On June 3, 2008, the first Three Dimensional Breast Surgical Simulator in Arizona
began operation at Dr. Nachbar's office in Scottsdale, Arizona.
Check out this demo, and call to schedule your consultation!
Breast enlargement, or augmentation, has been done since the 1960s,
and an estimated one to two million women have had breast augmentation with silicone
or saline breast implants.
Breast augmentation, when done for breasts which have developed normally and
are similar in size, is cosmetic surgery. It is especially beneficial for
women who feel self conscious about the size of their breasts. These women are
often embarrassed to be seen in a bathing suit or in summer clothes.
Often they have trouble finding clothes that fit both the upper and lower body.
Enlargement of the breasts to a more natural size and shape can greatly improve
their self esteem, and allow them to enjoy life without feeling self conscious.
Women who have developed loss of breast tissue following pregnancy will often
benefit from breast augmentation, which can restore lost breast volume,
and reduce the sagging that can occur after pregnancy and/or breast feeding.
Generally, for this to work, the nipple and areola (colored skin
around the nipple) should be at or above the fold under the breast. Other factors
to consider include whether the fold under the breast is elevated (and therefore
might be lowered) and the firmness of the breast tissue and skin. For more severe
sagging, a breast lift can be done, either with or without augmentation.
Pregnancy also often results in stretching of the abdominal area, and women may benefit from
abdominoplasty, liposuction, and/or thigh lifting at the same time as the breast surgery.
We call this combination of procedures the "Post-Baby Tune-Up®".
Women with one breast smaller than the other can have a larger implant placed
on the smaller side, thus reducing the asymmetry.
The procedure is generally done on an outpatient basis
under general anesthesia (with the patient completely asleep), although some physicians,
especially in private offices, do not put the patient completely asleep. In Arizona,
a special facility license is required for general anesthesia, and those physicians
who do not have that license will attempt the surgery with the patient "almost" asleep.
It is widely agreed that general anesthesia (with the patient completely asleep)
is much safer than deep levels of sedation without airway control.
Some surgeons who are not certified by the American Board of Plastic Surgery and who are not
permitted to do breast augmentations in the hospital will try to do the surgery in their office
instead. If you are considering using a surgeon who is planning to do the surgery in his office,
make sure that the reason is not that he is not premitted to do it in the hospital. Ask him for
the name of a hospital where he is permitted to do breast augmentation (not just surgery in
another specialty) and check with the medical staff office of the hospital that he actually
has privileges to do breast augmentation there.
After the patient is asleep, a small incision is made and the pocket is developed
for the implant. This is a crucial step, for the pocket must be precisely positioned
for the implant to have the correct position once healing is complete.
The implant is then put into place. A saline implant is filled after it is positioned.
By filling the implant after placing it in the pocket, the surgeon can use a smaller
opening, and therefore there will be a smaller scar. For a silicone gel implant, the implant
must be inserted already filled by the factory, so a somewhat larger incision (and thus scar)
is required for the insertion of a silicone gel filled implant compared with a saline
Both saline-filled and silicone gel-filled breast implants are used for
Saline-filled implants consist
of a silicone rubber shell that is filled with a saline (salt water) solution.
The saline is the same fluid that constitutes the majority of your body water.
Should the implant ever break, the saline would easily be absorbed by
the body and be excreted in the urine without problem. Women who might be concerned about
silicone gel may be comforted by the fact that these implants contain salt water.
Silicone gel breast implants were the most popular type before the early 1990's.
These also consist of silicone rubber on the outside, but the inside contains a
semi-solid gel of silicone. The gel has the consistency of molasses.
It is, however, not water soluble. Concerns were raised in the early 1990's that
patients with these silicone gel implants might develop systemic diseases (like lupus
or arthritis), but several carefully conducted studies have demonstated no difference
in the incidence of these diseases in women with and without silicone gel implants.
Modern silicone gel implants contain a "cohesive" type of silicone gel. If cut, this material
does not run out, but acts like a "gummy bear".
Silicone gel implants have been subject to a great deal of scrutiny and research during the
1990's and 2000's, and on November 17, 2007, they were again released for use in breast augmentation.
More details about silicone gel-filled breast implants are available here.
Another type of implant, filled with soybean oil, has been used to facilitate mammograms,
since the mammogram can see through oil but not water. However, due to concerns about
the stability of the oil over time, these implants have been recalled, and any woman
will oil-filled implants is urged to contact her physician to consider removal of the
oil-filled implants. Dr. Nachbar has never used oil-filled implants.
The implant used can have a smooth surface or a textured (rough) surface.
The texturing was originally introduced in silicone gel implants to reduce the
incidence of capsular contracture around the implant. A smooth implant will settle into the
breast more quickly and easily than a
textured implant, and may be less likely to show wrinkling.
A specialized type of textured implant is the "Anatomical" or "Teardrop" implant.
These implants are not round, and must be textured to keep them from turning the wrong
way in the pocket. These implants have a width that is different from the height,
and may be helpful in special situations. However, the final shape of the breast
is determined by the breast and muscle tissue, rather than the implant, which
is not strong enough to hold against the force of the tissue.
The implants can be inserted through incisions under the breast, underneath
the areola (the dark skin around the nipple), in the axilla (armpit), or
through the umbilicus (belly button). While all of the incisions heal fairly well,
the incision under the breast is the most easily hidden, and allows the best
access to the implant cavity.
A scar in the axilla is an exposed area in bathing suits
or evening wear, and positioning an implant through this incision is less precise than
through incisions on the the breast. Nonetheless, for a woman who wants to avoid
an incision on the breast, the axillary incision can work quite well.
