Breast Augmentation Orange County
Dr. Aiello is reputed as one of the top Orange County Breast Augmentation surgeons. He has years of experience providing happy outcomes on many different breast sizes and shapes. This operation is performed to enhance or restore the size and shape of a woman’s breasts. Breasts may be small because of a lack of development, or changes following pregnancy, weight loss, or congenital abnormalities. Sometimes a woman’s breasts are very asymmetric. This operation can improve a woman’s body image, self-esteem, self-concept, and quality of life! The intended result is to improve the shape, size and contours of the breast and to improve asymmetries of the breast and chest. This page will review some of the most commonly asked questions for this procedure. To view Before & After photos of Dr. Aiello’s Breast Augmentation patients, click HERE to go to the gallery.
WHAT INCISION SITE IS BEST?
There are four common incision sites: through the arm pit (axillary), around the nipple (periareolar), below the breast fold (inframammary) or through the belly button (umbilicus). Many patients are focused on where their scar is going to be. They are scared that if their scar is anywhere on the breast, then everyone will know they had a breast enlargement. This tends to be far from true. Always keep in mind that you can find bad scars on the internet for any of the incision sites. You need to see the good ones! And of course, it is important to choose a surgeon who gets consistently great results.
Belly Button & Arm Pit Incisions
We’ll start with Dr. Aiello’s NON preferred incision sites: through umbilicus also called a “TUBA” for Trans Umbilical Breast Augmentation and through the axillary. Once the incision has been made for these sites, a tunnel to the breast area must be made before a pocket can be created to insert the implant. Essentially the surgeon does not have ease of access to see the area the implant needs to be placed. Additionally, the TUBA incision is only for saline implants, and with the axillary, you can only use saline or very small silicone implants. There are plenty of women who have achieved beautiful results using these techniques, but specialized training, experience, and equipment are required by the surgeon and they are still not preferred sites even by the most experienced doctors. Achieving breast symmetry using these sites can be more challenging because your surgeon is not making an incision directly on the breasts. Keep in mind also these incision sites can only be used once, so down the road when replacement or revision is needed, another new scar will have to be created anyway.
Areola and Breast Fold Incisions
The better two options for most patients are the Inframammary and Periareolar. These have been popular for decades and although they may have a tendency to leave more noticeable scars, for most patients, the area between the darker pigmented areola and lighter breast skin leaves a good demarcation point for placing a very unnoticeable scar. And the small incision for the inframammary site is in the fold under the breast, so the breast falls over the fold and is only visible if you physically lift the breasts up to see it.
Dr. Aiello feels the Periareolar incisions (around the lower half of the nipple-areola complex) are the most optimal approach. This is because the nipple skin has less chance of causing thick scars on simple breast augmentations than inframammary and the dissection of a large pocket for the implant is easier to access since the incision is made in the middle of the breast rather than a few inches below like the inframmamary. The main thing patients worry about with this incision site is the loss of nipple sensation. This can occur, however, it happens rarely (less than 10% of patients) and it can happen with ALL Breast Augmentations because nerve damage isn’t due to the incision site! It happens when there is injury of the nerves at the outermost edge of the chest where the nerves leave the rib cage and run into the muscle, and then into the breast. All of the techniques have the same liability for injuring these nerves since they all have to lift the muscle to make a space for the implant. Although, the periareolar incision is preferred, Dr. Aiello will use either approach based on your anatomy and personal preference.
SHOULD I GO OVER OR UNDER THE MUSCLE?
The breast implant can be placed either partially under the pectoralis major muscle (submuscular) or on top of the muscle and under the breast gland (subglandular). When Breast Augmentation originally came about in the 1960s, all of these procedures were done over the muscle. Over time, surgeons realized that patients (up to 20%) were developing capsular contracture (more on this later) and by placing the implants under the muscle they could lessen this risk to less than 5%.
Dr. Aiello performs almost all of his breast augmentations by placing the implant submuscularly. A secondary benefit to going below the muscle is that the implant has more coverage over it, thereby somewhat camouflaging the implant’s edges. It is also easier to visualize the breast tissue on mammography since the muscle separates the breast implant from the breast tissue above it. Finally, there is a certain degree of support by the muscle that keeps the implant up, which is not found with the subglandular augmentation. The only downside for the patient is that there is generally more postoperative pain with the submuscular approach and the breast implants take longer to settle completely (approximately 3 months). For the surgeon, the procedure also takes a little longer than with the subpectoral approach. On a rare occasion, there may be an individual who prefers the sub glandular enlargement or she may have certain anatomical conditions that warrant it. Previous operations may preclude a patient from being a candidate for under the muscle as well.
