Wishing for larger, natural-looking breasts?

Perhaps no other area of a woman's body affects her sense of femininity more than her breasts. If you have often wished for fuller, more beautiful breasts, you're not alone. Breast augmentation is now the most popular cosmetic surgery procedure in the U.S. In 2007 alone, 399,440 women chose to enhance their breasts with silicone gel or saline implants.

What can breast augmentation do?

Breast implant surgery can do more than simply enlarge your breasts. This surgery, medically termed augmentation mammoplasty, can also help:

• Balance your breasts if they are unequal in shape or size
• Add firmness if your breasts have lost volume. (If you also have sagging, breast augmentation can be combined with a breast lift.)
• Bring your upper body into better proportion to your
  lower body

Breast implant surgery involves many choices

Once you've decided to have breast augmentation, there are many more decisions to make—but probably the most important is choosing a board-certified plastic surgeon with extensive experience in breast implant surgery.

Dr. Rappaport has performed hundreds of breast augmentation procedures and is widely recognized for producing beautiful, natural-looking results. During your personal consultation, he will evaluate you, explain the breast augmentation procedure, answer your questions and offer recommendations to give you the fuller, more beautiful breasts you desire.

What choices are involved in
breast implant surgery?

Which size implant is right for you?

Breast implant sizes are measured in cubic centimeters, or cc's, and range from 125 to 700 cc's. A given implant size does not correspond to a particular bra cup size. During your consultation, Dr. Rappaport will recommend a range of implant sizes in proportion to the width of your chest and the amount of breast tissue you have. You will then have the opportunity to “try on” different implant sizes to see how they will look on you.

“What's important is not the volume of the implant, but the selection of the base width,” Dr. Rappaport explains. “That's the key. Having a good measurement of your breasts' base width allows us to choose an implant size that will give you a well-shaped breast in proportion to your body. Then the determination becomes how much projection you wish to have.”

Do you prefer silicone gel or saline implants?

In November 2006, the U.S. Food and Drug Administration (FDA) lifted a 14-year restriction on silicone gel implants. Today many women prefer silicone gel implants because they look and feel more like natural breast tissue than saline implants.

Women with less natural breast tissue can develop visible “rippling” around the edges of a saline implant—especially if they choose a very large size. Choosing an implant size that's in good proportion to your chest and placing the implant under the chest muscle can help avoid rippling and palpability of the implant.

Saline implants require very small incisions, as they are placed in the breast before being filled. Silicone gel implants need longer incisions, as they are filled before being inserted.

What shape implants are best for you?

• Most women choose round implants, which sometimes produce greater fullness above the nipple than with natural breasts.
• Some women may choose a narrower, high-profile version of the round implant that creates more projection from the chest wall.
• Anatomical, or teardrop-shaped implants (also called contoured or shaped) are fuller at the bottom than at the top, like natural breasts. In the rare case when an anatomical implant rotates beneath the breast after surgery, it can affect the breast's appearance.

Should you choose smooth or textured implants?

The outer shell of breast implants is available with either a smooth or a textured surface.

• Smooth implants, which are more popular, may move slightly within the breast.
• Textured implants have an outer shell that feels like fine sandpaper. According to some studies, textured implants may help prevent capsular contracture, or hardening of the pocket around the implant. The rough texture promotes the body tissue's adherence to the implant surface. This may help prevent the implant from moving beneath the breast—especially important for anatomically shaped implants.

Where should the incisions be?

There are several techniques for placing breast implants:

• Near the inframammary crease. In this widely used technique, silicone gel or saline implants are inserted through incisions near the fold under the breasts. “This was the gold standard for years,” says Dr. Rappaport.
• Around the areola (periareolar). Silicone gel or saline implants can be placed through an incision around the edge of the areola—the dark tissue surrounding the nipple. “I tend to prefer this approach,” says Dr. Rappaport. “It's a bit more challenging, but it does not place a scar under the breast, so no scars will show, even in the most revealing bathing suit.”
• Axillary (in the armpit). Some women choose to have their implants placed through incisions in the armpit. “This approach has the advantage of not leaving any scars on the breast,” Dr. Rappaport explains.
• In or around the navel (transumbilical). This procedure—which can be performed only with saline implants—is often referred to as a transumbilical breast augmentation or TUBA. “The problem with this indirect approach is if there is post-operative bleeding or malposition, revisions would need to be made through an incision on the breasts,”
  says Dr. Rappaport.

Should the implants be placed above or below the
chest muscle?

After the incision is made, Dr. Rappaport creates a pocket or envelope in which the implant is inserted. This pocket can be:

• Directly behind the breast tissue (subglandular); or
• Below the pectoral muscle that underlies the breast tissue (submuscular).

“If I were to place the implant above the muscle, the patient would have to have an adequate amount of natural breast tissue to cover the implant,”
says Dr. Rappaport.

