Breast augmentation is the number one cosmetic procedure performed every year in the United States. According to the American Society of Plastic Surgeons (ASPS), there were 15.6 million cosmetic procedures performed in the United States in 2014. Out of that vast number, the most popular procedure was breast augmentation. While many people understand what a breast augmentation is, not as many understand the history of the procedure or realize the number of choices available to patients.
One of the first breast implant options was silicone implants which started in 1962. Currently available are 4th and 5th generation silicone implants. The 5th generation anatomical silicone implants, known as gummy bear implants, have more of a natural look since a surgeon can control the shape, height, and width of the implant. The round implant, for the 4th or 5th generation, is a two-dimensional implant where only the width and the projection can be controlled.
If somebody is trying to shape their breasts, anatomical implants give more of a natural look while the round implants give a bit more of an unnatural look since there’s not as much roundness on the top.
Saline implants were the default implant introduced in the United States in 1992. Saline implants have a silicone shell on the outside with saline that is filled in the operating room. Overfilling the implants can give a fake, round look because these implants are basically water balloons sitting on the chest. Saline implants have a tendency to be a bit firmer. It’s recommended to change them every 10 years because of a valve that may give and cause the saline to deflate on its own.
Fat grafting involves harvesting fat cells from other parts of the body and then injecting them into the part of the body being treated. Fat grafting is helpful for filling in the areas that an implant cannot take care of. For example, if the implant is in the breasts higher up towards the clavicle or the collar bone, fat can be put there or in the cleavage area to enhance the cleavage. The fat is there to act as a camouflaging agent over and around the implants. Fat injection performed for a breast surgery adds volume so the fat ends up becoming part of the breast itself. It ages as the natural breasts would age.
The safest and most reliable alternative is the anatomic gummy bears. By being able to shape the breasts in a 3D manner, a doctor can fill in the areas missing on the upper pillars. The best way to shape a natural breast is the anatomic 5th generation that allows a doctor to shape the breasts the way the patient wants them shaped.
A patient needs to be specific about their goals and desires. A 3D camera machine helps to visualize how they would look. For example, fat grafting is going to be their actual breasts except everything is going to be bigger (complete with sagging and everything else). But the breasts can’t be shaped as much with fat grafting as they can with an anatomical 3D implant. The pictures give them an idea of what differentiates the round versus the anatomical implant.
Prior to the surgery, patients need to stop taking Omega-3 fatty acids as well as any products that can cause bleeding during the surgery. Patients also need to stay healthy and watch what they eat.
With any type of breast surgery, there is going to be infections as well as seroma formation (food collection around the implant). The long term complication with any type of implant surgery is capsular contracture. Capsular contracture is when the inside scar around the implant tightens, which is why its important to minimize it. Also, the implants can move lower, to the side, or touch too closely to each other. These things can happen whether it is a silicone or saline implant.
With fat grafting, there is a concern for lumps and bumps forming. If lumps do form, such as a cyst or a fat that did not survive known as fat necrosis, generally an ultrasound or biopsy is needed to make sure it is nothing dangerous. They generally go away after a period of time. An ultrasound will say whether it’s a cyst or something that will not go away. If it is harder and does not go away, it can be cut out.
Nationwide, there is about a 30% reoperation rate. This number includes capsular contracture, size changes, and malposition (where the implants move centrally, down or to the side). Every 10 years the saline implants need to be replaced. Many times the revision surgery is due to something with the skin like a patient had kids, gained weight, or lost weight. Perhaps they underwent menopause and the skin loss is completely changed because of a lack of the hormonal effects on the breasts.
The length of recovery depends on what surgery has been performed. For example, a 5th generation textured procedure means the patient cannot lift anything heavy for about four to five weeks. They are not allowed to resume any major activities for up to five weeks because wherever the implant is placed, it needs to stay there until it heals. No major cardio activities for that period of time. For saline or silicone 4th generation implants, they can resume activities sooner because the implant does not have to be in a certain location. They can resume activities within three to four weeks.
With fat grafting, they can go home the next day. It is the liposuction part that hurts because the fat has to come from somewhere. Also, the areas where the fat is taken from may have some temporary lumps and bumps.
Females have more options than ever before when it comes to breast implant surgery. The important thing potential patients should remember is to research their choices and then discuss the options with their physician. Only after discussing the pros and cons of the various procedures can a person make an informed decision about which option is best to help them achieve their personal goals.
Written by Cosmetic Town Editorial Team – MA
Based on an exclusive interview by Dr. Allen Gabriel in Vancouver, WA