SILICONE OR SALINE: WHICH IS BETTER?
Both saline and silicone implants have advantages and disadvantages. When you consider breast enlargement, the best way to decide whether to have saline or silicone gel implants is to learn more about the different types of breast implants and talk about your ideal outcome from this procedure with Dr. Aiello. A saline breast implant is a shell made of silicone filled with salt water. The implant is inserted empty then filled with sterile saline through a tube during surgery. A silicone gel-filled breast implant is pre-filled with silicone gel, a soft-solid substance like jello. All silicone implants are now made of a cohesive gel which are anti-leak even when cut. It is often called “gummy-bear like”. For full disclosure you need to read the implant manufacturer’s brochure and the FDA patient information on breast implant safety, but for our patients we like to break down the basics. You will be given Dr.Aiello’s best recommendation during your consultation, but the final choice is up to you!
First let’s talk saline. Saline implants were first introduced in 1965. Over the years there have been many improvements in the shell integrity to decrease the chances of deflation, and in the valve to prevent leaks. Some advantages to saline implants can be a smaller incision, and therefore you have a smaller scar, they cost less than silicone and there is greater variability in size, because the fill level is adjustable. Something that is a positive to some patients, but a negative to others is that if you have a deflation with saline, it’s obvious. The harmless saline solution leaks away and your breast will be visibly smaller by the loss of volume. Another possibly disadvantage with saline implants are the feel that some patients say can be less natural than silicone and likelihood to show a rippling appearance, especially in thinner patients.
Next are silicone. Silicone implants pre-date saline by a few years. When it comes to silicone implants, safety is everyone’s concern. We are now on 5th Generation silicone implants in America and MUCH has improved since their introduction many years ago. The FDA ban on silicone implants was lifted in 2006, because as most plastic surgeons already knew, there was no conclusive evidence of them causing any health problems. That being said, this ban and re-evaluation caused breast implants to become one of the most well researched and tested medical products on the market. If nothing else, we now have a product that is better than ever! Silicone implants have a slightly lower rupture rate and some patients say they are softer and have a more natural feel. One of the possibly disadvantages of silicone implants is that it is harder to detect when they rupture. We say this is a possible disadvantage because patients happily live unknowingly with ruptured silicone implants with no adverse affects for years. The silicone does not leak so there is no volume loss so they are not affected aesthetically. The only other disadvantages would be their higher costs from saline and they may require a longer incision, and therefore scar. Also, due to FDA regulations, only patients over age 22 can receive silicone implants.
DO I NEED TO DECIDE ON AN IMPLANT PROFILE, TEXTURE & SHAPE?
In a word, No! Dr. Aiello will handle the details of choosing your implant profile. This is the width-height dimension for the implant. Relating and utilizing the implant diameter and projection to the relation of a patient’s body measurements and current breast volume are part of the process for an experienced surgeon. Patients are never expected to make a determination on this detail. For most all cases, Dr. Aiello uses smooth implants. Textured implants were once believed to reduce the incidence of capsular contractures, but it was found not to be true in all cases.For the most part, many surgeons who once used textured have switched back to the smooth surface implants for both saline and silicone. Shaped implants refer to a textured implant with a teardrop shape. They are sometimes referred to as “anatomical implants” however, the FDA made the manufactures stop referring to them as such, because it is a misleading title. These implants are not used as often because they lack upper pole fullness, which is a desirable effect in breast augmentation. Dr. Aiello uses round implants on most patients, but in some cases there may be reason to consider a shaped implant.
MY BREASTS ARE 2 DIFFERENT SIZES – WILL THEY BE EVEN?
Asymmetry affects everyone! Most women have one breast that’s bigger than the other just like they might have a leg or arm that’s slightly longer than the other. (And by the way, when you have your next pedicure, look and see if your toes exactly match!) The point is that it’s rare for the human body to be symmetrical. However, in some women the difference in breast size and shape is more noticeable, and this is where a breast augmentation and/or a breast lift can be a big help. It is very common to use two different implant sizes to adjust for the difference in natural breast tissue. In rare cases, one breast may need a lift while the other one does not. Interestingly, breasts often heal from surgery differently too!
WHY WAS I TOLD I NEED A BREAST LIFT – I JUST WANT IMPLANTS!