“Times have changed,” he says. “It used to be that we placed nearly 100% of implants above the muscle. Now the tendency is to place the implants below the muscle. One advantage of submuscular implant placement is that it allows more of the breast to be observed with a mammogram.

“Placing the implant under the muscle may also help reduce the chances of capsular contracture,” Dr. Rappaport explains. “If one believes that sub-clinical infection may be a cause of capsular contracture, then separating the implant from directly under the nipple and areola by the muscle may be an advantage.”

Are there minimum age requirements for
breast augmentation?

Yes. FDA guidelines require cosmetic breast augmentation patients to be:

• At least age 18 for saline implants
• At least age 22 for silicone gel implants

“It is also important for younger patients to have the emotional maturity needed to undergo breast enhancement,” says Dr. Rappaport.

How is breast augmentation performed?

Dr. Rappaport performs breast augmentation surgery on an outpatient basis using general anesthesia, so you will be asleep during the entire procedure. Surgery usually takes an hour. You will then recover in the surgical facility for about another hour before going home. You must have someone drive you home and stay with you for the first 24 hours.

How fast is the recuperation after
breast augmentation?

After surgery, you will be wearing a support wrap. You may experience mild discomfort which can be controlled by oral medication. Most patients are up and around on the evening of surgery. You will have a post-operative visit with Dr. Rappaport on the day after your surgery, at which time you will be placed in a support bra.

You can expect to return to work or school within a few days, and can safely resume light exercise in three weeks.

Dr. Rappaport answers questions about breast augmentation

Which type of implants do most of your
patients choose?

“Most of my patients choose silicone gel implants. During the consultation process, I counsel my patients on the distinctions between silicone gel and saline implants, and most are comfortable to go forward with silicone gel.”

Do most of your patients want to look like they've had breast implants?

“No. A good number of my patients are women who have had children and are trying to get back their pre-pregnancy shape, including the firmness of their breasts. I also have many younger women patients who are interested in natural-looking breast enhancement.

“Most of my patients don't want their breasts walking in the room before they do. I have a reputation for doing breast augmentation that's in proportion to a woman's size and shape. For the most natural-looking results, a woman's breast implants should not be too large for her torso.”

My breasts are uneven. Will breast implants help?

“If your breasts are uneven or asymmetrical, I will do what's necessary to give you a more balanced look. I may need to do a breast lift on one side or use a larger implant on one side than the other, for example. During your personal consultation, I will evaluate your breasts and recommend a treatment plan to make your breasts as even as possible.”

Will my breast implants interfere with
getting a mammogram?

“No, but when you go for your mammogram, be sure to tell the technician that you have implants. You will then have a diagnostic series as opposed to a screening mammogram.

“A special mammography method known as the Eklund technique makes it easier to visualize more of the breast tissue in women with implants. This technique is available at every accredited mammography facility in the U.S.”

What happens if an implant ruptures?

“Both silicone gel and saline implants are made with a thick shell to help prevent rupture—but ruptures can occur. One major difference between silicone gel and saline implants is what happens if they
do rupture.

“If a saline implant ruptures, you will know it. The implant will visibly deflate as the saline, or saltwater, is absorbed by the body. You will immediately see a loss in breast volume.

“Silicone gel implants can develop an unnoticeable or ‘silent’ rupture. Today's silicone gel implants have a more cohesive filling than prior generations of implants.

“The next available implants will have an even more cohesive gel like the inside of a jelly bean. If a rupture occurs, the gel is designed to remain intact.”

Are there any guarantees that my implants won't break or leak?

“There are no guarantees, but there are warranties available. Implants are engineered to withstand considerable pressure or impact. However, they are not lifetime devices. After your surgery, we will give you a serial number and warranty card from the manufacturer. You can also choose to purchase an extended warranty.”

How can I tell if a silicone gel implant has ruptured?

“In addition to your routine mammograms, the FDA recommends that you get an MRI screening three years after you have silicone implant surgery, and every two years thereafter to help detect
silent ruptures.

What is capsular contracture?

“It is normal for the body to form a lining or capsule around a breast implant. In some cases, that capsule will begin to tighten, which can result in discomfort or distortion of the breast. A surgical procedure can be performed to correct this situation if it occurs. In rare cases, the implants must be replaced or removed altogether. Following pre- and post-operative instructions can help reduce your risk of capsular contracture.”

What causes capsular contracture?

“The causes of capsular contracture are not fully understood. Some people believe capsular contracture is caused by sub-clinical infection or hematoma formation.

“Others believe it has to do with handedness—that is, whether you're right-handed or left-handed. But there is no conclusive evidence on what causes capsular contracture. The good news is that the incidence and degree of capsular contracture appears to be less in the latest generation of implants.”

Do implants need to be replaced every 10 years?

“No. Implants do not have an expiration date. But it is important to understand that they are not lifetime devices. Just like the car you drive today will not last forever, neither will your implants.”