What types of breast implants are available?
Women considering breast augmentation can choose between saline-filled and silicone gel-filled implants, each with a silicone shell. Silicone is a natural element that is used safely in many different medical devices. Both types of implants have been approved by Health Canada as safe options for women undergoing cosmetic or reconstructive breast surgery.
Breast implants are available with both smooth and textured surfaces. The sizes available range from 100 to 800 ccs, and implants can be round or anatomic (teardrop-shaped). We most commonly recommend smooth, round cohesive gel implants for breast augmentation, because they tend to produce the best results in the large majority of our patients. However, we also have access to the other options and will tailor our approach to your particular goals.
What are the advantages of cohesive silicone gel implants?
Silicone gel breast implants look and feel more like natural breast tissue than saline implants. They are less likely to ripple, a problem that creates visible waves or creases in the implant, particularly in the upper chest or cleavage area. Cohesive silicone gel implants can be placed either above or below the chest muscle, allowing even more versatility in customizing this procedure to the needs of each of our patients.
Are silicone implants safe?
Silicone gel implants were taken off the market from 1992 until 2002 in Canada (2006 in the USA) due to concerns that they were related to autoimmune diseases such as lupus and rheumatoid arthritis, and other medical problems. Since that time, multiple large studies have been done, each time concluding that there is no correlation between silicone gel implants and these diseases, and that silicone gel implants are safe to use in cosmetic and reconstructive breast surgery.
What incisions are used for the surgery?
The most common incision used for breast augmentation is placed in the crease under the breast (inframammary fold, or IMF). This preserves breastfeeding potential and avoids potential interference with the nipple itself. In addition, because most women who have breast implants will eventually require some sort of additional breast surgery in the future, the IMF incision can be used for most types of revisions without making a new incision.
Other options for incisions for breast augmentation include peri-areolar (around the lower edge of the areola), trans-axillary (through the armpit) and trans-umbilical (through the belly button). We rarely use the peri-areolar approach and currently do not offer trans-axillary or trans-umbilical approaches due to their potential risks and downsides. We prefer the IMF incision for breast augmentation in the majority of cases, because it offers the most consistent, positive results for our patients.
Which is better, over or under the muscle?
The pectoralis major muscle is a flat, triangular muscle that runs from the upper arm to the breastbone. Its lower edge is usually located at approximately the level of the nipple in a small-breasted woman. Breast implants can be placed either behind the breast tissue (subglandular), or behind both breast tissue and muscle (submuscular, subpectoral, dual plane). Because the pectoralis major ends at the level of the nipple, most submuscular implants are only partially covered by muscle, and the lower half to two-thirds of the implant is actually subglandular.
We offer both approaches, but prefer the subglandular approach when appropriate. The lower incidence of rippling with today’s cohesive gel implants has allowed successful subglandular placement in many of our patients. The advantages of subglandular placement include less post-operative pain, and avoidance of animation (where the breast implants move in an unnatural way when you flex your chest muscles), and prevention of the so-called “double bubble” deformity. If you are very thin or have minimal padding in the chest area, you may choose to place your implants partially under the muscle instead. This may give you a more natural upper slope of the breast, due to the additional padding of the muscle. We will discuss your options and help you determine which placement will provide you with the most optimal results.
How do I determine the best implant size for me?
Our goal is to deliver a beautiful result that fits your body, your lifestyle, and your goals. Many of our patients are very active, and want to avoid a result that is too large or unnatural. We will go through several steps during your consultation to ensure that we recommend the best implant for you. First is a frank discussion of your goals, including what you do and don’t like in regards to breast size. A full examination with photographic analysis and measurements helps us get familiar with your anatomy. We tried 3D imaging but the results are not yet accurate with their current software.
We will also give you a chance to try on some sizers inside a bra, so that you can see and feel what having fuller breasts of various sizes might be like. We’ll talk to you about trying the rice test at home, where you can put rice in a soft plastic bag and place it in a bra to help determine size. We also like to look at photos with you, both our own patient photos, and any photos you’ve found that will give us a better idea of the results you have in mind.
What is the breast footprint?
Footprint is the term we use to describe the level at which your breasts are attached to your chest wall. Some women have a high footprint (high breasted) and a relatively short distance between the collarbone and the upper border of the breast. Other women have breasts that start out much lower on the chest wall (low breasted) with a longer distance between the collarbone and the upper border of the breast. We cannot alter your breast footprint; we can only alter your breast shape within its existing position.
The addition of a breast implant will raise the upper breast border slightly and this may make a low footprint look somewhat higher. Otherwise, your existing breast footprint and shape will be similar to what you had before augmentation, but fuller, with the implant centered behind the nipple. Some patients will say that they wish that they had had larger implants because they think that larger implants will sit higher on their chest. Unfortunately, the opposite occurs: larger implants sit lower and eventually succumb to the effects of gravity.
Where is breast augmentation done?
Most cosmetic breast surgery is done under general anesthesia in our fully accredited office operating surgical suite. Dr. Hall-Findlay chaired the committee that set the standards, guidelines and accreditation systems for all outpatient surgical facilities in Alberta. Our facilities are state-of-the-art when it comes to safety, staff training and equipment.
Some patients may also be offered surgery at the Banff Mineral Springs Hospital, where overnight stays can be arranged when necessary.
How does breast augmentation affect nipple sensation?
Using the inframammary fold incision, nipple sensation is usually well-preserved. Some of our patients report some numbness on the lower part of the breast below the nipple, but this usually resolves with time. Conversely, some women actually have over-sensitive nipples after augmentation. This is also a temporary problem that will resolve without intervention.
Will I be able to breastfeed after breast augmentation?
Placing a breast implant through an inframammary fold keeps milk ducts leading to the nipple intact. Studies have shown that the ability to breast feed is not affected by breast augmentation alone. However, women may experience changes in breast size and shape due to pregnancy and lactation. This could alter the results of breast augmentation, requiring a revision procedure to restore the original results. A breast lift, with or without an implant, on the other hand, can reduce breast feeding potential to about 50%.
Do breast implants need to be replaced after 10 years?
The implants that we use now last far longer than 10 years and there is no specific timeline for replacement. Just like your favorite jeans, breast implants can wear with time and develop what we call “fold flaws”. We like to see and perform an examination on any patient who is experiencing changes in the breast. Diagnostic imaging such as mammography or even MRIs are not very reliable for indicating breast implant issues and we may not know for sure if there is a tear in the implant envelope unless we go back to surgery. Cohesive gel tends to stay in the implant pocket like a gummy bear, even if the implant shell breaks. Ruptured implants can be removed or replaced, depending upon the individual situation.
What is capsular contracture?
When any medical device is implanted, our body forms a thin layer of tissue around it called a capsule. In some women, for reasons we don’t completely understand, the capsule can become thicker or tighter, making the implant feel firmer than it should. Tight capsules can even become painful with time. This problem is known as capsular contracture and it can occur at any time after breast augmentation. We can take steps to lower a patient’s risk for this complication, but sometimes capsular contracture occurs despite our best efforts. Repeat surgery can sometimes help resolve the issue and restore the appearance of the breasts.
How do I know if I need a lift with my breast implants?
This is one of the most common questions we encounter. If your nipple position is low or if your breast tissue hangs below the crease under your breast, you may want to consider a lift in addition to augmentation. We will examine you in detail and discuss your goals before making a personalized treatment plan with you.
Breast augmentation boasts a high degree of patient satisfaction, particularly when it is performed by a surgeon that is well-versed in the procedure. To learn more about breast augmentation or find out if it is the right procedure for you, contact Banff Plastic Surgery today at 403-762-2055.