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Breast Augmentation

Breast Augmentation

Breast augmentation (also known as augmentation mammoplasty, breast enlargement or breast enhancement) is the surgical procedure that allows a woman to increase the size and improve the shape and appearance of her breasts. Many women undergo the procedure because they either had little breast development or never attained the size that they desired. Others lost volume and firmness following weight loss or pregnancy. Regardless of the underlying reason, it is the most popular cosmetic procedure that Dr. Turkeltaub performs and is among the top two nationally with an associated very high satisfaction rate of around 94%.

The concept and the procedure of inserting breast implants to obtain the breast enlargement sounds rather simple and straightforward to many people but this is most definitely not the case. Many options and factors must be considered and decisions made prior to surgery in order to be able to realize the most ideal results.

The goals of breast augmentation surgery are to select the appropriate volume to obtain the desired size, improve the breast shape and do so with incisions that are as inconspicuous as possible. To achieve this, the plastic surgeon must have an exceptional eye for aesthetic norms and issues, an appreciation of each patient’s tissue characteristics, an understanding of the three dimensional effects of the implants on the tissues, consideration for the changes over time and superior surgical skills. Equally important, he must be able to thoroughly understand and interpret his patient’s goals, needs and concerns so as to be able to deliver the desired outstanding results (see blog: Breast Augmentation and “Natural” Looking Breasts). Dr. Turkeltaub consistently strives to ensure that the results he creates for his patients are exactly what they desire.

Selecting the Ideal Implant Size

The number one topic that people think and talk about regarding breast augmentation is size. Though it isn’t the only important factor, size really does matter. In fact, when women are not thoroughly satisfied with their results following a breast enlargement, the number one reason relates to size and it is usually because they want to be larger. Therefore, it is crucial that the patient have an idea of the look she wants to achieve, how it impacts the appearance and harmony of her body size and shape, the affect that the enhanced breast size may have on other aspects of her lifestyle, and the image that will be projected.

In Dr. Turkeltaub’s experience, most women prefer to be slightly larger than proportional though there are many who request to be double “D’s” or larger. What is “proportional”? This is an ambiguous term which will mean different things to different women. What is proportional to one person may be either too small or too large (rarely) for somebody else. Compounding this problem is the confusion as to what appearance different cup sizes represent since there are no universal standards. As a consequence, bras of a specific cup size manufactured by different companies may fit completely differently. One company’s “C” cup may be the same size and shape as another company’s “D” cup.

Dr. Turkeltaub finds that trying on implants, photographs and imaging can be helpful but they do have their limitations. In the end, he finds that selecting the most appropriate size is both a science and an art.

For additional information about the importance of implant size, read Dr. Turkeltaub’s blog “Size Does Matter”.

Considering Various Breast Implant Options

Silicone or Saline

The two types of breast implants available for breast enlargement are silicone and saline. The silicone implants are the “gold standard” with regard to the aesthetic outcome: they feel and can look more natural and generally last significantly longer than the saline implants.

Well over 90% of Dr. Turkeltaub’s patients select the silicone implants for their breast augmentations. Anecdotally, in his patients who have had both types of implants at different points in time, everyone of them preferred by far the silicone ones over the saline implants.

Natrelle® 410 Gummy Bear Breast Implants

Recently approved by the FDA, Allergan, Inc.’s Natrelle® 410 breast implants are composed of highly-cohesive silicone gel and are anatomically shaped (in the form of a teardrop) to resemble the natural curves of your body. Also referred to as “gummy bear implants,” these form-stable implants are designed with the latest advancements in silicone gel technology and have been proven to provide firmer and longer-lasting results when compared to other breast implant options. Natrelle® 410 implants have also shown reduced rates of wrinkling and rupture, and they generally result in a more natural look and softer feel. This advanced implant option can be used during breast augmentation, breast reconstruction, and breast revision surgeries for patients 22 years and older.

Implant Projection Style

Implants can be categorized based on their relative projection as related to their base width. This is a very important parameter that must be considered in order to be able to obtain the best possible results. Though terminology can vary, implants come in super-high, high, moderate and low profile. What does this mean? High profile breast implants will have greater projection and less width for a given size compared to a moderate profile which is broader and less projecting.

