Breast Augmentation in Fort Worth

Breast enhancement surgery patients sometimes ask about the safety of silicone gel implants due to lingering concerns generated by poor, biased reporting in the early 1990s. Silicone gel breast implants are the most studied medical device in history, and the FDA has repeatedly confirmed their safety. There has never been evidence linking silicone gel to breast cancer, autoimmune diseases (like lupus), or any other illness. Our practice uses these silicone gel implants during our breast implant surgery almost exclusively for cosmetic augmentation and universally in breast reconstruction patients after mastectomy.

Both are FDA approved for use in breast augmentation. Some similarities:

• Both add volume to the breast
• Both are available in various sizes, shapes, and textures
• Both have a silicone shell
• Surgical risks are similar

And some differences:

• Saline implants:
  • Cost less
  • Tend to be more firm, palpable
  • Have more visible rippling/wrinkling, especially in thin patients
  • Rupture is easy to identify (the saline is absorbed, and the breast looks flat/smaller)
• Silicone implants:
  • Cost more
  • Feel more natural Have less rippling/wrinkling
  • FDA label suggests use in patients 22 and older (although they are safe in younger patients)
  • FDA label recommends periodic MRI exams to check for implant rupture (rare)

Patients often focus on cup size when determining their desired result from their breast augmentation. However, breast implants are not sized by bra cup size. A breast implant with a given volume may give one woman a C cup and another woman a DD cup. This is because the final cup size depends on the starting breast volume, the implant size, the chest/breast circumference, and where the patient buys her bras. We encourage patients not to focus too much on a certain bra size, but rather look at the volume and the proportionate increase in size. Dr. Steele will take various breast measurements and use the Crisalix 3D imaging system to assist you in your size selection and give you with the most realistic preoperative simulation of your postoperative results.

Finally, review your surgeon’s before and after gallery and find patients with a similar height, weight, and preoperative breast size.

Breast implant projection is how far the implant sticks out from the body. Women tend naturally to choose an implant volume that is in proportion with body size and breast diameter for their breast augmentation. In a high-profile implant, the volume is the same, but the diameter is narrower, and the projection is greater. If the diameter of the implant size you select is about the same or smaller than your measured breast diameter, then a standard implant is appropriate. If the diameter of the desired breast implant is larger than your breast diameter, then you should consider high profile breast implants.

Yes. All incisions leave scars. Plastic surgeons are especially trained to leave scars that heal very well and are almost imperceptible after one year. Additionally, Dr. Steele uses the Keller Funnel™ to insert his breast implants, allowing him to make a smaller incision during breast implant surgery.

Typical breast implant surgery through an inframammary incision lasts between 45-75 minutes. The time variations are due to differences in patient size and anatomy.

We recommend the use of general anesthesia when performing breast augmentation. This allows for greater patient comfort and allows the anesthesiologist to give a muscle relaxant which paralyzes the chest muscles making implant placement easier and reduces bleeding from the muscle. At the time of breast enhancement surgery, a long-lasting local anesthetic is placed along the chest wall and in the breast, tissues to help with postoperative pain relief.

Absolutely. We often combine breast augmentation with body contouring procedures such as liposuction or a tummy tuck during a mommy makeover procedure. Facial procedures can sometimes be combined with a breast augmentation as well.

Most patients can get back to an office job within 2-3 days. We advise patients to avoid strenuous activity that increases blood pressure or heart rate for 3-4 weeks, at which time it is safe to resume cardio exercise. No lifting more than 15lbs is advised for the first 6 weeks. In submuscular implants, no pectoral (chest) muscle exercise are advised for at least 8 weeks to minimize the risk of implant displacement. Patients are able to drive as soon as they are no longer taking any sedative medications (pain pills and muscle relaxants).

Yes. Most patients can still breastfeed without any difficulty after breast augmentation, even when placed on top of the muscle. This is because the breast ducts connected to the nipple are not disturbed with routine breast augmentation. Some patients will have difficulty, however, after breast reduction or a breast lift (mastopexy) procedure.

