Breast Augmentation

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast. There are many options that a patient should consider prior to having breast implant surgery.

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Dr. Hilton Becker has extensive experience using silicone gel breast implants. He has been part of the FDA Adjunct Study of Silicone Breast Implants and has been using silicone gel implants since the study was started in 1992.

Composite breast augmentation

Composite breast augmentation is the technique of adding fat grafting to the breast augmentation procedure thus adding a new dimension to breast augmentation.

A breast implant is effective in adding volume to the breast, however often falls short of supplying the correct shape. It is for this reason that there are a multitude of breast implant shapes and configurations. Furthermore asymmetry is often difficult to achieve

Now, thanks to enhanced techniques of fat grafting procedures, it is possible to add extra tissue to shape and sculpt the breast to the desired size and shape.
Liposuction is performed at the same time as the breast procedure. The harvested fat is then injected around the implant .The implant is covered with an extra layer of tissue concealing the “implant look”. A more voluptuous breast shape is created and irregularities and rippling are avoided.
Sub muscular placement is no longer necessary thus eliminating the abnormal movement and distortion seen when the implants are placed under the muscle.
Breast implants sometimes result in a lack of fullness to the upper pole, or do not provide sufficient cleavage. Fat grafting allows these two problems to be corrected. Fat grafting is also used to correct abnormally shaped breasts such as tubular breast or asymmetric breasts.
Composite fat grafting is an excellent method of correcting a wide range of breast complications following breast augmentation, breast reconstruction and even radiation defects.

Dr. Hilton Becker is best known for having developed the adjustable breast implant. He is now pleased to offer his patients the New Cohesive Gel (Gummy Bear – MemoryGel) implants.”Results with these new implants are now better than ever. The results look and feel more natural. Our patients that have received these implants are simply delighted”.

Dr. Becker is recognized as an international authority on both reconstructive and cosmetic surgery, Including breast enlargements (augmentation), breast lift (mastopexy), breast augmentation with lift (invisible scar breast lift), correction of breast implant complication and breast reconstruction following mastectomy. He has lectured, taught workshops, written several chapters in text books and published many articles on breast surgery. He is therefore proficient in a broad range of breast surgery.

Dr. Becker’s breast augmentation technique:

  1. Surgery is performed either under local anesthetic or IV sedation in our AAAASF (American Association for Ambulatory Surgery)
  2. There are several options as to the placement of the incision (scar):
    • Areola– This is an circular incision on the lower pole of the areola
    • Circum-areola (Peri-areola) – incision made around the areola – performed when a invisible scar breast lift is needed.
    • Infra mammary – incision made in the inframmary fold
    • Trans-axillary – incision made in armpits.
  3. Type of implants used: Although there are many different types of implants available, Dr. Beckers breast impants of choice are:
    • Silicone Cohesive Gel (otherwise known as ‘Gummy Bear”) smooth and round
    • Saline – option to adjust size after the surgery
    • Silicon/Saline adjustable implants (Becker 50/50, Spectra®)– Click here for details
  4. Interal Mesh Bra – This is a special mesh that has been developed by Dr. Becker to decrease the common complaint of breast sagging after a breast lift (mastopexy) has been performed. It is also used to correct implant complications and in breast reconstruction surgery. Click here
  5. Implant position – Although there are reasons for placing the implant either under the muscle or under the gland, Dr. B choice is SUB-FACIAL. This is a layer of connective tissue that is between the muscle and breast tissue. Dr. B has modified the sub-facial technique to offer implant support at the same time having no muscle contraction over the implant causing distortion. Click here
  6. Contamination Avoidance during the insertion of the implant – The sterile implant goes straight from the implant container into the breast without touching anything before it is inserted into the clean pocket that Dr. B has made. A one time use – ‘implant funnel’ is used to prevent bacterial contamination of the implant from the skin and enables the implants to be placed through a smaller incision. Click here
  7. Intra operative tissue expander – This is a temporary implant shell that is inserted into the newly made pocket to gain symmetry and helps stretch the skin intra-operatively.
  8. Post operative drainage – To drain any collection of fluid that remains in the pocket after surgery.
  9. Frequent postoperative visits – It is important that patients are seen frequently after surgery as there is a window of opportunity early after surgery, where potential complications can be avoided, such as asymmetry.
  10. Yearly follow up – Having breast implants is a life time commitment. potential implant complications, such as capsular contracture can be avoided. Early physical therapy is initiated if necessary Aspen Rehab.
  11. Mentor Implant Enhanced Warranty – All patients receive the Mentor Breast Implant warranty that covers manufactures defect. Click here
  12. Mentor Volume Sizing System – Try the New You Visualizer and Visualize the new you now!
  13. 2-Year Warranty – We offer our patients a full 2 year warranty on their surgery. Provided that you keep your follow up appointments. We will correct any complication that should occur at no additional cost to you (excluding anesthesiologist) revisions are usually done under local anesthetic.

