Breast Augmentation

Q. Which incision is the best?
A. I have placed over 9,000 implants since 1984 via all incisions except the belly button approach (see below).  In my hands the axillary (underarm) incision is by far the best approach as far as the resultant scar, aesthetic result and patient satisfaction.  This scar is very difficult to detect after 6 - 12 months.  The periarreolar and inframammary incisions are useful in only certain conditions. I recommend patients not to do an inframammary incision unless absolutely necessary.   The Trans-umbilical placement of the implants cannot be done as accurately as if done under direct control from the areola, inframammary or trans-axillary endoscopic approach. Re-operation / revision rates may well be higher. Beware of false claims.

Q. Are saline implants safe?
A. Absolutely.  There is no scientific evidence to date that show that saline implants lead to any medical condition or symptom.  Sterile saline solution is placed within the silicone shell of the implant. There are, however,  implant related complications i.e.: capsular contracture, infection (rare), implant rupture, or wrinkling.  I can explain these conditions and their likelihood during the consultation process.. 

Q. Is it better to place the implant above or below the muscle?
A. Subpectoral (under the muscle) placement is better in most cases, especially with saline implants. Placement above the muscle has a much higher association rate with capsular contracture (hardening), as well as rippling and can make mammography a little more difficult.   Placement of the implant below the muscle gives the breast a more natural "teardrop" appearance and greatly reduces the amount of rippling in the upper and inner aspects of the augmented breast.  This gives a much softer and smoother look and can increase the longevity of the implant to 15 - 20 years, as opposed to much less if placed above the muscle. I personally will only place textured silicone implants above the muscle.  

Q. Why can even submuscular placement of implants lead to undesirable results?
A. If the implant is properly placed below the muscle with a proper release of the lower attachments, the resultant shape and position will be excellent.  Care must be taken not to place the implant too low or to the side.  Most surgeons do not understand how to release the muscle properly and give a natural appearance to the breast. This release is accurately performed with the use of the endoscope (video camera device) during surgery through the axillary incision. These deformities do not occur in my patients, due to proper release of the muscle. The only negative of submuscular placement is the breast / implant movement with muscle flexion.  Also in those that use the chest muscle or workout heavily, the implant may be displaced downward or to the side.

Q. Is it true that placing implants below the muscle is a more painful procedure?
A. There is  more discomfort when the implant is placed below the muscle but the benefits far outweigh the added discomfort. Pain is controlled with post-operative medications.  I am also working on ways to decrease the amount of postoperative discomfort with lighter or no dressings and medications placed around the implant at the end of the procedure.  Also, with the use of the endoscope there is little to no bruising which significantly decreased the amount of discomfort after surgery.  You will be smiling in no time.

Q. What is the recovery period for augmentation mammoplasty?
A. The first 2 - 3 days are usually the worst.  Patients may drive at 5 days as long as they are not taking pain medications. Light duty without arm reaching is recommended for 2 weeks.  Aerobic exercised may begin at 2 weeks  with a gradual return to normal by 4 - 6 weeks.

Q. What about "tear-dropped" or "natural shaped implants?
A. Don't believe the advertisements.  These implants only look good in magazine ads or on a countertop.  I have personally removed more of these than I have put in.  They give rise to abnormally shaped breasts and there is no way to keep them from rotating. A recent study where they x-rayed women's breasts showed the "tear-drop" implant to look round and the "round" implant to look tear-dropped!.  The resultant breast shape is determined by the pre-operative breast shape and how the implant is inserted, not the implant shape.

Q. Can I breast feed after augmentation mammoplasty?
A. There should be no interference whatsoever with breast feeding after submuscular placement of the implants.