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). The trend in the U.S. has been greatly in favor of preference for silicone implants.
- Saline advantages
- Length of scar
- Ease of diagnosis of rupture
- Saline disadvantages
- More ruptures
- Feel firmer
- More rippling
- Less natural shape
- More likely to displace
- Silicone advantages
- Softer feel
- Less rippling
- More natural shape
- Rupture less common
- More stable
- Silicone disadvantages
- Length of scar
- Silent rupture
Which breast implant brand should I choose?
Although differences exist between brands most breast augmentation plastic surgeon are loyal to one brand or another. Some of us (like Dr. Yates) prefer to use all brands for a more precise implant fitting. There are subtle characteristics of each implant brand that can assist in picking the BEST implant for a given patient, not just one that works. There are four implant brands with FDA approval for use in the U.S.
- Mentor breast implants
- Full line of saline and silicone implants with four profiles
- Mentor Round silicone implants are called MemoryGel ®, FDA approved in 2006
- Mentor round silicone implants less cohesive than other brands
- Mentor round silicone implants have a lower fill ratio than both Sientra 106 (smooth) and 206 (textured) and Allergan Inspira high fill ratio implants. Less roundness (good or bad) but potentially more rippling (bad).
- Shaped implants are called MemoryShape ® which were FDA approved in 2013 and currently have 5 shape options
- Textured implants (Siltex ®) use a stamp manufacturing method and has less tissue ingrowth than Sientra or Allergan but a high coefficient of friction. There are no standardized studies comparing contracture rates and stability over time to know which texture type is best. Suffice it to say that all textured implants have a slightly lower contracture rate and position stability at the expense of a higher rippling rate.
- Sientra breast implants
- Silicone implants only
- Round and shaped implants FDA approved in 2012
- Distribute ONLY to board certified plastic surgeons
- Fewer size and profile options than Mentor and Allergan (although they are working on this)
- Most cohesive round silicone implant which they refer to as 5th generation. They have two round options the HSC and HSC+. The HSC+ is filled with the same material as their tear drop shaped implant and as such is truly a round gummy bear implant
- Textured implant (TRUE texture ™) and between Mentor and Allergan in terms of tissue ingrowth
- Shaped implants come in 5 shape options
- Allergan breast implants (Natrelle and Inspira)
- Full line of saline and silicone implants with the largest amount of profile and size choices
- Round Allergan silicone implants approved in 2006. These are most similar to round silicone Mentor implants
- Shaped implants (style 410) FDA approved in 2013
- Inspira implants approved in 2015. These have a high fill ratio designed to give more fullness and less rippling. Inspire implants have more size and profile choices than any other round implant. This can be helpful in correcting small degrees of asymmetry
- Textured implants (Biocell ) are manufactured with a “salt loss” technique resulting in very aggressive tissue ingrowth. This may help stabilize implant position but has a higher risk of peeling the capsule away (double-capsule)
- Allergan shaped implants have the most shape options (12) of any brand currently
- Ideal breast implant
- FDA approved in 2014
- “Structured” Saline implant that feels a lot like silicone
- More expensive that typical round silicone implants
- Selling point is that there are no silent ruptures as the entire implant is saline filled
- Limited profiles and sizes
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. The ideal candidate for a tear drop implant is interested in a very natural shape, and would consider a slightly greater expense and small risk of rotation of the implant an acceptable trade-off. These tear drop shaped implants are not for everyone and generally patients who prefer a “rounded” upper breast are better candidates for round implants.
There is a new saline implant, called the Ideal Implant ®. What is it?
The Ideal Implant is a new saline implant with inner chambers that slows the flow of saline creating a saline implant that feels a lot like a silicone implants. The Ideal implant ® received FDA approval in November 2014. These implants are more expensive than traditional saline implants but have many of the advantages of silicone implants including a more natural feel, and lower rippling risk. The major advantage of these implants as compared to silicone implants is there is no risk of “silent rupture”. This is should be strongly considered in any woman who is very concerned about silicone or silent ruptures.
One limitation is in implant sizing. There is only one profile in the ideal implant which closely matches a high profile silicone implant. Every patient has about 100 cc range of implant volume that fits their breast dimension well and these implants may be too narrow in very small sizes for most patients. There are only a few plastic surgeons who have been given access to the ideal implant and although this may change we are one of only two offices that offer the Ideal implant in Utah.
How much does breast augmentation cost?
The average cost of breast augmentation is $3,708, according to 2014 statistics from the American Society of Plastic Surgeons. This average is for the surgeons fee component of the procedure and the patient should anticipate additional fees including operating room fees and anesthesia fees. For example our all inclusive cost for breast augmentation using round silicone implants is $5,700 – 5,900. For a list of the costs of other common procedures performed by Dr. Yates click here.
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. The implants can also be placed in the subfascial plane, which is above the muscle but within the dense fascial covering of the muscle.
Advantages of placement beneath the muscle include improved implant coverage and a more natural appearing breast enhancement. Submuscular implants have a lower capsular contracture rate and improved support of larger implants as well.
The major advantages for placement above the muscle (subglandular) include decreased postoperative discomfort, improved soft tissue “lifting” and less animation deformity. The implant can feel 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 done a lot of subglandular and subfascial augmentations with gummy bear implants with excellent outcomes. Good candidates for this technique have good support, a fair amount of tissue for coverage and are not choosing very large implants.
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 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, reviewing photos brought by the patient of “ideal” breast size or aesthetics and 3D imaging. Vector 3D imaging 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.More information about choosing your implant size is on my blog
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>.
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 45-60 minutes.
What should I expect from the recovery from breast enhancement?
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”?
Yes we use “rapid recovery” techniques, although not as a selling point. Breast augmentation has advanced tremendously in all aspects including patient recovery. There are surgical and postoperative 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. However, plan on some degree of recovery, no surgeon can guarantee a painless breast augmentation recovery.
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
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.