Breast enlargement or enhancement by implants, and more recently fat grafting, is the most popular of all cosmetic surgical procedures. Last year over 300,000 women in the U.S. had breast implant surgery, and the procedure has nearly tripled in popularity since the year 2000. The reasons for this dramatic increase are many but improvements in implant biomaterial, advances in operative and anesthesia techniques, and overall patient comfort and safety have resulted in more natural and balanced results with long-term patient safety and high satisfaction levels.
The good news is that when performed by an appropriately-trained and credentialed plastic surgeon in a regulated operative facility, the high patient satisfaction rates and safety have proven in clinical studies to significantly improve patient self-confidence and quality of life. Unfortunately, when the above criteria and considerations are not followed, complications and costly long-term problems can occur which may not be entirely correctable. At evolv Plastic Surgery, Dr. Frank Barone believes strongly in the benefits and safety of comprehensive patient education and the importance of making informed choices when it comes to any cosmetic or plastic surgical or non-surgical procedure. The fact is that the most informed patients generally make the best choices. https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/questions
Because there are so many choices in any elective aesthetic or cosmetic procedure, and especially in breast implant augmentation, we believe it is critical for any woman contemplating breast implant surgery to carefully review the following fundamental considerations.
Goals and Benefits
The goals of breast implant augmentation are consistent with the goals of every properly performed cosmetic or aesthetic procedure – to safely enhance or improve body contour and restore natural youthful features in order to increase self-confidence, enhance self-image and subsequently improve overall quality of life for each patient. Each patient’s motivation may vary but improving self-image and confidence is not simple vanity but is connected to our evolution and the human desire to improve appearance for ‘survival’ benefits. Like it or not, appearances matter, and multiple studies have consistently proven that naturally-appearing and enhanced, youthful features provide distinct advantages to quality of life.
Properly done aesthetic procedures should be balanced, safe and natural-appearing, but we have all seen poorly done cosmetic surgery in the news, that is far from ’natural appearing.’ This is especially true with breast augmentation. Patients and providers who do not respect this fundamental concept will often have unnatural and negative outcomes with the risks of increased complications, additional costs and detrimental long-term results.
What Breast Augmentation Can and Can’t Do
Breast implant augmentation can:
- safely improve fullness and projection to benefit overall female contour and balance
- help restore areas, such as the upper pole of the breast, that may have lost fullness after pregnancies or aging
- help correct imbalance or congenital and developmental asymmetries of the breasts
- help improve self-image and self-confidence when done properly and for the right reasons in each patient
Breast Augmentation cannot correct significant sagging or laxity of the breasts that may have occurred from weight loss, multiple pregnancies or aging. In these situations, a breast lift or mastopexy with or without implant or fat graft augmentation may be suggested by your plastic surgeon.
Costs – Price Shoppers Beware
The price of breast implant augmentation can vary widely depending upon:
- training, qualifications and experience of the surgeon
- location of the surgery (accredited outpatient facility vs doctor’s office operating room or clinic)
- type of anesthesia and qualifications of anesthesia provider (certified anesthesiologist vs less experienced staff)
- experience, training and qualifications of ancillary staff
- manufacturer, type and quality of breast implant
Surgery is expensive and affordability is a key concern for patients contemplating breast implant surgery; however, ‘price shopping’ can be very dangerous for many reasons including all the above considerations. The most proven and important consideration is the training and qualifications of the surgeon. Many consumers do not realize that any physician with a medical license can legally perform breast implant surgery, as well as any cosmetic surgical procedure, in their own clinic or office even if they have not had credentialed training in that surgery or specialty. Savvy marketing and advertising or attention grabbing ‘deals’ can be difficult to resist for many patients who have limited resources to afford the procedure. When these ‘bargains’ are carefully analyzed, there is always a reason why the price is considerably lower, and it is no coincidence that these are the situations where more complications and re-operations occur. It can be very costly to repair complications, and often results are compromised. In the words of the world’s greatest investor Warren Buffet, ‘Price is what you pay….value is what you get.’
A variety of implant styles, shapes and types are available. The quality, safety and performance of breast implants has dramatically improved in recent years as have patient outcomes. All breast implants in the United States must undergo long term and rigorous testing as well as clinical studies to obtain FDA approval, and constant monitoring is done annually. Some of the considerations in implant choices are:
Fill – Implants may either be filled with either sterile saline (salt water) or silicone gel. Both have been thoroughly studied and fully approved by the FDA. Gel is more popular due to its natural ’tissue like’ feel, but a discussion with your plastic surgeon will help determine which option is best for each patient’s goals and concerns. Recently a form stable gel, often referred to as the ‘gummy bear’ implant, has been approved and has the advantage of holding its shape in anatomic or ’tear drop’ styles and avoiding the chance of leakage.
