choices choices choices help!

Dr. Greenberg did a breast fellowship after her training at Stanford and has published on breast implant surgery. She strongly recommends you meet with a board certified plastic surgeon to help you sift through all of these choices. Her aesthetic is all about natural look and feel.

What are the choices?

ROUND or SHAPED (anatomic)
PROFILE. There are many different profiles of implant within “round” or “shaped.”
- In round we now have 5 profiles: super low profile, low profile, medium profile, high profile, and super high profile. These vary in width and projection, which gives a different look.
- For shaped implants we have different heights and projections.
SIZE
SILICONE GEL or SALINE
- In silicone implants you can now also choose the cohesiveness of the fill
TEXTURED or SMOOTH SHELL
IN FRONT OF or BEHIND THE MUSCLE
INCISION SITE

As an extensively trained plastic surgeon, Dr. Greenberg will help you pick a shape and profile once I have seen your anatomy, know the volume you choose when trying on breast sizing implants, and understand how you want your breasts to look and feel. This is part of why she meets with you directly for your consultation. She will have you try on sizing implants to see what the change would look like. She uses 3D Vectra imaging so you can get a picture of what your result may look like.

There are pros and cons to many of these issues, and Dr. Greenberg will go over all of these at your consultation. Dr. Greenberg believes in science, and is constantly updating and improving her practices. She has written over 600 blogs. Many of these topics are covered in some of her breast augmentation blogs as well.

saline vs. silicone implants

SALINE BREAST IMPLANTS:

Saline implants are frequently placed behind the muscle and give a natural look. Other benefits are they have lower risk of implant hardening, equal risk of deflation (and if it leaks it is just salt water), and smaller scar.
The negative to saline is wrinkling or rippling, particularly with lower profile implants, and the feel is not as natural. There are tricks we use to minimize this, but it can be an issue for women with thin tissue.

SILICONE GEL BREAST IMPLANTS: were reintroduced in November 2006 for breast augmentation patients. Silicone implants never fully left the market. They restricted our use to patients who qualified for a study, for which I was a member of Inamed and Mentor.

The gel implants I use are the newest third generation of “cohesive gel” implants. The benefit of silicone implants is the feel. They look the same as saline implants. But when you feel the breast, particularly in a thin patient with little natural breast tissue, silicone implants feel more like fat and natural breast tissue.
The true downside is a higher risk of capsular contracture, or “turning hard.”

As for how to choose, the look of saline and gel is similar. The difference is in the feel. Some women do not like the idea of silicone in their body. I understand, and for these women saline implants are better. For others, they need the breast to feel as “real” as possible, so gels may be a better choice. Again, I find silicone implants particularly useful for breast enhancement in thin patients, as thin patients have higher risk for palpable rippling with a saline implant.

This is a difficult decision for most patients. For additional information please see: www.natrelle.com/breast_augmentation.aspx and www.mentorcorp.com.

implant size

I like you to have a ballpark idea of cup size, but I find trying on sizing implants the most accurate way to choose the appropriate volume. You will try on sizing implants in my office, and the 3D Vectra photo imaging lets you see the potential results as well.

I urge you not to focus on a certain cup size. There is no standard for bra sizing. What is a 34C in one company, is not in another. What you think is a 34C may not be .
Focus on liking what you see in the mirror with the sizers.
I recommend you get used to seeing yourself with breasts. Many women have an initial shock when they see themselves with breasts. To help you pick a more accurate size and avoid the “I wish I would have gone a little bit bigger” phenomenon, stuff your bra for a while before surgery. Padding your bra, inserts, the rice test: all are good ways to test out the new size.
Think about these questions: Are you comfortable? How do you feel in your workout gear? work wear? picking up the kids? going for a run? out on a Saturday night?

Bring in form fitting tops to try on the sizers. High crew necked shirts in light colors or a tight fitting turtleneck will make you look the largest. You need to be comfortable in all your clothes.

At home the RICE TEST is also helpful. The blog here shows you the conversion of rice to cc’s.

implant shape

There are two basic shapes of implant: round or anatomic.

ROUND: are the traditional implants, which still are the most used implant. They come in different profiles, widths, and projections. Round implants give a natural look and because there is no orientation “up” or “down,” they have movement in the pocket which gives them a very natural bounce and feel.

SHAPED: Also known as “teardrop” or “anatomic.” These are textured shaped implants. The media has liked the term “gummy bear” implant. (The true gummy bear is a more cohesive gel implant, the style 410, which is a shaped, form-stable implant.) Originally these implants were conceived to make the breast implant look more like a natural breast, though many studies have shown there is no shape advantage.

I did use this style for very specific patients- those with very thin tissue cover and certain ribcage shapes. Then a rare cancer called ALCL was associated with textured implants. Allergan has removed their product from the market, so the style 410 is no longer available. The other brands Sientra and Mentor still have textured shaped implants on the market. I will review all of this with you at your consultation.

The style has benefits of less rippling, more shape (particularly for super thin patients or breast cancer patients), and less mobility, which is good for some ribcage shapes.
There are some negatives, such as size of incision, lack of movement, and firmness of implant.
Textured implants have been associated with the rare ALCL cancer. See the blogs on the subject HERE.

Again, we review this during your consultation process, where you can actually feel the different implants.

implant profile

There are many different profiles of implant within “round” or “shaped.” Within each of these categories, there are different choices for the same volume. In round we now have 5 profiles: super low profile, low profile, medium profile, high profile, and super high profile. These vary in width and projection, which gives a different look. For shaped implants we have different heights and projections. I will help you pick a shape and profile once I have seen your anatomy, know the volume you choose when trying on breast sizing implants, and understand how you want your breasts to look and feel.

capsular contracture & biofilm

One of the biggest negatives to implants is if they turn hard. If they do, it can be uncomfortable, look rigid and round, and cause asymmetry with your other breast. If your breast feels hard after implants it is not the implant. What happens is the capsule around the implant has thickened or contracted.

Whenever you put something foreign into your body, your body walls it off with a layer of scar tissue. This is a capsule. It does not exist right now. It forms as a reaction to your implant. Why would the capsule turn hard? There are many theories for why this happens, but the two leading theories are inflammation or a low grade infection called biofilm.

I believe in this, and I go to great lengths to minimize this risk. How the implant is prepared, skin prep, antibiotic use, incision placement, placement behind the muscle, use of the Keller Funnel® for inserting the implant, a “no touch” technique– all contribute to the health of your implant and minimizing your contracture risk. I will review all of this at your visit.

I also believe women who feel bad from their implants, what is called BII/Breast implant illness, and then feel better when they are removed, it may be you are treating the biofilm. It is important to be mindful of technique to avoid issues.

Breast Implants