Breast Enlargement & Enhancement in New Jersey

Breast augmentation is the most common procedure that Dr Friedlander performs, and the second most common plastic surgery procedure performed in the US today. It is intended to restore, enlarge and improve the size shape and appearance of the breast. Like all plastic surgical procedures, the result is a collaborative effort between the surgeon and the patient. Here, as with any other cosmetic procedure, the surgeon has the ability to use the structural integrity of the breast, add fullness which is otherwise lacking or misplaced and create a breast which provides harmony to the psyche and soul.

If you are like most women seeking breast augmentation, you have been considering the operation for many years. Some of you are looking to have natural appearing breasts that bring your body into balance while others are looking for an increase in size without the telling signs of surgery. It is performed to enhance breasts which appear to be too small as a result of inadequate development, post pregnancy shrinkage or large fluctuations in weight. It may also be used to correct breasts which are asymmetrical. The result is intended to enhance the physical appearance, and improve self esteem and inner confidence.

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There are many considerations that go into planning a breast augmentation procedure, and often, many choices that have to be made. Some are best made by the surgeon, but always in consideration of what her patient desires. The biggest choice, and sometimes the easiest choice to make, is the selection of a silicone implant verses a saline implant. Both create excellent results, with subtle differences. The silicone implants are softer and more natural in feel and appearance. They are less likely to show rippling or wrinkling, particularly in thin patients. Both are safe. In 2006, the FDA approved a new generation of silicone implants. These implants are "form stable", meaning that they maintain their shape even if the integrity of the shell is compromised, unlike the previous generation of silicone implants that were taken off the market in 1992 which had a gelatinous consistency.

Breast augmentation is a procedure that involves the placement of an implant to enlarge the size of the breast. It is not a generic procedure as there is a great deal of planning that goes into creating an excellent result. Few women are symmetrical. The differences between the breasts may be subtle, but can be magnified by the procedure. When we look at ourselves in the mirror, we focus on the shape and size of the breast. Other considerations for the plastic surgeon include the position and size of the nipple, the location of the natural fold, and the distribution of tissue. Breast augmentation is intended to restore fullness to the breast. Visually, the implant needs to be centered behind the nipple. Variations in chest anatomy such as curvature created by scoliosis, a prominent rib cage, nipples which naturally are located to the side or one breast being higher than the other will need to be addressed by the surgeon to create an aesthetically pleasing result.

Pregnancy and nursing often contribute to the issues we wish to address, such as areolar enlargement and nipple hypertrophy (increase in size and projection). During pregnancy the breasts enlarge stretching the skin. There is a loss of elasticity of the skin, which typically is not appreciated because the skin retracts afterward. The breast can easily accommodate a larger implant, restoring the fullness that we all liked during pregnancy. The use of extremely large implants can contribute to further stretching and should be thoroughly discussed. Often times the nipple and breast tissue descend downwards and require additional techniques such as breast lift or mastopexy(see below) to correct.

There are many different variables, such as location of the incision, the size, shape, and type of implant, as well as the location of the implant (under or over the muscle) that play a role in planning the surgery. Dr. Friedlander prefers to place the implant behind the muscle, as this may decrease the potential for capsular contracture (scar tissue) and will interfere less with future mammograms. This is also associated with less implant visibility (particularly rippling) and creates a more natural appearance, especially in thin women.

Surgical procedures are safe, and carry few risks in healthy patients. It is important to disclose any health problems and any medications (prescription and over the counter) that you are taking as they may impact the surgery, such as the use of baby aspirin, a blood thinner. There are risks with any surgery such as infection, bleeding or altered sensibility. These are not specific to breast augmentation. The implants may leak or rupture, and may need to be replaced. There is a common misconception that implants need to be replaced every 10 years. This is of course untrue. Issues requiring revision may include rupture, capsular contracture or a change in size.

The procedure is performed on an outpatient basis and patients are followed closely in the office after surgery. Postoperative swelling is normal. As the swelling disappears, the implants will look smaller. They are not. It is simply the swelling improving. The body is not symmetrical. Swelling postoperatively is not symmetrical as well. Most of the swelling is gone by 4-6 weeks after the surgery, and the implants "settle" into their final position after a couple of months. Most women are able to resume regular work 5-7 days after the procedure although they can work from home after 1-2 days. No strenuous activity or heavy lifting is permitted for 4 weeks.

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Selecting an Implant Size

Selecting an implant can be an exciting experience. Dr Friedlander has sizers that will help you to visualize what your breasts will look like after the surgery. The concepts involved can be confusing because they are not standardized.

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First and foremost is the concept that implant selection is based on cup size. Implant volumes do not correspond to cup sizes. The cup size that is created by the surgery is dependent not only on the implant, but on how much natural breast tissue is present, the distribution of the tissue (that is the shape of the breast), the dimensions of the chest, the height and weight of the patient etc. It now becomes easier to understand why a given implant cannot create a specific cup size, and why a given implant looks different on different women.

