By Dr. Daniel Lee

Breast augmentation or getting breast implants is the most popular cosmetic surgery in the US.  There are many reasons why women seek a cosmetic surgeon for breast implants. At New Life Cosmetic Surgery Center, patients are usually wanting to enhance their breast volume and sometimes add a lift if their breast tissue is drooping.  

When a patient comes to see Dr. Lee for a consultation, they go over the patient’s desires for size and appearance.  It’s an in-depth visit where he goes over the following: type of implant, incision location, placement of implant, size of implant, and whether a lift is needed.  Below let’s briefly discuss these so you have a better idea prior to your consultation.  

There are multiple decisions to make in regard to the implants: silicone gel (gummy bear) or saline, size, shape, placement location, incision location, and shell.  

Implants are filled with either silicone gel or saline water.  Dr. Lee usually uses silicone gel for multiple reasons. To highlight a few of them: fewer chances of capsular contracture (discussed below), rippling, and deflation.  

The size is determined by the patient with input by Dr. Lee.  We do a fitting process that allows the patient to try many different sizes of implants.  An important point is that one size will look different depending on the woman’s breast size.  For example, a 350cc implant will look a lot larger on a woman with an “A” cup versus a “C” cup.  The larger the breast cup size the more volume is needed. In general 150-200 cc increases 1 cup size.  However, this is just an estimate. If women are needing a lift, then usually a size less than 350cc is best because higher volume implants can place more tension on the incision and lead to there being a dropping effect on the breast sooner than a lower volume implant. 

The shape is very important.  The most common are high and moderate profile versus low profile.  The high profile gives more volume in the upper pole (area) of the breast.  This is preferred for women wanting more fullness in the upper breast, sometimes it can look faker. However, in patients with very little breast volume, especially patients with very saggy small breasts then low volume (<350cc) high profile implants may be a good option.  Moderate profiles are the most popular at New Life Cosmetic Surgery Center. They provide a natural look but still provide a good amount of volume in the breast. Low volume is not as popular in the U.S., more seen in Europe or women that have size A cup and want a subtle increase in volume.  

The placement of the implant is either under the pectoral muscle (subpectoral) or on top of the muscle (subglandular).  Dr. Lee usually does subpectoral for the following reasons: less chance of capsular contracture can be easier to read mammograms and can look more natural in women with a small amount of breast tissue.  Over the muscle placement (subglandular) is used in a select patient who may have tuberous breasts or bodybuilders.

The incision on the skin can occur in different locations.  Dr. Lee and most cosmetic surgeons prefer the inframammary fold (IMF). The reason why most prefer this location is that it has a lower chance of capsular contracture, the scar is usually hidden in the fold under the breast, and some more technical reasons.  The periareolar incision is the next most common location. Dr. Lee will use this location in some patients, but it does have a higher incidence of capsular contraction. The benefit is the incision is often hidden in the lower areola border. Two other incision locations are the axilla (armpit) and umbilicus (belly button), Dr. Lee does not use these incisions for reasons he will discuss in the consultation.  

The shell is easy to discuss.  There are two options smooth versus texture.  Dr. Lee has never used textured implants. Textured implants have few benefits, but the main problem is their association with anaplastic large-cell lymphoma (ALCL). This is not typical breast cancer but a rare form of non-Hodgkin’s lymphoma.  Although the risk is very small, less than 1%, the risk is not worth any of the benefits for Dr. Lee.  

Now let’s talk about the complications of breast implants.  You may find it surprising but breast augmentation has one of the highest incidences of short-term and long-term complications in cosmetic surgery. 20% of women will develop some sort of problem after their breast augmentation. The most common that are concerning to patients are capsular contracture, rippling, asymmetry, and nipple/breast sensation changes.  

It’s first important to point out that there is not increase risk of breast cancer with breast implants. The largest study of patients with breast implants contained nearly 25,000 women who were followed for an average of 20 years, showed a decrease in the number of breast cancers in these women compared to the general population.

Capsular contracture is when the breast pocket around the implant becomes calcified and hard.  The chance of this happening is from 10-20% by 10 years. The process is not completely understood but seems to be affected by bacterial contamination or biofilm, blood, silicone gel leakage and tissue trauma.  Dr. Lee takes many steps to prevent this in his patients. These include: giving IV antibiotics at the time of surgery, limiting blood loss, using a “no-touch” Keller Funnel technique, irrigating the pocket with triple antibiotic solution, minimizing tissue trauma during the surgery, providing early detection and medicine treatment (milk thistle 1,000mg twice daily and Singulair 10mg daily) if needed. 

Sensory changes can be seen often as a decreased sensation but the majority of women have a complete return of sensation. Up to 15% of breast implant cases can lead to permanent altered sensation to the breast. This usually is not a major complaint if it occurs, as over 95% of women are happy they had their breast augmentation.  

Who should not get breast implants?  A few examples would be. 1) Women who want two identical breasts.  This can’t be done no matter what a surgeon tells you or what you see in online photos.  Breasts are “sisters and not identical twins.” 2) Patients who are very thin who will have a problem with feeling the lower edge of the implant. 3) Women who desire large implants but will be frustrated with them dropping or sagging over time.  As you age your skin gets thinner and will be less able to support the weight of a large implant. 

As mentioned above, breast implants have an overall very high satisfaction rate.  That is one of the reasons it is the most common cosmetic surgery. It’s surgery with limited health risks, takes only about an hour, minimal downtime from work and daily living, relatively affordable, and improves self-confidence.

If you have more questions about breast augmentation surgery or want to schedule an appointment with Dr. Lee, call our office at 956-564-2883.