Women who are unhappy with sagging in their breasts often mistakenly think getting breast implants will magically lift and reposition their breast to a higher place on their chest. Unfortunately, this just isn’t how our anatomy works. Breast sagging (ptosis) is usually a result of pregnancy and breast-feeding or weight-loss, but not always. To restore breast volume and shape, an implant is used in conjunction with a breast lift (Mastopexy) to restore fullness in the upper part of the breast. During a Mastopexy, the breast is lifted by removing the excess skin and restructuring the breast tissue underneath. There are several types of lifts. In many women a delicate incision around the nipple area (areola) is all that is needed. In others, who have a large amount of excess skin, the incision will need to be extended. We understand it can be a disappointment if you come to our office for breast augmentation and Dr. Aiello explains that to achieve a pleasing shape and perkiness, you’ll need a breast lift as well. So here’s a good way you can tell. Standing in front of a mirror, look at your nipples in relation to the natural crease beneath your breasts. If your nipples are lower than your breast crease, adding implants without removing excess skin will make them sag even more! And it will just get worse with gravity over time. And, yes, you will find a surgeon out there that will tell you to just use bigger implants, but, please just believe us, this is NOT a good idea. You can learn more about breast lifts at our procedure page for: Mastopexy.
WILL I BE ABLE TO BREASTFEED AFTER IMPLANTS?
Absolutely! Again, the breast implants are behind the muscle, so the milk ducts can still function. If you have already had children and breastfed successfully prior to having implants, you should have no difficulties in breastfeeding with future pregnancies. If you have yet to have children, your implants shouldn’t change any factors that affect whether or not you can breast feed. To learn more you can visit our blog on this subject: Breast Augmentation & Breast Feeding.
WHAT IS CAPSULAR CONTRACTURE?
The human body’s immune response to any surgically installed foreign object whether it a breast implant, cardiac pacemaker or orthopedic prosthesis is to encapsulate it with scar tissue in order to isolate the foreign object so the body can tolerate its presence. This normal event becomes abnormal when the scar tissue capsule around the implant thickens and compresses the breast implant. If you’ve ever heard someone say their implants hardened, capsular contracture is what they are referring to. The implant itself has not hardened, but the scar capsule surrounding it has thickened and squeezed the implant. All surgeons have dealt with capsular contracture in their careers and research has shown some factors we now know can contribute to whether or not a patient will develop it, but no one is 100% sure of all the causes. We do know that capsular contracture rates are about twice as high in smokers as in non-smokers, so avoiding smoking is crucial. You must quit smoking prior to having surgery anyway, so you may as well continue avoiding tobacco use after your surgery! During your breast augmentation, Dr. Aiello uses a meticulous surgical technique to avoid any factors that could contribute to capsular contracture, including placing your implants submuscularly. During your recovery you are instructed on the steps you can take to ensure your healing goes smoothly, including massage and compression. IF you have any early indicators your scar tissue capsule is hardening we will take immediate steps with oral medication. But rest assured, though Dr. Aiello is experienced in surgical correction of capsular contracture, with all the steps we take to minimize the risk factors, we see less this complication in less than 1% of our patients.
WHEN WILL I HAVE TO REPLACE MY IMPLANTS?
Now that you know the differences in the implants themselves, you can understand that they are not inserted the same way and they behave differently after the surgery too. Many people are under the mistaken impression that breast implants need to be replaced every ten years. This is not true. There is no finite time frame for when you have to replace your implants. As long as you are happy with their appearance, your breasts are soft, and there are no problems with leaks, there is no need to change out your implants. They are by no means, once in a lifetime device, but the most common reason implants are replaced is when a woman wants to change her breast size. Implant manufacturers provide warranties in case of implant rupture. This is great news, but rarely used.
More information on Breast Augmentation in greater detail may be obtained from the references listed below:
- American Society for Aesthetic Plastic Surgery www.surgery.org
- FDA www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants
- American Society of Plastic Surgeons www.plasticsurgery.org
- Smart Beauty Guide www.smartbeautyguide.com/procedures/breast/breast-augmentation
- Mentor 800-235-5731 www.mentorcorp.com or Natrelle 800-362-4426 www.natrelle.com
We understand the importance of having well-informed patients, and will take the time to thoroughly review all of your options for breast augmentation so that you are confident with your choices. If you would like to learn more about breast augmentation at Ocean Plastic Surgery Center, CLICK HERE to contact us! We look forward to speaking with you and to scheduling your complimentary consultation with Dr. Aiello.