Commonly Asked Questions about Breast Augmentation
How do I know which size is best for me?
One of the hardest decisions to make about breast augmentation is determining size. There is naturally a lot of anxiety about choosing the right size-not too big, but not too small. The anxiety is made worse since the patient is asleep during the procedure and has to trust the surgeon for the final implant determination. In my office, I spend a considerable amount of time with each woman discussing their goals-what they want their breast to look like, how much larger they want to be, and also how they want their breast to look in different clothing styles. Women naturally talk about their breast size using bra cup size as a measure, but this is notoriously inaccurate since no two bras are the same size, cup size volumes differ depending on whether the bra is a 32, 34, 36 or 38, and because different women like their bras to fit different ways. As an example, if you take a 32 C bra and a 38 C bra and turn them over and fill them with water, the 38 C bra will hold quite a bit more water than the 32 C bra. This can sometimes be almost a 200 cc difference for some bras.
Breast implant don’t come in bra sizes, they are sized by volume. As you go up in volume, the implants diameter gets larger. (The implant companies make implants with different profiles; the ratio of the implants diameter to the projection or height of the implant, but in general as you go up in volume with the same profile, the diameter is larger.) For every woman’s body, there is a size range of implants that will look natural based on their frame, breast width, how long or short their torso length, and the amount of laxity in their breast tissue. If you exceed the natural range, the breast tend to look overfilled and fake.
At your consultation and pre-op appointment, our office uses several methods to help you choose an implant range. While I will certainly put in an exact volume if requested by apatient (if it will look reasonable for their frame), I prefer to have a range of implant sizes that I take into surgery. The reason for this is that there really is no totally accurate way to pick an implant volume before surgery and have it look exactly the same once it is implanted. There are just too many variations of anatomy that affect how the breast will look to be exactly accurate with the volume. Even after placing implants for over 16 years, I often will end up using a slightly larger or smaller implant to get the best match to the patient’s desired size.
In our office, we use several methods to help patients understand sizing and choose an implant range. One of the easiest is to look at before and after pictures of patients shaped similar to your frame, breast and body measurements. While your implant size may not match theirs, the pictures allow me to know what size range you like, and what you consider too larger or too small. We also let you try different size implants in your clothing to choose the implant range to make you look the size you want.
In surgery, I use a temporary implant called a breast sizer that is an exact replica of the permanent implant dimensions to determine exactly what you will look like with a certain size. While this step adds a little time to the surgery, it really is worth the effort. It allows me to precisely pick the implant volume that works the best for your size goals and your unique body frame.
Silicone or Saline: which is better?
When considering breast augmentation or breast augmentation with a breast lift, one of the biggest decisions women have to make is choosing between silicone or saline implants. There are pros and cons to each type of implant which can make one or the other a better option depending on your goals and your body type. The good news is that both implants are safe and provide a nice result.
The main difference between the two implants is the substance inside the implant. Both are made with a solid silicone outer shell. Saline implants are filled with saline from an IV bag. Silicone implants are filled with a semi-solid cohesive silicone gel. Because silicone is a thicker substance than saline, most people believe that silicone implants feel more natural than saline implants.
The benefits of saline implants include lower cost, a smaller incision for insertion and easier leak detection. When a saline implant leaks, the fluid is absorbed by the body and the breast deflates, something that is fairly easy to see! Drawbacks to saline implants include a less natural feel than silicone, and a tendency for rippling of the implant shell which can be felt and sometimes even seen in thinner women with little breast tissue. In women with thicker skin and moderate amounts of breast tissue, saline implants can feel soft and natural, and can be a great option for these women. The leak rate for saline implants is about 7% over the first 10 years, then increases, but saline implants don’t need to be replaced until they leak.
Silicone implants today are manufactured to be much higher standards than the old silicone implants of the 1970’s. New silicone implants have a much thicker shell than the old implants and the gel is a thicker, semi-solid gel that sticks together even when the shell is torn. This has lowered the rate of problems with silicone implants. These implants feel softer and more like natural breast tissue than saline. They have less rippling, making them a better choice for thinner women with very little breast tissue. Silicone implants cost a little more than saline and need a longer incision for insertion since they are pre-filled. If the implant leaks, the silicone gel is not absorbed by the body so there is no volume change to the breast. This makes it more difficult to detect a leaking implant. In a comparison study, silicone implants have a lower leak rate than saline implants.
Both types of implants are safe and neither is associated with any increased risk of breast cancer or other systemic diseases.
Over the muscle or under the muscle?
Breast implants can be placed in one of several positions. These are commonly called subglandular placement (over the muscle), or subpectoral (under the pectoral muscle). There are actually subcategories of each placement position and there are pros and cons to both.