The style that would be most appropriate for you would depend on many factors including your chest width and configuration, amount of breast tissue present, and the ultimate size, projection, shape, cleavage, and overall appearance that you desire. (See Figure 1a and 1b)

Figure 1a. This is a side view of implants of the same volume but different projections. The implant on the left side is a high profile implant and the one on the right is a moderate profile implant. Note the greater projection and narrower width of the high profile implant.

Figure 1b. Frontal view of the implants in Figure 1a. Note the greater width of the moderate profile implant on the right which projects less than the narrower high profile implant.

Breast Implant Shape

Most of the breast implants available and used today for breast enlargement are round in shape. Anatomic style implants, which are generally filled with saline, are longer either in a vertical or horizontal axis. This may allow for a more customized result in certain situations.

Smooth or Textured

The outer shell (envelope) around the breast implants can have either a smooth or textured surface. With technological advances in implant design and construction, there does not appear to be persuasive evidence in most situations regarding silicone implants that this is an important factor. In some situations regarding capsular contracture, textured silicone implants may offer some protection from recurrence. (See Figure 2)

Figure 2. The Silicone breast implant on the left is a smooth surface implant while the one on the right is a textured surfaced one.

Implant Insertion Choices

Incision Location

There are three acceptable locations of the incisions for the insertion of the breast implants in breast augmentation. Each can have its advantages and disadvantages based on individual factors (The belly button incision, also known as the transumbilical approach, is not considered for a variety of reasons.) These insertion sites are:

  1. Inframammary. This is the most common approach and involves an incision placed at the bottom of the breast, in or near the fold where it arises from the chest. This location provide the most flexibility both short and long term, superior visualization and exposure for surgery, and more predictable results on average compared to the other sites. Research studies have documented additional important advantages that can be discussed with Dr. Turkeltaub during your consultation.
  2. Periareolar. The incision is placed at or near the margin of the lower half of the nipple where it borders normal breast skin. Some women indicate a preference for this location but they do need to consider some important issues before selecting it such as an increased risk for loss of sensation of the nipple, an elevated risk for the development of capsular contracture, postoperative scarring that can cause contour irregularities of the breast, and scars that may be fairly conspicuous. Women with smaller sized areolas either can’t or shouldn’t consider this approach especially if using silicone implants.
  3. Transaxillary. Implants are inserted through an incision in the armpit with the big selling point being that there will be no scar located on the breast itself. When performed endoscopically, results can be good but there are several important issues and risks that must be discussed and considered before electing this option. Dr. Turkeltaub can review these with you during your consultation.

The incision chosen for the insertion of the breast implant can impact the ultimate sensation of the nipple after surgery. For more on this, read: The Incision Used in Breast Augmentation Can Affect the Sensation of the Nipple-Areola Complex.

Behind or in Front of the Muscle

Breast implants can be placed in a “pocket” either behind the large chest wall muscle known as the pectoralis major muscle (subpectoral or submuscular) or directly in front of it (submammary). The appearance and dynamics of the breasts are quite different between these two locations as are the consequences of gravity, weight fluctuations, implant size and time. The most significant advantages for placing the implants in a submuscular pocket include:

  1. Mammograms are usually more easily and accurately read versus when implants are situated in front of the muscle (submammary).
  2. The risk for developing capsular contracture (hardness of the breast caused by the formation of scar tissue around the implants) is lower.
  3. There is a greater amount of soft tissue coverage of the implant which translates into a decreased risk and extent of visible rippling as seen on the skin as well as buffering the ability to feel the implant.
  4. A superior and more natural interface is present between the implant and chest wall allowing for a more normal appearance rather than that a fake, extremely round look.
  5. The muscle provides significantly better long term support of the underlying implants as compared to skin only support when the implants are situated above the muscle. In a submammary location, the weight of the implant will cause greater stretching and thinning out of the skin over time resulting in a greater relative amount of drooping. This problem is exacerbated with very large implants.

Because of these important advantages of having the breast implants in a submuscular location, this is Dr. Turkeltaub’s recommendation for most of his patients.

Your Breast Augmentation Procedure

Breast augmentation surgery is performed under general anesthesia at Piper Surgery Center, associated with Scottsdale Healthcare-Shea. The procedure typically takes around an hour followed by around one to one and a half hours in the recovery room. Dr. Turkeltaub uses a very gentle and precise technique which helps to minimize postoperative discomfort and the risk for non-ideal outcomes.

