The Answers to Every Question Beverly Hills & Los Angeles Women Need to Ask about Breast Implants!
It is not uncommon for me to consult with women who have become frustrated and confused with their choice of breast implants, especially after they've met with multiple plastic surgeons in Beverly Hills, Los Angeles, or other cities throughout Southern California.
As a plastic surgeon who consults who consults women regarding breast augmentation from all of Southern California, and especially from Beverly Hills and Los Angeles, I have decided to try to answer their most pertinent questions about breast implants in this plastic surgery educational article.
What are saline breast implants used for?
Saline breast implants are medical prostheses, which are used by cosmetic plastic surgeons for breast augmentation, enlargement, or reconstruction. The use of breast implants to increase breast size and to improve its shape is very common, not only in Beverly Hills and Los Angeles, but also throughout California and the rest of the United States. Aside from their use for enlargement of breast size, breast implants are also used to correct congenital or acquired breast deformities, such as tubular breasts, Poland's Syndrome, breast asymmetry, breast ptosis or sagging, and finally for breast reconstruction after breast cancer surgery.
At what age do women get breast implants?
According to the American Society of Plastic Surgeons (ASPS), the average age of women who undergo breast augmentation with implants is between 19 to 34. Their reason for choosing breast implants is either because their breasts never matured to a full size during adolescence, or they lost their breast volume after pregnancy, or weight loss.
What are saline breast implants made of?
The saline breast implants most commonly used in Beverly Hills and Los Angeles are manufactured by Mentor or Inamed/ Allergan Corporations. These breast implants are considered FDA-regulated medical prostheses, which are made of a silicone shell and filled with a sterile saline (saltwater) solution by the plastic surgeon after insertion into the breast.
What are the costs of saline and silicone breast implants?
Breast implants are restricted medical devices that are not for sale to the public. Saline breast implants cost approximately $1,500 to $2,500 for a pair, depending on their texture, shape, and profile. Silicone breast implants are usually at least $2,000 more expensive than saline breast implants. This translates into an overall cost of $5,300 to $8,000 for saline implant breast augmentation surgery, depending on if you have it done in Los Angeles or Beverly Hills. This price usually includes the costs of the surgery facility fee, anesthesiologist's fee, surgeon's fee, implants and warranties, and follow-ups. It does not include financing or credit card fees, nor the cost of revision surgery.
What is the difference between smooth and textured breast implants?
Textured breast implants are made from the same material as smooth implants, with the exception that they have a rough surface. Scientific studies in plastic surgery medical literature have demonstrated that textured implants are less likely to get hard. This is caused by formation of a thick scar capsule. The disadvantage of textured implants is that they might be more palpable and may cause more rippling (wrinkles). This means that you might be able to see and feel the boundaries and irregularities of a textured implant more than that of a smooth implant. Because submuscular placement of implants reduces the risk of capsular contracture of smooth implants to nearly that of the textured implants, I often use smooth implants in the submuscular pocket in order to minimize the risks of capsular contraction as well as rippling. In patients who have had a history of capsular contracture, I would instead use textured implants in the submuscular pocket.
What is the difference between round and anatomic ("teardrop") implants?
Anatomic implants are usually narrower and longer. Their projection peaks not at the center of the implant, but towards the bottom of the implant. Esthetically speaking, a woman who has had children, breastfed, or has lost breast fullness in the superior aspect of her breasts would benefit from a round implant that compensates for this loss of fullness superiorly. On the other hand, a very thin woman who does not have sagging breasts will have less superior breast fullness with a teardrop implant. In addition, anatomic implants are more challenging to place, and run the risk of turning onto their sides (which will make one of your breasts look like a horizontal loaf of bread). MRI radiographic comparisons of round and teardrop implants in women that are standing do not demonstrate any significant difference between their shape and appearances.
Who would benefit most from high profile breast implants?
Standard breast implants are round and have low to moderate profile. Women who want very large and protruding breasts, but have small and narrow chests, would benefit from high profile implants because they have a relatively small diameter but a much higher profile than standard implants. In certain types of cases, when breast augmentation is combined with a breast lift or reconstruction, high profile implants might also be of advantage.
How small or how big of a breast implant can I get?
You can have a saline-filled breast implant as little as 120 cc or as big as 850 cc. If you are a small size, the 120 cc implant would make you a size A, and the 850 cc implant would make you DD. The size of the breast implant is not the only determining factor in your bra size; obviously it also depends on the size of your existing breast tissue. As the size of breast implants increase, their width increases relatively faster than their projection. Therefore, the larger the implant size you choose, the wider the breast implants will be. While larger or wider implants create a strong cleaveage, there is a limit on how large of an implant can fit on your chest. Your plastic surgeon will make a chest wall measurement and most likely recommend a range of breast implant sizes that you can choose from. In my practice, I have the patients try on different size breast implants in order to see how it looks on their figure.
What happens if a saline breast implant ruptures, leaks, or deflates?
Unlike a silicone breast implant, the content of a saline breast implant is strictly a saltwater solution. Unlike silicone implants, leakage of saline implants results in a relatively rapid and noticeable reduction in the breast size. Therefore, it is easy to know that your saline implant has ruptured. The released saline is harmless and is excreted from your body through urine. On the other hand, leaked silicone accumulates in the breast tissue without any noticeable change in the breast size. This makes it difficult to detect leakage.
Do breasts implants come with a warranty?
Both saline and silicone breasts implants that are manufactured in the United States come with a warranty. Mentor breast implants have a standard five-year warranty, with an additional five-year purchasable option. Allergan breast implants come with a standard 10-year warranty, which covers the implant and pays $1,200 towards the surgery cost.
Is it better to have the implant placed under or over the muscle?