Subglandular placement has a higher percentage of capsular contracture in most studies, and the implant can be more palpable and more visible in thin patients with little breast tissue. This problem is magnified when using saline implants as they have more of a tendency to wrinkle or ripple than silicone implants. The benefits to subglandular placement are a quicker return of chest muscle strength and no distortion of the breast shape when the chest muscles contract. With my technique of precise pocket dissection bleeding and swelling are minimized which makes my patients’ recovery relatively painless. Many are able to have surgery on Thursday or Friday and return to work on Monday with the only restrictions being heavy lifting and jogging or running which they can’t do for four to six weeks.
Subpectoral placement means the implant is placed beneath the pectoral muscle. This is often called submuscular, but the implant is not completely covered with muscle-only the upper half to two-thirds of the implant is under the muscle. This approach has many advantages including a lower risk of capsular contracture (scar tissue formation), less palpability of the implants and less wrinkling and rippling, especially with saline implants. Many surgeons also believe that there is less sagging of the breast over time. The main drawbacks to submuscular placement are a longer time before heavy lifting or physical activity, and as stated above, there is some distortion of the breast shape when the chest muscle contracts over the implant. Despite these issues, this is my preferred route for most patients regardless of the implant.
You may also hear the term Dual Plane as a placement option. This really is a combination of both techniques since the upper part of the implant is subpectoral and the lower part is subglandular. This technique is often used in women with mild sagging to prevent the breast implant from sitting too high on the chest and the breast falling off of the implant when standing.
Where will my incision be?
There are four incision locations used for breast augmentation:
- Inframammary Crease
Incision placement is really a matter of preference for the both the patient and the surgeon. I prefer the inframammary incision (IMF), but also do the periareolar incision if a patient desires this route. I will replace old implants through a previous axillary incision, but I do not like this approach or the transumbilical approach for first time augmentation since it is more difficult to make a perfect breast pocket and a lot of revisionary procedures cannot be done through these incisions necessitating a second set of incisions in the future.
I prefer the inframammary incision for several reasons. It is the best route to ensure precise breast pocket dissection which in my mind is the key to a beautiful breast shape. This incision has a lower incidence of capsular contracture than the periareolar incision and there is a lower incidence of numbness compared to the periareolar and axillary incision. Implant replacement and revision surgery are also easier to do through this incision, and as mentioned, it actually may be impossible to correct some problems through an axillary or umbilical incision.
The incision length for saline is about one inch long. For silicone, it is between one and a half and two inches long. It has to be slightly longer since silicone implants are prefilled and the incision has to be larger to place the implant into the pocket without putting too much pressure on the implant and weakening it.
How long is the surgery?
I perform all of my breast augmentations in a fully accredited surgery center under general anesthesia supervised by a board-certifiedanesthesiologist. This ensures the utmost safety and sterility to the procedure and the best possible care for my patients. The procedure usually takes less than an hour to complete and patients spend about 4 hours at the surgery center.
Implant exchanges and some minor breast procedures can sometimes be done in an office setting under local anesthesia.
How long is the recovery?
Recovery from breast augmentation is fairly easy. Most women say that their breast feel tight more than painful. Intraoperatively, a local anesthetic is placed into the breast pockets and intravenous anti-inflammatory medications are given during surgery to minimize pain. Muscle relaxers and low potency narcotics are given for a few days. Patients can also take over the counter non-steroidals like Motrin, Advil, and Alleve to lessen the need for more potent narcotics. Many patients return to work within a week, and often after only 2 to 3 days. Normal activities can be resumed immediately. Heavy lifting, running, and strenuous exercising can be resumed after 4 to 6 weeks.
What will it cost?
Breast augmentation costs include the surgeon’s fee, implant fee, and OR and anesthesia fees. Breast augmentation with saline implants costs approximately $4994. With silicone implants, the cost is approximately $6000 due to the higher cost of the implants.
How do I know if I need a lift?
Some women want a breast enlargement, but also have some sagging of their breast tissue either after pregnancy, breast feeding, weight loss, or just as a result of how their breast formed. If there is only a minor amount of sagging, a breast augmentation alone may be okay. But, if there is too much sagging or loose skin, the breast will look larger after a breast augmentation, but it will still sag, or the breast tissue and skin will “fall off” the implant when you are standing up making the breast look droopy.
Here is a good test to know if you may need a breast lift:
Stand in front of a mirror with your shoulders straight and look at your nipples in relation to the natural crease of your breasts. If your nipples are lower than your breast crease before surgery or your nipples are near the crease, but you have a lot of breast skin that hangs lower than the crease, adding implants without removing excess skin will make them saggier.
At your consultation, Dr. Griffin will evaluate you and discuss whether or not you will would benefit from a breast lift with your augmentation.