Breast implant surgery will improve breast size and fullness but will not correct breast sagging (ptosis). Breast implants will provide a slight elevation of the breasts and may be enough in patients with borderline breast ptosis. Patients who have significant breast sagging with loose skin, who also desire enhanced upper pole fullness, are great candidates for a breast lift with implants.

It is normal to have some altered nipple sensation for a temporary period after breast enhancement surgery. This is because the many nerves that run through the breast tissue are under significant stretch due to the volume of the implant and associated swelling caused by plastic surgery for breast augmentation. Some patients report increased sensitivity after their breast augmentation, while others note some level of numbness. These sensations will generally resolve by 2-4 months after breast enhancement surgery. It is quite rare to have permanent numbness after breast implant surgery.

The answer will actually depend on whether you are breastfeeding or not. We generally recommend waiting 3-6 months after lactation has ceased for a breast augmentation. This will allow the breast to recover and return to their pre-pregnancy size.

In addition to risks of cancer and heart disease, smoking can impair wound healing and increase your risk of infections. Smoking causes the blood vessels in skin to constrict down, thus reducing the blood flow. This can result in wounds that are slow to heal and scars that are wider and more visible. Additionally, chronic smoking will accelerate skin aging and loss of elasticity; which explains why smokers look much older than their age. For the breast tissue, this can result in more sagging and drooping with the implants “bottoming out.” It is best to stop smoking 4 weeks before and after breast augmentation surgery for optimal healing.

Implants placed above and below the muscle will block a small portion of the breast from being visualized on a mammogram. Placing the implant below the muscle will increase the amount of breast tissue visualized. With modern ultrasound and MRI technology, this is much less of an issue but is still a concern for many women. Patients over the age of 40 are usually advised to get a mammogram prior to proceeding with breast enhancement surgery if they have not had a previous mammogram within the past 12 months. Patients with a strong family history may need to start at age 30.

While breast implant technology has improved over the last 30-40 years, they are not perfect and will not last forever (like any medical implant). Saline implants have a 1-2% chance of rupture each year and this adds up to a roughly 15-20% chance of rupture at 10 years. Silicone gel implants are sturdier with rupture rate of approximately 8-12% at ten years. Most patients will need to have some sort of revisionary breast enhancement surgery (for a variety of reasons) around the 15-20 year mark.

Capsular contracture describes hardening and distortion of the breast due to shrinking or contraction of the scar capsule around the implant. The scar capsule is important because an inadequate capsule will result in early stretching and bottoming out of the implant (1- 2% of patients). The opposite of this is encapsulation. In its mildest form, the breast feels firmer to the touch. More aggressive cases of capsule contracture will result in narrowing of the breast with implant malposition (generally moving superiorly). In the most severe form, the breast is distorted and painful.

Early capsule contracture can sometimes be treated with the off-label use of montelukast (an asthma medication), breast massage, and the use of a breast band. If this does not work, revisionary breast implant surgery to remove the implant and scar capsule with placement of a new implant may be necessary. Symptomatic capsule contracture occurs in roughly 10-12% of patients at the 8-10 year mark. Placing the implant under the muscle through an inframammary (under the breast) incision seems to decrease the risk of encapsulation, as does the use of a textured implant.

BIA-ALCL is a very rare form of non-Hodgkin’s lymphoma that has been recently tied to the use of textured silicone breast implants. There have been roughly 400-900 cases reported in the world literature, with a lifetime estimated risk of around 1: 30,000. The overwhelming majority of cases have been associated with a textured implant, and the cause is unknown. Typical symptoms include delayed (8-10 years) presentation of an enlarged breast with fluid around the implant. Treatment begins with obtaining a fluid sample for pathological examination and removal of the implant and implant capsule. Most cases are cured with capsulectomy alone, but more advanced cases may require chemotherapy and radiation.

Download these .PDFs to learn more:

Allergan Breast Implant Information

Sientra Breast Implant Information