Numerous national studies have pointed out the benefits of submuscular placement with respect to a lower rate of capsular contracture, rippling, and sagging. Some plastic surgeons do prefer subglandular breast implant placement because the implant settles faster and therefore reaches its natural shape sooner.
Which incision is best for placement of breast implants?
Breast implants can be inserted via several routes: axillary (arm pit), periareolar (by the nipple), inframammary (breast fold), and transumbilical (belly button). In general, periareolar and inframammary approaches result in the best symmetry and the strongest cleavage. The axillary and transumbilical routes provide no visible scars on the breasts. The nature of the scar can be very minimal with all of these approaches depending on the surgeon's experience. The transumbilical route (TUBA) is controversial due to the higher risk of complications. There could be a higher chance of loss of nipple sensation with the periareolar approach if the areola is too small and the surgeon is not familiar with this approach.
Are there adjustable breast implants?
Yes, there are implants designed for adjustment after placement. These implants are not usually used for cosmetic breast enlargement; rather as a temporary implant during expansion of breast skin for breast cancer reconstruction surgery. The implant is filled via a small port which is implanted under the skin of the outer chest wall. The size of this breast implant port is that of a watch.
What is the chance of loss of nipple sensation with breast enlargement?
Depending on the surgeon's technique, the incidence of loss of nipple sensation varies significantly. Periareolar incisions can potentially interfere with the nipple sensation if the diameter of the areola is too small. In my hands, the risk of complete loss of nipple sensation with the periareolar approach is about five percent, while there is a 15 percent chance of partial loss of nipple sensation. All other approaches for breast augmentation also carry a five to 15 percent chance of loss of nipple sensation.
What determines the extent of the cleavage with breast augmentation?
Breast cleavage is considered one of the most visible and attractive esthetic features of breasts. Reviewing many before and after pictures of breast augmentation from plastic surgeons throughout Beverly Hills, Los Angeles, and Southern California, it always amazes me to see the lack of a strong cleavage in these pictures. Why is that? Insertion of a breast implant via the periareolar or inframammary approach ensures precise placement and strong, beautiful cleavage, which usually cannot be achieved via the axillary or transumbilical approach. The second most important factor is the size of the implant; larger implants are wider and result in stronger cleavage. Choosing an optimal implant size is a very crucial decision, which involves close-decision making between you and your plastic surgeon. Finally, the basic shape of your breasts, chest, and possible existence of chest wall deformities or concavities can affect the extent of cleavage.
Can inverted nipples be corrected with breast augmentation using implants?
If an inverted nipple can protrude with rubbing, excitation, or heat, the chances are that the placement of an implant can push out the nipples. Otherwise, the inverted nipples can be corrected by surgical means, either during or after breast augmentation.
What activities can possibly cause breast implants to rupture?Saline breast implants are not designed to deflate when exposed to much force, trauma, or with squeezing. I have had patients with breast implants that were kick boxers, gymnasts, athletes, and bodybuilders. None of these women ever experienced implant rupture or deflation. Saline breast implant rupture is not caused by blunt trauma or squeezing, but rather by the formation of small cracks in the implant wall at the site of wrinkles or folds. To minimize this, manufacturers direct the plastic surgeon to "over-inflate" saline breast implants. Squeezing of breasts during mammography does not harm the breast implants. Placement of the implants via a transumbilical approach (TUBA) can potentially harm breast implants. Finally, closed capsulotomy, a maneuver that is designed to break the breast implant-scarred capsule, can also weaken or rupture the implant shell. The ASPS advises against closed capsulotomy.
What are the most common reasons for breast implant removal or exchange?
The most common reason for undergoing breast augmentation revision and exchange of breast implants is dissatisfaction with breast size (37 percent)! In most such cases, women want to go bigger. In order to avoid this expensive misfortune, I usually have my patients try on breast implants of different sizes prior to breast augmentation in order to get a good feel of how the implant is going to look on them. The second most prevalent reason for implant removal or exchange is implant leakage, and the third is capsular contracture or hardening of the breast implants. Despite this, there are steps that each plastic surgeon can take to help minimize such risks and complications.
What are the potential risks & complications of breast augmentation with saline breast implants?
Every surgery carries potential risks and complications. Although the rate of these complications is usually very low, nevertheless, they can happen. The potential risks and complications associated with breast augmentation using saline breast implants include: infection, hematoma, seroma, chronic pain, scarring, capsular contracture, skin wrinkling or rippling, alteration or loss of nipple sensation, implant displacement and tissue stretching, asymmetry, symmastia, bottoming out of breasts, implant rupture, implant extrusion or tissue necrosis, damage to deeper structures, inability to breastfeed, change in the ability to detect breast masses on a breast exam or mammogram, and a delay in wound healing.
Are small breast implants safer than large ones?
Although there is a basic rate of complications for breast augmentation with all breast implants, there is a slight higher risk of complications associated with very large breast implants. For instance, very large implants tend to stretch the breast skin and sag more, thus increasing the need for future breast lift procedures. Because they tend to stretch and thin out the breast skin, breast implant ripples or irregularities become more visible. Finally, they have a slightly higher chance of becoming displaced over time. This becomes a dilemma when considering that the most common reason for revision surgery is to go to bigger! To solve this, I recommend that you try on the implants prior to surgery, and to choose an implant that looks proportionate with your figure. Furthermore, if you have extensive breast sagging or poor skin elasticity, you should avoid going too large.
During consultation with Dr. Sean Younai, he usually reviews your treatment options for breast augmentation and enlargement with breast implants, including pros and cons of each technique, potential risks and complications, recovery course, pre- and post-operative instructions, and esthetic outcomes. You will also have an opportunity to "try on" different types of saline or silicone breast implants in order to see which one looks the best on you. There are also many before and after pictures and high resolution images of breast augmentation available in our photo gallery.
Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern and Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.