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December 2006
Medical | Plastic Surgery
By Amy M. Ortega, M.D.
Breast Augmentation Answers: Part 3
Previously addressed in the last two columns, breast augmentation has become one of the most commonly requested procedures in the United States, and one that poses many questions and concerns. Here is a compilation of some frequently asked questions that your client should get answers for.
Gummy bear implants
Q: Are “gummy bear implants” better or more natural looking?
A: The gummy-bear concept is a way to describe a type of silicone gel implant that became available in trial studies in recent years. These are silicone gel implants using gel that has been cross-linked and, therefore, is not as runny as previous implants. This means that rather than being runny, if the implant ruptures, the silicone is firm and will not leak from the implant as a liquid.
The earlier cross-linked implants were called gummy bear implants because they were firm much like gummy bear candy. These implants also had an anatomic shape to them, meaning more fullness on one end than the other. The idea here was to better match the shape of the breast.
Many plastic surgeons participated in the implant-use trials and found that they produced good results. However, the implants were significantly firmer than previous silicone gel implants. In addition, because the implants were “anatomic” rather than a round shape, unfortunately there was the risk of the implant flipping over, causing an unnatural shape.
Although many physicians may prefer to use this implant, I think that its firmness is harder than that of a natural breast and therefore is somewhat unnatural in appearance and feel. Mainly, for this reason, I prefer to use smooth, round implants whether filled with gel or saline.
Implant consistency
Q: Do the silicone gel implants of today have the gel of a more runny or watery consistency, or more of the gummy-bear consistency?
A: Silicone gel implants of today are a good compromise between the firmness of gummy-bear consistency and the almost oily or watery consistency of implants produced many years ago. Silicone gel implants that are made at the present time are cross-linked, producing a gel that does not run but that is not so firm as to cause the breast to feel unnatural.
This can be demonstrated by cutting the implant in half with a knife. The implant sits there in two halves and the gel does not run out of the implant. It is much like the consistency of Jell-O, soft and resilient but not runny.
If a patient requests gel implants and qualifies to be entered into the studies required, I often recommend this type of smooth, round silicone gel implant.
Incision placement
Q: What are the various incision options available today?
A: Incisions can be made in the axilla (armpit), around the areola, or in the crease under the breast.
Once healed, the axillary incision is well hidden but, until then, shows a red scar that is visible when wearing sleeveless tops and raising one’s arms, and it can also interfere with shaving the underarms depending on how the scar heals.
Working further away from the breast also can make it more difficult for the surgeon to achieve accurate implant placement. Many surgeons perform this procedure with great success, some with an endoscope (small camera) and some without.
Incision placement around the bottom edge of the areola (pigmented skin around the nipple) hides very well. However, some surgeons have experienced a slightly increased rate of infection with this method, possibly because the dissection may proceed through the breast ducts. Also, in theory there may be an increased risk of decreased or changed sensation in the nipple, although that has not been the case in my experience.
Incision placement in the crease under the breast (“inframammary fold”) also hides very well because of a natural crease and shadowing in that area. This incision allows the surgeon the most access to the breast area, possibly allowing for more accurate implant placement.
A breast crease incision may be considered the “gold standard” for breast augmentation incisions. Your surgeon can help you decide which incision may be best for you.
Scarless breast augmentation
Q: I have heard of “scarless” breast augmentation by putting the implant in through the belly button. Is this true?
A: While some surgeons routinely use this method with good results, it has not become a common procedure because of several considerations.
First, the surgeon is working far away from the breast and through a very small opening, making it more difficult to achieve accurate implant placement.
Second, some patients who are thin can develop a V-shaped “ridge” visible on their abdomen, with the belly button at the bottom of the “V,” due to scar tissue formed under the skin from the dissection from the belly button to the breast area.
Finally, the placement of the implant through this route actually causes enough trauma to the implant that it may damage the implant; for this reason, placement by this method may void the manufacturer’s warranty.
Downtime
Q: What kind of recovery period and downtime can I expect form this surgery?
A: Most patients feel somewhat tired and groggy from anesthesia for a day for two. Typically, patients will also feel pain and fatigue for a few days.
I have many patients who have surgery on Friday and go back to a “desk job” on Monday. Some people have to take their pain medicine for only a few days whereas some people have a lower pain tolerance and are on pain medicine for over a week.
If you are taking pain medicine, you cannot drive, therefore you cannot go to work. After your surgery, you will be restricted in terms of activity and should avoid heavy lifting or heavy, repetitive motions such as workouts with the upper body or arms for several weeks.
Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. Her office is located in Atlanta, GA. To reach her, call (404) 751-2500. For more information ABOUT DR. ORTEGA, visit her website, www.ASAbeautiful.com.