Having breast implants is a life time commitment. potential implant complications, such as capsular contracture can be avoided if early physical therapy is initiated. Early physical therapy is initiated if necessary at Aspen Rehab.
 

Options for Breast Augmentation:

Incision and Placement

The circum aereolar incision is Dr. Beckers preferred incision.

Placement of Implant

Sub Glandular (above the muscle – under the fascia)

Advantages:

  • More natural position, appearance and feel
  • Less painful, quicker recovery

Disadvantages:

  • Less tapered upper pole (less noticeable with sub fascial placement)
  • Possible increase in capsular contraction

Sub Muscular (behind the muscle)

Advantages:

  • Gives more coverage and support to the implant, particularly in thin patients with small breasts
  • More natural upper pole fullness
  • Possible less interference with mammography
  • Slightly less risk of capsular contracture

Disadvantages:

  • More painful
  • Longer recovery
  • More movement with muscle contracture
  • Possibility of visible step-off at muscle edge

Sub Fascial

Combines the advantages of subglandular and submuscular placement while decreasing the disadvantages. Dr. Becker uses the Sub Fascial Placement in most of his implant patients.

Types of Implants

Cohesive Silicone Gel (MemoryGel – Gummy Bear) Implants

Advantages:

  • Very low leakage rate (cohesive)
  • More natural feel
  • Less chance of rippling

Disadvantages:

  • Larger incision necessary

Saline Implants

Advantages:

  • Smaller incision
  • Lower cost
  • Slightly less incidence of capsular contracture

Disadvantages:

  • Higher leakage rate
  • Higher incidence of rippling
  • Heavier than gel

Textured versus Smooth Implants

Smooth implants

  • More natural feel
  • Less incidence of seroma (fluid) formation after surgery

Textured

  • May decrease capsular contracture (this has not been proved with the new cohesive gel implants).

Our Current Recommendations

Gel Implants

  • Smooth, round, moderate profile – plus cohesive gel implants, preferably placed above the muscle, under the fascia (sub-fascial).

Saline Implants

  • Adjustable saline implants with external, or buried injection ports
  • If the patient wishes to ultimately have silicone gel implants, adjustable saline implants are used to expand and adjust the pocket above the muscle. These can subsequently be replaced with silicone gel implants, usually with local anesthetics.

For patients with previous saline implants who wish to replace with gel implants

  • Submuscular saline implants are removed, the muscle is returned to its original position and new silicone gel implants are placed above the muscle (it is usually not necessary to remove the capsule unless it is calcified).

Breast augmentation with fat grafting

It is now possible in selected patients to enlarge the breasts entirely from the patient’s own tissue.
Thanks to new enhanced techniques of fat grafting, it is possible to harvest fat at the time of liposuction and inject the fat into the patient’s breast. This technique is used for both breast augmentation and breast reconstruction.
The breasts can now be enlarged without scarring or breast implants.
Dr Becker is a pioneer in both breast surgery and liposuction.
He developed the Becker series of liposuction cannulas that are commonly used to harvest the fat for fat grafting procedures.
PRP. Platelet rich plasma (rich in growth factors) is often combined with the fat graft procedure.

Dr. Becker’s response to questions on realself.com

Click here for Dr. Becker’s response to questions on realself.com