What is it?
Breast augmentation surgery is one of the most common plastic surgery procedures today with over 250,000 performed annually. Breast implants placed beneath the existing breast tissue can provide the added size and volume that women want while still providing a natural and youthful appearance.
Who is a candidate?
- A healthy patient with no significant medical problems
- At least 18 years of age
- A patient displeased with small breasts
- A patient displeased with asymmetric breasts
Breast augmentation techniques have evolved over the years. Dr. Galanis believes very strongly in personalizing the procedure for each individual patient. It is also important to note that in some cases, a breast lift is required at the same time as implant placement. Each of the following factors is discussed in greater detail below:
- Saline vs. silicone implant
- Choosing the right size of implant
- Implant style
- Incision location
- Pocket placement (under or over the muscle)
Saline or Silicone?
Both implants have essentially the same safety profile. Due to concerns that silicone might be related to autoimmune disease, silicone implants were temporarily removed from the market in 1992. Over the subsequent several years, several large scale studies were performed which concluded that silicone implants were in fact safe. The FDA approved them for return to the market in 2006 and in the ensuing years through millions of surgeries, their safety has been validated. Both saline and silicone implants have a silicone rubber shell. Saline implants can be placed through a slightly smaller incision since they are inflated after they are placed in the pocket. Saline implants are filled with sterile salt water and can feel more firm and exhibit more rippling than their silicone counterparts.
|Cost||Less expensive||More expensive|
|Feel||More Firm||More soft|
|Appearance||More rippling||Less rippling|
|Incision||Less then 4 cm||4-5 cm (dependent on implant size)|
*When an implant is placed, the body normally forms a thin capsule around it. Over time, this capsule can become thicker, harder, and can even distort the appearance of the breast. This is known as a capsular contracture. The only known treatment is surgical correction.
If and when saline implants rupture, the implant deflates as the fluid leaks out. Silicone implants are filled with a thick jelly-like substance (silicone) which yields a soft feel with less incidence of rippling. If and when a silicone implant ruptures, it is frequently imperceptible to the patient as the gel remains in place (see video). Imaging such as an MRI or Ultrasound can be used to confirm rupture if it is suspected.
What are gummy bear implants?
Shaped implants, commonly referred to as “gummy bear” implants, are the latest in breast implant technology. UCLA Medical Center – where Dr. Galanis trained and still serves as a Teaching Instructor to residents – was one of the first institutions authorized to use this style of implant. These implants contain a cross-linked cohesive silicone gel designed to hold together and maintain shape even in the event of rupture. The shell is textured to encourage tissue ingrowth, reduce the risk of capsular contracture, and reduce the risk of implant rotation. For patients with minimal breast tissue, these implants give a more natural tear drop shaped appearance in which the less prominent upper portion of the breast slopes down to a fuller lower portion of the breast mimicking the natural breast shape. These implants are more expensive than conventional implants.
What size is best for me?
Choosing the appropriate size is an important part of the process. Implants come in a range of sizes measured volumetrically in cubic centimeters (cc’s). Frequently, patients come to the office requesting a specific cup size or asking what cup size a particular implant volume will give them. Unfortunately, due to unique characteristics in each patient’s anatomy as well as the fact that cup size measurements are not standardized between manufacturers, predicting cup size relative to a volume of an implant can be highly inaccurate even in the most experienced hands. Rather than focusing on a cup size, patients are advised to focus on the look they are trying to achieve. By using 3 basic tools, Dr. Galanis can effectively educate and empower patients so that they can accurately define the look they want to achieve and take an active role in choosing the appropriate implant:
- “Goal” Photos: They are encouraged to provide goal photos – from online sources, magazines, etc. – to give Dr. Galanis an idea of what they want for themselves.
- Bra sizers: Dr. Galanis uses a specially designed external sizing system in his office that lets patients “try on” different implant sizes with a specialized bra to give them a sense of what different sizes will look like.
- 3D virtual imaging: Dr. Galanis employs the state of the art Crisalix 3D imaging system. With this system, Dr. Galanis creates renditions of a patient’s very own body and then shows 3D renderings of how their body would look with a range of different implant sizes and styles.
What are the options for incisions?
The three options available for placement of silicone implants include:
- under the breast (inframammary)
- around the nipple (periareaolar)
- armpit (axillary)
There are pros and cons to each incision which Dr. Galanis discusses with his patients during their consultation. In general, there is a slightly increased risk of infection and contracture with both the axillary and periareolar incisions when compared to the inframammary incision although this increase risk is very small. Additionally, with larger implant placement, the axillar incision may leave a scar that is visible when wearing halter tops, tank tops, bikini tops, etc.
Will the implant be placed above or below the muscle?
Breast implants can be placed either above the muscle (known as subglandular position) or beneath the muscle (known as submuscular position). In patients with thin skin or a notably small breast, Dr. Galanis prefers the submuscular placement as the muscle coverage of the implant helps contribute to a better aesthetic outcome. There may also be a slightly decreased risk of capsular contracture with implants placed beneath the muscle in select cases. Although mammograms are possible for patients with either pocket placement, it is thought that the submuscular placement may make the detection of breast disease easier.
- Outpatient Surgery
- Result: Immediate increase in size. Initially the implants may rest high and feel firm. Over time, however, the tissues soften, the muscle relaxes, and the implants settle into a position filling out the lower pole for a more natural aesthetic. This process typically takes around 3 months (see image time lapse images of Dr. Galanis’ patient below).
- Pain: Variable. Oral pain medicine may be needed for up to 2-5 days.
- Special garment: A compression bra will be provided and should be worn for 2 weeks. A sports bra may be worn beginning at 2 weeks. A wire bra may not be worn until at least 4 weeks postoperatively.
- Drain removal: No drains
- Suture removal: All sutures are dissolvable
- Activity/Shower/Driving restriction: No restriction on basic daily activity. May shower 2 days after surgery. No lifting greater than 10 pounds for 2 weeks. May drive when no longer requiring narcotic pain medication. Non-impact cardio (stairclimber, elliptical machine, etc) at 4 weeks. Impact cardio (running), heavy lifting at 6 weeks.
- Time off work: Expect to require no more than 1 week off of work depending on job demands.
- Follow-up: You will be seen in office following surgery at 1 week, 2 weeks, 6 weeks, and 3 months or as needed.
How long will my implant last?
Once placed in the body, breast implants do not come with an expiration date. There is a common misconception that breast implants need to be exchanged at 10 years. Generally speaking, if you do not have a problem with your implants and are not experiencing any pain or change in appearance, then nothing needs to be done. That being said, no man-made device should be expected to last forever. On average, roughly half of patients will require a revision surgery by 10 years according to the FDA. Reasons include implant rupture, capsular contracture, desire to change sizes, desire to exchange silicone for saline implants, or other reasons associated with a desire to change the breast aesthetic.
If you would like to learn more about breast augmentation, please fill out our contact form and we will be happy to assist you! Alternatively, you can call to schedule a consultation to see Dr. Galanis in Beverly Hills at 310-858-8930 or in Chicago at 844-GALANIS (844-425-2647).