Most women want to be proportional after the surgery. Proportion is a perception. It is not a concrete object. For some women, proportion is a B cup, for others it is a full C cup, bordering on a D cup. This problem arises for 2 reasons. First, there is no consistency between bra manufacturers. That is to say, a B cup in a 32 bra has a different cup size than a B cup in a 34 bra, and a 34B bra in one manufacturer will fit differently than a 34B cup by another manufacturer. Secondly, proportion is determined by height weight and body dimensions, and not necessarily cup size. Often times, women who are naturally large and wear a D cup, will look proportioned. This can all be very confusing. Communicating your concept of proportion to your surgeon is important during this selection process.

You will be asked what your desired cup size is, but this useful as a guide only. If you wish to be large, do not hesitate to say so. Your surgeon cannot read your mind. Implants are sized by volume and by dimension. As the volume increases, so does the diameter and projection of the implant. Women with a petite frame, or who are very thin, may not be well suited for very large implants. Adjustments in implant dimensions may need to be made to accommodate your chest size or your desired result.

The best advice that can be given during the implant selection process is to be open minded. Select an implant that looks good on you, that you are comfortable with, without committing to an arbitrary cup size beforehand. Frequently, the selection can be narrowed down to one or two implants. If you are having a hard time at that point, remember, the implants will look slightly smaller once the surgery has been completed. Also, the difference between implants is typically 25 CC-30 CC or less than 2 tablespoons. This is barely noticeable and typically results in a slight difference in fullness.

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Selecting an Implant Shape - the Evolution of Breast Implants

Gel breast implants were introduced in the 1960's, followed by saline implants several years later. The gel devices have evolved extensively over the years. They are significantly different from the early devices in the 60's and the later devices that were taken off the US market in 1992. Currently three manufacturers are FDA approved to market gel implants in the US. All 3 have a "form stable " implant. The term" form stable" relates to increased "cross linking" of the silicone gel imparting an additional degree of stability to the implant. Unlike the earlier gel implants and the saline implants, these newer implants containing the "more cohesive silicone gels" are more likely to maintain their shape allowing the surgeon to "sculpt" and "shape" the breast rather than just "fill" it.

The round version of "cohesive gel", "form stable" implants is most frequently used and produces excellent results. A small set of augmentation patients, however, benefit from shaped implants that can create greater fullness in the lower pole of the breast. This shaped implant has been available in Europe for many years and is now available in the US to satisfy a variety of patient needs.

The implants of all three manufacturers have been extensively reviewed by the FDA. FDA approval of the shaped Allergan and Mentor implants which are still involved in ongoing clinical trials is expected. Sientra received FDA approval in March 2012 to market its shaped implant. Surgeons now have greater flexibility to create an attractive breast shape or to correct a preexisting deformity.

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Asymmetry

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Asymmetry is present in everyone. Most asymmetries are subtle and do not need to be addressed, in fact, they typically are not even noticed until pointed out. Most commonly, they are noticed after pregnancy and nursing, when one breast developed more or was favored by the baby. Asymmetries tend to be developmental and come in many shapes and forms. They can involve the size, shape and position of the breast as well as the nipple. Correction of these issues, which can be challenging, can lead to a more aesthetically pleasing result. In its simplest form, asymmetry can be corrected by using implants of different sizes and dimensions. This however can lead to additional asymmetries and should be used only for larger size discrepancies, and after thorough discussion. Correction of nipple discrepancies can also improve the aesthetics but sometimes result in additional scars. Breast position issues can also addressed by adjustment of the natural fold position. If asymmetry is marked, the correction may require a combination of several different techniques including reduction, uplift, and augmentation. There may be several options for correction, if desired, and Dr. Friedlander will discuss these with you.

Revision Surgery

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As the numbers of women with breast implants increases, we find that there is an increasing need to revise previous surgeries. This can be a complex intervention because the anatomy may have been distorted by the initial procedure, the tissues may have thinned or stretched and the original records including implant size may not be available. The treatment is determined by the problem, and there are instances where a recommendation is made not to proceed with surgical intervention, or even to proceed with explantation(removal of the implants). The most common need for revision is capsular contracture where scar tissue forms around the implant, sometimes displacing it, causing distortion and pain. Once capsular contracture occurs, it is more likely to reoccur. Implant malposition, bottoming out, and droopiness are other reasons for revision. Issues related to saline implants such as rippling and visibility, can be particularly distressing when seen near the breast bone or when leaning over and are often the stimulus for revision. Some women are desirous of larger or smaller implants, and some choose to have both implants replaced at the time correction of a deflation is performed. The need for a revision may also be related to changes in the tissue caused by weight fluctuations and pregnancy. The surgeries are complex, and may involve removing scar tissue, replacing the implant, repositioning the implant, adjusting the pocket and sometimes adding tissue to support the implant where the natural support has been lost.

Some revisions are inevitable. Some can be prevented by preoperative discussion and planning.

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