moderate profile implants were used. Because high profile implants are narrower and project more for the same volume, more volume can be fitted into the same width. And some women just prefer the “perkier” shape of high profile implants. If high-profile implants are chosen that are too narrow for the breast width, they can give a “torpedo look”, particularly with larger implants.

Gel high-profile implants do not project as much for the same volume as high-profile saline implants, and high-profile saline implants are used much less often than high-profile gel implants.

The gel form-stable shaped implants come in different profiles and width/height ratios to accommodate the different requirements of women with different chest height/width ratios and personal preferences. For example, there is a style with a round base, tear-dropped shape that has a high profile. This is excellent for most women who want a projecting lower breast, moderate upper pole fullness and may have a little bit of droopiness or ptosis, since it puts the most projecting part of the implant slightly lower than the middle of the breast.

There are form-stable shaped gel implants that are wider than they are high, with low, moderate and high projection. These are good for women with broad chests who wish to fill up the width of the breast, but not have an overly large round upper breast that would occur if they chose round implants of a size to fill up their breast width.

Patient preference plays the determining role in deciding which implant to use. Many women still prefer the rounder look of round implants, whether gel or saline. Since tear-drop shaped implants are coming into more common use, starting in 2012, patients in the US will have a chance to make their own esthetic evaluation as more before and after pictures of women with these implants are published.

Round breast implants that are not too large and not over-filled, and that are covered adequately by soft tissue in a breast without sagging, give a very soft and pleasing result. Most women seem to prefer this rounder look. Problems can occur over time as the skin envelope stretches out under the weight of large implants, weight gain and loss, or subsequent pregnancy. Implants that were initially held up in place by a tight skin envelope now descend on the chest and some upper pole fullness is lost. Saline implants may become more palpable or traction wrinkling or lateral palpability may increase. Use of gel implants cannot prevent stretching of the skin but a more naturally feel will be preserved. The use of textured, form-stable implants is thought to aid in preventing stretching and sagging and descent of breast implants because they are held in place better by the interaction of the textured implant surface and overlying tissues.

Many women have definite preferences for either a round or anatomic implant. Over the past five years, I have noted that after having made their choice, 95 percent of patients who selected the round implant shape, and close to 100 percent of those who chose the anatomic shape are happy with their decision. The key to patient satisfaction is explaining that trade-offs occur with any of the current breast implants. During your consultation at our center, the trade-offs of palpability, mobility, and size limitations will be thoroughly discussed. This step usually helps patients make the decision that is right for them.

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