Breast Augmentation Syracuse
“Breast augmentation enhances the size of your breasts. It can also help correct breast droop.”
Breast Augmentation: Decisions
Breast augmentation is a very personal, often emotional decision. In CNY, changes after pregnancy is the most common reason for wanting augmentation. Here are a few things you need to consider:
Saline: This is the least expensive option. This implant is filled with IV fluids during your surgery. To minimize risk of leakage, the implant is filled to a level that is firmer than normal breast tissue. This has a higher risk of both leaking and rippling than other implant choices.
Standard Gel: This has a more natural feel than saline implants. There is a lower risk of leakage than saline implants, but a higher leakage rate than the gummy bear implant. The cost is in between saline and gummy bear implant.
Gummy Bear: Otherwise known as the form stable implant. This means if you cut this implant in half, the gel remains in place. If you squeeze the cut implant, the gel bulges, but when you relax the squeeze, the gel pops back in place. While this implant is more expensive, it has the lowest failure rate at 10 years. It also has a lower incidence of rippling. There are several versions of the gummy bear, including anatomically shaped implants, and a firmer version that may be useful for implant patients with ripples. Though more expensive, my preference is for the gummy bear implant.
This is the most difficult choice. Often, looking at internet pictures can skew your thought of implant size. Here is how I help you choose:
Vectra 3-D Imaging allows you to see your possible result, both au naturel or in a bikini top. With Vectra, you can see yourself from every angle. In addition, you have the option of viewing your pictures at home after your consultation on the secure website, ViewMyConsult.
Sizing Implants placed in your bra or bathing suit top help to confirm you choice of implant size. Working with my staff, you will be able to review and confirm your choice of size.
Rice or birdseed in a zip-lock bag can be used at home to gauge your implant size. You should “test” your new size in other clothing, including test-fitting clothes at your favorite store. Bring the clothing and your “implant” to your consult or a sizing visit at the office.
Where to place your implant: Above or Below your chest muscle
Below: Though the internet shows more implants placed below the muscle than above, you have the choice of above or below. Below the muscle may mask the risk of implant rippling, but has a higher risk of the implant moving out of position. The choice of above or below is your preference. If you are very thin with very little breast tissue, I may recommend your implants be placed below the muscle. When placed below the muscle, your post-operative pain is usually more intense. Below the muscle is best done with general anesthesia.
Above: In Europe, where the gummy bear implant has been available for years longer than the USA, more implants are being placed above the muscle. Your surgery is usually done under local anesthesia with sedation, but you still have the general anesthesia option. In my practice, above the muscle is the most common option selected. In particular, if you have a highly developed chest wall muscle (such as a body builder), above the muscle is probably your better option. These women have a higher risk of implant moving out of position, as well as a risk of breast deformity caused by contraction of your chest wall muscle.
Where to have your surgery
While having your augmentation in an approved office surgery facility may be less expensive, I feel strongly that your safest option is to have implant surgery in a hospital surgery center. If you want the science behind this recommendation, see Biofilm below.
Bottom line: When making recommendations for your surgery, I use the family standard. In other words, what would I do for my wife. The added cost of NESC surgery center is not a cost, but rather an investment.
While augmentation “fills” your loose skin for most patients, sometimes you need to deal with your excess skin.
Breast lift can be combined with augmentation. It does require a longer incision, and a longer recovery. Many women accept loose breast tissue over their implants. They’re happy with their appearance in clothing, commenting that the only time they’re undressed when it matters, the lights are off. If you’re not sure, although it’s another surgery, breast lift can be done later.
Baby facelift uses the injection of human placenta tissue under your skin. This acts as a biomodulator to improve the natural quality of your skin. While this is natural, it is not yet a proven treatment. This cannot replace surgery, it can work with surgery, but can make your breast skin “perky.”
Radiofrequency is currently being studied as an alternative for limited skin tightening & lift.
No surgery is without risk. For augmentation, risks fall into two categories: Surgery related and Implant related. Common risks of any surgery are bleeding, infection, scarring, altered sensation, and the possible need for more surgery. Implant related complications are:
Capsular contracture is the single most important factor in how natural your breast looks and feels. It is the relationship between your implant and the healing tissue around your implant. The best research shows capsule contracture is related to something called “biofilm.” While not yet proven, I believe that the number of particles in the OR air will increase risk of biofilm and capsule contracture. I have other tools that I use to help reduce chance of contracture.
Shadow on mammography may require extra views to adequately evaluate your breast tissue for cancer.
Implant leaks can occur with any implant, but is most common with saline implants, least common with the gummy bear. Implant leak is not a medical emergency. It does not create a risk to your health. All implants are warranted for your lifetime. If it leaks in the first ten years, you are also eligible for financial assistance to replace the implant.
Rippling is most common in saline implants. There is a new version of the gummy bear implant that is supposed to have the lowest risk of rippling.
Why do I think this is important? Because biofilm is associated with capsule contracture, and because biofilm starts with bacteria attaching to a surface, I believe that air quality will prove to play a role in long term success of your surgery.
When you consider everything you know about bacteria (infection, antibiotics, antiseptics), this is only half the picture. This traditional view of bacteria describes how bacteria behave in solution, and is called the “planktonic” state. The alternate bacterial state is called “biofilm.”
If you think of planktonic bacteria like college kids on spring break in Cancun, biofilm acts like a retirement condo complex in South Florida.
Biofilm starts by bacteria attaching to a surface, like your skin or a breast implant. It changes its behavior to create a slime layer. Bacteria in the biofilm state are resistant to antibiotics and antiseptics. The gene that allows the bacteria to be recognized by your immune system is turned off. There is a continuous exchange in the slime layer, where bacteria shift between the planktonic state and the biofilm state. While biofilm is not an infection, there is very strong research that shows capsular contracture is related to biofilm.
What we don’t know is how or why bacteria attach to start the biofilm in the first place. Silicone can attract dust like a Swiffer, which intuitively means the less dust in the air of the operating room the better.
When any foreign body (like a breast implant) is placed, you want the lowest risk of foreign material contamination possible. Agencies that certify Office surgery centers do not have a criteria standard for particles in the air or air circulation. At the NESC (NorthEast Surgery Center), where I perform breast implant surgery, the OR air is changed 22 times per hour, and it is ultra-filtered.
In research done in co-operation with the Centers for Disease Control, we measured the numbers of particles (dust) in the air of an office, as well as the NESC operating rooms. In the office, there were 2000 particles per cubic centimeter. In the NESC OR, the particle count was 35-50 particles per cubic centimeter.
What does this mean? While there is no conclusive way to treat or prevent biofilm, there are a series of steps I take before and during your surgery minimize your chance of biofilm formation. Do I still see capsular contracture in my patients? Yes, but much less often and less severe. Unfortunately, some of these steps add some cost to your surgery.