The incision around the areola is up front, the scar is often lighter than the
surrounding skin, and nipple sensation and breast feeding are more likely to be affected by this
incision. This is true because, unlike the other incisions, surgery through the
incision around the areola goes through the breast itself, rather than around the breast.
Insertion through the umbilicus makes it hard to position the implant
accurately, generally allows placement only above the muscle, and puts
significant stress on the implant. Few Board Certified Plastic Surgeons insert
the implant through the umbilicus.
Dr. Nachbar can place the implant through any of
these incisions (except the umbilicus incision), but most often uses a 3.5 centimeter
(just under 1 1/2 inch) incision under the breast. Of course, a somewhat larger incision
will be required for a silicone gel-filled implant.
The implant can be inserted under the breast alone, or at a deeper plane, under both the
breast and the Pectoralis Major Muscle. An implant placed under the breast has less tissue
covering it, and so may be more visible than an implant placed more deeply; wrinkles in the
implant may be more visible as well.
All implants block the view of some of the breast tissue on mammogram, and a
more superficial implant may block more of the breast tissue.
An implant placed under the muscle will tend to look higher, since the
muscle will push down on the implant, holding it up; this may
produce a less natural shape, although it does improve significantly over the
first weeks and months following surgery. An implant placed
under the breast (above the muscle) will "settle" into the breast more quickly,
giving a more natural shape,
especially early on. However, like a normal larger breast, the breast will probably develop
drooping more quickly as the breast tissue and implant pull on the breast skin, stretching it.
After surgery, the patient goes home in an elastic wrap. After the first day,
the wrap may be removed, and either a loose elastic sports bra, the original elastic
wrap, or a light shirt may be worn, at the patients preference. In any case, the bra
or wrap should not be tight or push upward on the breast. Showering is permitted, and
clean tap water may run over the incision, but soaking the incision
(in a bathtub or pool, for instance) is not permitted.
Initial discomfort is controlled with oral medication.
Absorbable sutures are used; a portion of the suture is usually removed 14 days
Activity can be resumed as tolerated. Most patients can resume light activity in
a few days, and often are back at work within a week. Activity can be slowly
advanced, but care should be taken to avoid excessive force or blood pressure
elevations for 4 to 6 weeks. Aerobic exercise will raise your blood pressure,
which could cause late bleeding and harm your result. Use common sense: start slowly,
and if it hurts, stop.
A loose sports bra can be worn during the first 4 weeks, if desired, but Dr. Nachbar
asks you not to wear a bra with an underwire (which can put pressure on the
incision under the breast) for 4 weeks following surgery when that incision is used.
Additionally, no bra should push upward on the breast until the patient is satisified
with the settling of the implant, which may be as long as six to nine months following surgery.
As with any healing area, exposure to sunlight should be avoided, as it will
cause darkening of the skin. Sunlight can even pass through a bathing suit, so
sunscreen should be used on the scar. Scars take at least one year to fade completely,
depending on your skin type. If some areas of the breast have reduced sensitivity,
be careful, as you may not feeling sunburn developing.
You may resume driving when driving does not cause pain. This usually occurs in
4-6 days if you have a car with power steering. Again, common sense dictates that you
not drive until you are in complete control of your vehicle.
If the implants are placed under the muscle, the muscle will push them upward after the
surgery is complete. By the next day, the implants will look quite high. They then begin
the process of settling, which continues for many months, sometimes for up to a year.
During the first week, the very beginning stages of settling occur, just enough to let
you know that it is happening. During this time, the breasts look good in clothing, but
may look strange without clothing, or in a bathing suit. Usually after about four weeks, they
have settled enough to look good in a bathing suit. After about three months, they usually
have a good appearance, but if the breast tissue was soft and beginning to sag before
surgery, it may be six to twelve months before the appearance is maximized.
All surgical procedures have some degree of risk. Minor complications that do not affect
the outcome occur occasionally. Major complications are unusual.
However, you should expect that the implants will not last as long as you do, and that
they will need to be replaced at some point. Generally, the same
scar that was used for placing the implants
can be used for the replacement surgery. When saline implants fail, the saline
leaks out and is absorbed by the body, resulting in a reduction in breast size that can
occur in a matter of hours, or may take weeks or even months. While no one can say how long the
implants will last in any individual,
the best information available to date suggests that
8.9% of women will have one implant fail in the first four years (meaning that 91% will
have the implants last longer than four years.
The major implant manufacturers provide a limited warrantee, a copy of which should
be available from your surgeon. Currently, both Allergan and Mentor offer both lifetime replacement and, if
the implant fails in the first 10 years, will pay up to $1200 of your other costs of
replacement. Since they do not charge $1200 for a pair of saline implants, clearly they feel that
most of their implants will last at least ten years.
Silicone gel implants have some other issues you should be aware of if you are considering
using them. More information about silicone gel implants is available here.
There has been only one
comprehensive national survey on satisfaction following breast augmentation.
This survey found that 93% of the
women were satisfied with the results of their implant surgery, and 96% said they
would definitely or probably choose to have the surgery again. These results make
breast implant surgery among the most successful surgeries done today.
This information is provided for general information only.
Please consult with your local Plastic Surgeon for specific information
about your own situation. I recommend that you see a Plastic Surgeon
certified by the American Board of Plastic Surgery. In the United States
and Canada, call 800/635-0635 or 888/4PLASTIC for the names of board-certified Plastic
Surgeons in your area.