BREAST AUGMENTATION PROCEDURE OVERVIEW
Palm Beach Institute of Cosmetic Surgery
Plastic Surgery for the Face and Body

>> Breast Augmentation before and after photos

BREAST AUGMENTATION CONSIDERATIONS AND OPTIONS
There are many considerations and options regarding breast enhancement surgery, each of which you will want to discuss with Dr. Dedo. The first decision many women are faced with once they know they want to have breast enhancement is:

• What size Breast Implants? The number one "wish" we have heard from ladies who have breast augmentation is "I wish I had gone just a little bit bigger."
• "If you could change one thing about your breast augmentation, what would it be?"
  48% Have "not yet" had the procedure
  38% Would have gone "bigger"
  9% Should have done it "sooner"
  5% Would have gone "smaller"

WHAT TYPE OF BREAST IMPLANT IS RIGHT FOR ME
Breast implants can be smooth or textured, saline or silicone, and round or anatomical ("tear-drop" shape). They each have their pros and cons, as follows:

Smooth Breast Implants vs. Textured Breast Implants

Smooth Breast Implants (+) PROS - As a rule, regardless of any other consideration, smooth implants wrinkle less than textured implants. Thus, if the implant is going to be placed above the muscle, you will most likely want smooth. The exception to this is if you have a previous history of capsular contracture (hardening of the breast tissue around the implant) with saline implants. When this is the case, textured implants may be better indicated for you. This is a consideration you will obviously discuss with Dr. Dedo. (-) CONS - Smooth silicone implants have a higher rate of capsular contracture than do textured silicone implants. (Approximately 34% vs. 15% respectively, according to some studies). In terms of saline implants, studies have shown the rate of capsular contracture to be about the same (approximately 8% to 14%, according to some studies) regardless if the saline implant is smooth or textured. Textured Breast Implants (+) PROS - There has historically been a lower rate of capsular contracture for silicone, textured implants than for silicone, smooth implants. (-) CONS - Textured implants generally wrinkle more than smooth implants.

Saline Breast Implants vs. Silicone Breast Implants

Since 1992, when silicone breast implants were taken off of the American market, the vast majority of breast implants have been saline (salt water). This water is exactly the same as you would be given through an I.V. if you were dehydrated, or going to be placed under general anesthesia, and is generally not going to be harmful to the body. Silicone has recently come back on the American market and is available to some patients, but only under certain circumstances. Saline Breast Implants (+) PROS Less perceived risks. No auto-immune disease controversy. Lower rate of capsular contracture than with silicone implants. (-) CONS Feel. No Saline implant will ever feel quite as nice as silicone gel. Silicone Breast Implants (+) PROS Feel. Silicone almost always looks and feels more natural than any saline implant. (-) Perceived and perhaps real risks of adverse reactions to silicone gel by the body. A higher rate of capsular contracture than with saline implants. Just as there is someone allergic to virtually everything, some people may have allergic reactions to the silicone gel in silicone breast implants.

Round Breast Implants vs. Anatomical Breast Implants

Round Breast Implants (+) PROS Round implants consistently provide the most natural look and feel with the least potential complications. (-) CONS Some will say round implants offer less control over long-term superior pole (the upper portion of the breast) fullness. Anatomical (tear-drop) Breast Implants (+) PROS Anatomical implants were developed to provide a contour more like the natural shape of the breast itself. In long-chested women the implant may provide greater control of superior pole fullness. (-) CONS The implant must be textured so it will adhere to the breast tissue, and not rotate in the body. This concern with "directional orientation" results from the fact that if the implant does rotate, the upper portion of it could end up inappropriately positioned outward or inward. With round implants, all sides are the same by definition. Therefore, if a round implant does rotate, it does not matter. Of course, the anatomical implant does have many indications, and is a favorite of some excellent surgeons. Ask Dr. Dedo if he thinks this implant might be the best for you.

Standard Breast Implants vs. High Profile Breast Implants

Introduced to the market in Fall, 2001, the High Profile (HP) implant claims to give the highest projection per base width, within the US market. It is available in both Saline and Silicone-filled and Textured and Smooth versions. (+) PROS The High Profile implant has the same projection height as an implant that is a fraction of the volume of a Round implant. In a nutshell, if placed side by side, an HP implant will extend off of the breast plate further than a similar volume and base diameter Round one would. Also, a Smooth Saline HP could ripple less than a similar Round Smooth Saline one would. (-) CONS Also, because these implants have an anterior diaphragm valve, they can only be filled once, at the initial time of surgery.

BREAST IMPLANT PROS AND CONS
There are advantages and disadvantages to every consideration in breast implant surgery, and there is no single best way for the surgery to be performed. Following are many of these considerations, and their trade-offs.

Should my implants be placed above the muscle or below the muscle? In both cases the implant is behind the mammary glands and the breast tissue. The difference is that sometimes the implant is placed in front of the Pectoralis Major chest muscle, and other times it is placed behind it. Your individual body type, current amount of existing breast tissue, and the look you desire will help you determine which position is best for you, as follows:

1) If you have very little breast tissue… it is most likely you will want to "go behind the muscle", for the following reasons: a) When the implant is in front of the muscle, there will not be much breast tissue to cover the implant, so more of the implant roundness, and potentially wrinkling, will be both visible and palpable (you can feel it). Clearly, if 1/2 to 2/3 or more of the implant is covered by muscle, it will be harder for you and others to see, feel and notice that an implant is there.

2) If you have some breast tissue… (approximately 3 cm or greater) you will have more of a choice between above and below the muscle. At this point new considerations need to be taken into account: a) If you exercise, the implant that is placed behind the muscle is more likely to displace, or move, when doing exercises that use the chest muscles. There is a slightly greater chance of capsular contracture, or implant hardening, when the implant is placed in front of the muscle.

3) If you have some breast tissue and a "saggy" or "droopy" breast… You will almost certainly want to go above the muscle for the following, very logical reason: Even though the breast (tissue and glands) itself has fallen, or drooped, down toward the abdomen, the chest muscles are still in the same place they have always been. So, if you were to put an implant behind the chest muscle, you would have the previous breast still in the same position it was before surgery (drooping low), but now you would have a breast implant protruding out from the chest wall a couple of inches above the rest of the breast.