Shape – Breast implants are available in a round or anatomic (tear drop) shape. Each has a particular advantage, and these options should be reviewed with your surgeon. Many choices in implant dimensions such as width, heath and projection are also important features in choosing the most appropriate device for each patient’s anatomy, goals and lifestyle.
Surface – Breast implant shells may be smooth or textured, and each choice has a potential advantage depending on the patient’s goals and interests. Textured surfaces may reduce the possibility of capsular contracture or excessive firmness of the tissue around the implant. A rare form of lymphoma called implant associated ALCL (anaplastic large cell lymphoma) has been recently reported in approximately 1:50,000 patients with textured implants. ALCL is usually cured by removal of the implant and the surrounding capsule, but this issue should be discussed with your surgeon if a textured device is preferred.
Risks and Safety
When performed by an experienced, board certified plastic surgeon in a properly credentialed facility, breast implant surgery has a very high (greater than 96%) satisfaction rate and is also safe and effective. But any procedure has risks, and these should be completely reviewed with the patient in the preoperative examination. A thorough physical examination and complete medical history are also an essential component of reducing risks and complications. Openly defining risks and benefits along with a comprehensive medical assessment and photographic documentation/imaging are important and integral parts of properly planned aesthetic surgery.
Being well informed and prepared for surgery will reduce anxiety and improve the overall experience. For the breast augmentation procedure, the plastic surgeon will discuss recommended anesthesia options, choice of incision location, location of implant placement (either below or above the chest wall muscle), implant type, volume and dimension, and expected postoperative course and recovery. At evolv Plastic Surgery, Dr. Barone often utilizes the Vectra 3-D, a 3-dimensional imaging system to help predict implant choices and results specific to each patient’s own anatomy and goals. The implant surgery typically takes less than 2 hours in the operating room.
Recovery and Down Time
After the surgery is completed, patients are dressed in a custom post-operative bra and taken to the recovery room. Because the anesthetic is light, recovery room time is usually less than one hour for most patients. Patient comfort is a priority at evolv Plastic Surgery and precise and less traumatic dissection techniques, headlight illumination, prevention of bleeding and long-acting nerve blocks (Exparel) and post-operative lymphatic massage all play an integral part in minimizing discomfort and downtime and improving the overall experience for our patients. Each patient will be given specific instructions and advice on resuming activities and return to work.
The Most Important Decision – Choosing a Plastic Surgeon
Breast Augmentation surgery involves many choices. Studies confirm that the first and most important choice is selecting a qualified plastic surgeon that you can trust and who is a member of the American Society of Plastic Surgery as well as board certified in Plastic Surgery by the American College of Surgeons. As members, these surgeons must meet the following rigorous standards:
- Board certification by the American Board of Plastic Surgery (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada
- Complete at least six years of surgical training following medical school, with a minimum of three years of plastic surgery residency training
- Pass comprehensive oral and written exams
- Graduate from an accredited medical school
- Complete continuing medical education, including patient safety, each year
- Perform surgery in accredited, state-licensed or Medicare-certified surgical facilities
Be wary and cautious of other ‘official’ sounding boards and certifications or by the term ‘board certified’ if it is in another specialty.
The decision to have breast augmentation surgery is a highly personal one, as is any aesthetic surgery or procedure. Any woman considering breast implant surgery should carefully evaluate their options, take appropriate time to learn as much as possible from reliable sources, and take their time in making a well-informed decision. The most important decision is choosing an experienced and board-certified plastic surgeon. Despite the excellent safety and high satisfaction rates in breast implant procedures, it is still a significant surgical procedure and one that can have higher risks and complications if done by a less experienced or non-specialty trained physician in an unregulated clinic or office procedure room. Aggressive internet marketing and advertising that attracts patient candidates with considerably lower price offers and unrealistic outcomes are not only unethical but dangerous.
Trust is the most important criteria in the doctor-patient relationship and must be earned with honest communication, transparency and dedication to specialty training and ongoing education. If you are interested in more information or would like to learn more about the many facets and options in breast implant augmentation, please contact Dr Barone at evolv Plastic Surgery and Medical Aesthetics.
Thank you for your attention and interest!