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?
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 BREAST IMPLANTS:
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.
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.
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.
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.
“They are absolutely perfect. I feel so much more comfortable, confident and beautiful and now it all beams through my body language.” – B.B., San FranciscoView More Testimonials*Individual results may vary
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.
Again, we review this during your consultation process, where you can actually feel the different implants.
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.
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.
WHAT IS THE VOLUME (IN CC) OF A CUP SIZE?
HOW MUCH WEIGHT WILL I GAIN WITH BREAST IMPLANTS?
DO BREAST IMPLANTS CHANGE THE VOLUME OF YOUR BREAST TISSUE?
WHAT KIND OF BREAST IMPLANT IS RIGHT FOR ME?
WHICH IMPLANTS ARE USED MORE OFTEN FOR BREAST AUGMENTATION: SILICONE GEL OR SALINE?
Implants are not lifetime devices. Let me just repeat that- you will need to replace your implant at some point.
Silicone gel implants should be replaced every 10-15 years. After that point there is an increased risk of silicone leakage. Leaking could be anything from silicone gel bleed to a ruptured shell. If a silicone implant has leaked, breathe. Your body has formed scar tissue around the implant, which we call a capsule. In most cases the capsule will capture the silicone, so none extends beyond the capsule.
Saline implants do not need to be replaced until there is an issue. As it is evident when a saline breast implant leaks (it gets smaller as the saline is absorbed by your body), you can wait until there is an issue. If you have an older implant which is still going (and I do have patients with 20 year old saline implants which are still going strong), you can decide to replace it before you have an issue.
Warranty varies by brand, when did you do the augmentation (warranties have changed over the years), and did you buy extended coverage. In the past, the warranty did not cover capsular contracture at all. Now the warranty may cover capsular contracture for silicone implants and new implant. See my blog on what the warranty is BREAST IMPLANT WARRANTY
Saline implant leakage is obvious. The implant will reduce in size as the saline leaks out.
Silicone implants are trickier. There is a thing “a silent rupture,” where the silicone implant is not intact, but you don’t know it. When a silicone implant leaks, it can be anything from silicone bleed (where the shell of the implant feels greasy) to a tear in the implant shell and silicone leaking out.
It is silent because your body created a scar envelope around the breast implant which we call a capsule. All implants have a capsule. If the capsule is thin and flimsy, you can’t feel it. If the capsule is thickened or tight, that is what causes a “hard implant” which is really capsular contracture. So when the implant leaks it is caught by the capsule, so you may not notice much of a shape change.
We started doing ultrasounds in our clinic for this reason. We do an in office ultrasound- no pain, no radiation, non invasive- to see if the shell looks disrupted. The cost is nominal and applied to surgery cost if you need to replace your implant.
Alternatively, you can do an MRI to look for implant rupture.
After 5 years you should do it every couple years. For sure after 10 years. I have started to have patients come in with implants that are older than 15 years old and many of them are ruptured- they look great, they are soft, but they are leaking.