If your breasts are sagging, you may need to have a breast lift (mastopexy) in addition to the enlargement. Tummy tucks and liposuction are commonly done at the same time as a breast augmentation as part of a “Mommy Makeover”.

Recovery from Your Breast Augmentation

A dressing is placed following surgery that provides some compression and comfort for 2 – 3 days. This is then replaced by a sports type bra which is worn day and night for at least one week. A regular, comfortable bra can then be worn. Dr. Turkeltaub recommends that patients with relatively large implants wear a supportive bra on a regular basis to help maintain the breast shape and minimize drooping from the increased weight over time.

During the first few days after surgery, discomfort may be mild to moderate. Analgesics and a muscle relaxant are prescribed which will help make you more comfortable. Most patients can return to a non-strenuous job or school within 5 – 7 days. If your job requires heavy lifting or repetitive upper extremity movements (such as a hairdresser), modifications of your activity or greater time off from work are strongly recommended. You should avoid vigorous activities such as sports, aerobics and heavy lifting for three weeks and pectoralis major muscle exercises for eight weeks. It is not uncommon to experience muscle tightness and even spasms early on but these usually resolve fairly quickly.

Your breasts initially will be swollen, firm and may appear larger than you were anticipating. Much of the swelling will subside after several weeks resulting in a more defined shape and a size closer to what you can expect long term. With additional time, the skin and muscle (if the implants are in a submuscular location) will relax even more resulting in a softer, more natural feel and appearance.

Whether or not to pursue a breast augmentation is a highly personal decision that a woman must make for herself. There are clearly many long-term benefits of having a breast enlargement. Some of these include looking better, feeling more feminine and attractive, having greater self-esteem, and being able to find clothes that fit and that are more complimentary. The overwhelming majority of breast enlargement patients are extremely happy with their results.

For more information about breast augmentation and other breast enhancement options or to schedule a complimentary consultation, please call us at the Arizona Center for Aesthetic Plastic Surgery at (480) 451-3000 or reach us through our Contact Us page. We have offices in both Scottsdale and Glendale.

Breast Augmentation Before and After Photos

Click here for our full gallery.

Breast Augmentation Patient Testimonial Videos

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Frequently Asked Questions

Q: Do silicone breast implants feel significantly more natural in general compared to saline implants for a breast enlargement?

A: Silicone breast implants are constructed with a thick, cohesive gel that simulates the feel of a breast. In contrast, saline implants are filled with salt water which doesn’t have the viscosity and other important characteristics of silicone implants translating into a in a less natural result. On average, silicone implants do last longer than the saline ones. We have using them for well over 20 years with excellent results.

Q: Will I need to have my breast implants replaced sometime in the future?

A: Breast implants should not be expected to last forever. They may last 5-30 years, possibly less or even longer, but expect that at some point in time they will need to be replaced or removed. Saline implants deflate usually rather quickly and noticeably in size in the affected breast. Loss of integrity of silicone implants is more difficult to detect since there is no real change in volume and often no change in shape. You may experience some unusual mild discomfort or develop firmness of the affected breast. An MRI may be needed to help make the diagnosis though this isn’t 100% accurate. Please click here to read more about breast implant durability.

Q: Which type of implant lasts longer, silicone or saline?

A: Silicone implants do last longer, on average, compared to the saline ones which means that you may require fewer implant replacement procedures in your lifetime. Dr. Turkeltaub has been using them for well over 25 years with excellent results.

Q: Do most of your patients choose silicone implants over saline?

A: In excess of 96% of our patients select silicone implants over saline implants for their breast augmentation. They want an implant that will provide them with the most natural appearance and feel and silicone is the one that meets those criteria.

Q: Will I still have sensation of my nipples?

A: Immediately following surgery, your breasts may “feel” somewhat numb. Most patients do ultimately regain most if not all of the sensation of their nipples and breasts. It would be extremely rare to lose total sensation in both of your nipples.

Q: Will I be able to breast feed?

A: Breast augmentation surgery should not have any impact on the ability to breast feed particularly if the periareolar approach is not employed.

Additional Information About Breast Augmentation from Dr. Turkeltaub

Read more about breast augmentation from Dr. Turkeltaub’s blog, click here.

Specific Information About the Allergan Breast Implant Warranty

Dr. Turkeltaub’s offices in Scottsdale and Glendale are conveniently located near the following: