Breast Augmentation


Breast augmentation/ breast enhancement/ breast implants in the Salt Lake City, Utah area.

Should I choose saline or silicone breast implants?

Breast implants consist of a silastic shell filled with either saline (salt water) or silicone. The choice of saline vs. silicone breast implants is an important one. Silicone breast implants generally have a more natural look and feel. Silicone implants have a lower risk of rippling, rupture, and generally have a higher patient satisfaction. Saline breast implants are less expensive, more adjustable, and can be placed with a slightly shorter scar. There is concern with “silent ruptures” with silicone breast implants but not with saline implants.  A silent rupture occurs when there is a rupture of the implant that is not apparent to the patient.  There is some controversy regarding the safety and method of diagnosis of silent ruptures. Current silicone breast implants are cohesive meaning they are more solid than liquid.  Cohesive silicone is much less likely to get into the surrounding tissues than previous implants and typically remains contained in the implant capsule.  This is particularly true of the highly cohesive 5th generation silicone implants (tear drop shaped in all three manufacturers and round in Sientra).

Coming soon!  The Ideal implant ™ received FDA approval in November 2014.  Product should be available in May 2015.  This is a saline implant that “feels” like silicone.  More information as it becomes available.

    • Saline advantages
      • Cost
      • Length of scar
      • Adjustability
      • Safer rupture
    • Saline disadvantages
      • More ruptures
      • Feel firmer
      • More rippling
      • Rounder shape
    • Silicone advantages
      • Softer feel
      • Less rippling
      • More natural shape
      • Safety of ruptures?
    • Silicone disadvantages
      • Cost
      • Length of scar
      • Silent rupture
      • Safety of ruptures?

Should I choose teardrop shaped or round implants?

The choice between teardrop and round breast implants has reappeared after several years off the market.  Teardrop shaped “gummy bear” silicone breast implants have been used outside of the U.S. for years and have recently been FDA approved for use in the U.S. for breast augmentation.   All three of the major implant manufacturers now have FDA approval for their shaped implants.   These implants are more cohesive than other round silicone implants and as such able to be manufactured in a teardrop shape.  These are the implants that for years have been termed “gummy bear breast implant” or anatomical breast implants.   For some breast augmentation patients these can have the advantage of achieving a more natural breast shape.  The increased projection in the lower breast can help with slight degrees of breast droop as well. These teardrop shaped implants are a little firmer than other silicone implants but in the body there is little difference.  Sientra makes the softest tear drop shaped implant on the U.S. market.  The gummy bear implants made by Mentor and Allergan are firmer.  The “best” compromise between shape stability and softness is unknown at this point.  The ideal candidate for a tear drop implant is interested in a very natural shape, and would consider a slightly greater expense an acceptable trade-off. Gummy bear implants have some long term advantages with a lower risk of rippling, contracture, and changes in shape.   As we have gained a lot of experience with these implants these are currently Dr. Yates FAVORITE breast implants for consistently beautiful results.

Where are breast augmentation scars placed?

Three incision choices are generally used; around the nipple, beneath the breast, or in the armpit. The incisions beneath the breast or around the nipple are preferred by Dr. Yates as perfect symmetry of the breast implant pockets is more consistently achieved. Dr Yates takes pride in making his scars as small and unnoticeable as possible. There is increasing data that a crease (inframammary) incision has the lowest risk of capsular contracture and has the lowest complication rate.  The majority of plastic surgeons, including Dr. Yates, prefer this incision for the majority of breast augmentation patients. There is another incision choice worth discussing, the umbilical incision (TUBA). This is also known as “scarless breast augmentation” for marketing purposes. In reality there is a scar and most plastic surgeons, including Dr. Yates, believe that this is an inaccurate surgery.  This fad seems to have gone away, hopefully for good.

 

Where are the breast implants placed in breast augmentation?

The breast implant can be placed either above or below the chest muscles, although most patients (particularly with round implants) benefit from placement beneath the muscle.  Advantages of placement beneath include improved implant coverage and a more natural appearing breast enhancement. Submuscular implants have a lower capsular contracture rate as well.  The major advantages for placement above the muscle include decreased postoperative discomfort, improved soft tissue “lifting” and less animation deformity.   The implant also feels more like breast tissue when not separated from the breast tissue by muscle.  With the approval of gummy bear, tear drop shaped implants there are fewer disadvantages and more advantages of subglandular placement.   These implants have a lower risk of many of the complications seen more commonly in subglandular augmentation such as rippling, implant edge visibility and capsular contracture.  We have been doing a fair amount of subglandular augmentations with gummy bear implants with excellent outcomes. Very few plastic surgeons perform a full submuscular breast augmentation anymore.  Rather, the lower pectoralis muscle is divided from the chest to decrease animation deformity and provide an improved shape, the so called “dual plane” technique. 

How do I pick my best breast implant size?

One of the most difficult and important decisions for a patient is determining which size of breast implant to use. The degree of breast enlargement is dependent upon the volume of the patients breast tissue in addition to the size of the breast implant used. We will use a variety of methods to arrive at the ideal implant volume including “trying on” breast implants of various sizes, dimensional analysis, and reviewing photos brought by the patient of “ideal” breast size or aesthetics. 3D imaging. This is a confirmatory method of breast implant sizing. A 3D image of the body is taken which can be modified with imaging software. The “breast sculptor” module allows us to simulate and visualize the changes that can be made with a variety of implant shapes and sizes.

This is spectacular in person!

More information about choosing your implant size is on my blog

What is the perfect or ideal breast shape?

The perfect breast shape for natural breasts should have a little more breast volume below the nipple than above with nipples tilted slightly upward.  Many patients who want breast implants want a greater degree of upper fullness than natural.  What you consider your ideal breast shape requires careful consideration and discussion with Dr. Yates.  In general, rounded implants (left)  help achieve a rounder, fuller upper half of the breast and tear drop shaped implants (right) achieve a more natural transition in the upper breast.  I have provided a lot of useful information on breast shape <here>.

87424-3090

98507-6865

Can asymmetric breasts be improved with breast augmentation?

Yes, the breast implant size can be larger in the smaller breast to help improve asymmetry of size. If there is a significant asymmetry of shape of the breasts a breast lift may be required to improve symmetry.

How is breast augmentation performed?

Breast augmentation can be done under either general anesthesia or local anesthesia with sedation. Dr. Yates preferred technique is a deep sedation (not general anesthesia) with excellent local anesthesia in our AAAASF certified office operating suite. The patient is sedated and monitored by the anesthetist. The level of sedation is deep (no pain, no awareness), like a very deep sleep. Dr. Yates injects the area with a lot of local anesthetic. The implant pockets are developed and compared for size and symmetry. The breast implants are placed and the incisions closed. The amount of sedation is lightened at the time of closure and the patient is awake enough at the completion of the procedure to walk assisted to the recovery room. Most patients have basically no pain in the recovery room because of the local anesthetic in the implant pocket. The pain increases as this medicine wears off and pain medications as necessary are started.

How long does breast enhancement take?

Dr. Yates does a lot of breast augmentation surgery. This is a very efficient operation and there are a few tricks to make it quick and relatively easy on the patient. The overall surgery time is around 30-45 minutes.

What should I expect from the recovery from breast enhancement?

After discharge you will be given antibiotics to prevent infection and medications for pain and nausea.   There will be discomfort for the first few days after the procedure.   Most of our patients are off narcotic pain medications by the next day.  Your activity will be limited for six weeks.  You may return to desk work as soon as you feel able, usually 2-5 days.  You may resume moderate lifting at 3 weeks and may return to the gym at 6 weeks.  You will be given a supportive bra which will be used for 6 weeks. Generally avoid underwire bras for the first 6-12 weeks. On our Facebook business page, other patients have discussed their recovery and experience after breast augmentation as well as other procedures.

What about fat grafting to the breasts, or “natural breast augmentation”?

This is a controversial topic but is slowly gaining momentum.  Fat is taken from unwanted areas of the body and reinjected in the breast.  The controversy is regarding safety and effectiveness.  This is a big topic and I have written about it on my blog.   The concerns are calcifications and issues with breast cancer.  It is unquestionably effective, although most of my patients would be unhappy with the modest volume enhancement that can be achieved with fat grafting. My best advice to a patient considering this type of breast enhancement is to look carefully at the credentials of the individual who will be performing the procedure.  I have all of the equipment necessary to do this type of breast enhancement and commonly use it for buttock augmentation but am waiting for additional data before I will do large volume fat grafting in the breast.  I will commonly use small volume fat grafting for shaping the breast in cases such as rippling and to soften the appearance of implants.

Is it possible to breast feed after breast augmentation?

Generally yes, but there are exceptions to every rule. Click for more information about breast feeding with breast implants.

Do breast implants have warranties?

Yes the manufacturer provides a free lifetime warranty against implant rupture or deflation.  They also offer help with the surgical fees of replacement of failed implants for 10 years.  Previously unheard of, Mentor and Sientra are now offering very generous limited warranties against capsular contracture.

My saline breast implant has deflated, what now?

Saline breast implant deflation is relatively easy to diagnose and correct. The saline is absorbed and the breast deflates. This generally requires a simple remove and replace procedure.

I suspect my silicone breast implant has ruptured, what now?

Silicone breast implant rupture is a little more difficult to diagnose and treat than saline implant deflation. The implant material is not absorbed and can cause hardening and deformity of the breast. It is also harder to correct surgically as the implant material may need to be removed as well. For more information about treatment of silicone breast implant rupture click here.

What risks are associated with breast augmentation?

As with any surgery, there are possible risks and complications. As a perfectionist, Dr Yates takes every precaution to prevent these. Dr. Yates will discuss these at the time of your consultation. These risks include, but are not limited to, asymmetry, unhappiness with size, implant deflation, implant rupture, implant rippling, capsular contracture, and poor scarring. Generally these complications require breast implant revision surgery.

What is the difference between a “boob job”, “boob jobs”, breast augmentation, breast enlargement, and breast enhancement?

Nothing really, they all describe the same thing. However, “boob job” and “breast jobs” are not generally terms used by professionals.

How long have breast implants been used?

The history of breast implants is an interesting one.  The first implants were placed in the early 1960’s and there has been a lot of improvement in techniques and implants since that time.

Does Dr. Yates offer “rapid recovery breast augmentation”?

“Rapid recovery” breast augmentation is for the most part a marketing tool. Certainly there are tricks to help the patient recover as quickly as possible, such as early arm motion and precise pocket formation avoiding bleeding and tissue trauma.  Dr. Yates is very aggressive with pain management and we have many patients who require no narcotics for pain.  No surgeon can guarantee a painless breast augmentation recovery.

How much does breast augmentation cost?

The costs associated with breast augmentation include 1) surgeon’s fees, 2) cost of implants, 3) anesthesia fees, and 4) facility fees. As Dr Yates has an in-office operating suite, the facility fee is minimal. This is a cost savings directly to the patient. For a list of the costs of common procedures performed by Dr. Yates click here.

How do I schedule a consultation or schedule surgery?

Contact Dr. Yates office or feel free to email him any additional questions you may have.

Before & After

Procedure:

before and 3 weeks after subglandular breast augmentation. She was concerned with dynamic implant motion with exercise and wanted a natural shape. We chose 400 cc classic base moderate projection Sientra tear drop shaped (gummy bear) silicone implants placed in the subglandular position.  View More.

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