Breast Augmentation

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To correct a reduction in breast volume and sagging after pregnancy.
• To balance a difference in breast size.
• As a reconstructive technique following breast surgery

Correction of these problems can greatly improve self esteem for many women.

There are many options that a patient should consider prior to having breast implant surgery, such as type of implant, placement of the implant (above or below the muscle) and incisions used to place the implant.  These options will be discussed with you during your consultation with Dr. Becker, at which time the optimal choices that best suit your body and desires will be determined.

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. 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.

Cost of Breast Augmentation Surgery

Price Anesthesia Implant Position of Implant Incision Location Most Expensive General Anesthetic w/Anestheologist Adjustable Silcone Sub Muscular or Sub Fascial Circum-Areolar Hospital   Cohesive Silcone Gel(Antomical)         Cohesive Silcone Gel(Round)       Twilight Anesthesia Adjustable Saline   Trans-Axillary Surgery Center Least Expensive Local Anesthesia Saline Sub-Glandular Inframammary Under Breast Office

In view of the fact that there is much confusion about the type of implants available and their appropriate use, Dr. Becker has written an article in order to facilitate you to make an educated choice for your breast augmentation.

What You Should Know About FDA Approval of Silicone Breast Implants

By Dr. Hilton Becker, M.D., F.A.C.S

The FDA has approved Silicone Breast Implants after years of instense studies. If you have had or are considering Breast Augmentation, here are some facts you need to know.

Incision and Placement

Due to the firmer nature of the cohesive gel, a larger than normal incision is necessary; therefore, the inframammary (under the breast) incision is preferable for the insertion of these implants. The gel implant may also be inserted through a breast lift incision or an abdominoplasty (tummy tuck) incision.

Saline-filled implants, on the other hand, are placed through a smaller incision, as they are not filled until they are placed in the pocket.

Placement of Implant

Sub Glandular (above the muscle – under the breast tissue)

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)
• Lighter than saline therefore less tendency to cause sagging if place above the msucle
• 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, therefore preferable placement is behind the muscle to avoid sagging

Adjustable Implants 

Advantages:

• Volume can be changed after surgery
• Patient has input into final size
• Better able to correct asymmetry
• Better able to treat complications following previous breast surgery i.e., irregularities in shape, capsular contracture, symmastia (disruption of midline)

Disadvantages:

• Injection dome has to be removed (can be buried or externalized)
• If the injection dome is buried, a second minor procedure, performed under local anasthetic, is necessary to remove the injection dome.
• If the injection dome is exteriorized, no further surgery is necessary for removal

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 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 capsue unless it is calcified).

Breast Augmentation & Lift

The most common breast problem seen after a woman has had one or more children is sagging of the breasts, combined with a loss of volume. This condition is best treated by combining a breast lift procedure with a breast implant. However, by combing the two procedures, the risk of complications are increased since the breast lift procedure results in tightening of the breast skin, while the implant enlarges the breast, resulting in increased tension on the scar. It is for this reason that the sub-areola technique and the adjustable implant is beneficial when combining mastopexy with augmentation. Dr. Hilton Becker uses the adjustable implant, known as the Mentor-Becker implant, which he developed and pioneered in 1984. Use of this implant, either saline or a combination of gel-saline, reduces the risk of scarring and complications associated with the mastopexy augmentation procedure.

If the adjustable saline implant is used, it is placed under the muscle. The siligone gel implant is placed above the muscle.

A minimal amount of saline is placed in the implant at the time of the surgery. Saline is added slowly over a period of 5-10 days to allow for healing of the incision. When swelling has subsided and the implants are filled to the desired volume, the fill tubes and domes are then removed. The implant seals itself with a self-sealing valve.

If a vertical scar is warranted, due to excessive ptosis (sagging), use of the adjustable implants greatly improves the shape and symmetry of the breast, while reducing the amount of scarring.

The new Silicone Cohesive Gel (MemoryGel –Gummy Bear) implants have been used with excellent results in combination with a sub areola mastopexy procedure.

Dr. Becker has lectured and performed live surgery at several national and international plastic surgery meetings on these techniques. He has written two chapters in plastic surgery text books and has published three articles on this topic, including:

1. The Adjustable Breast Implant - Plastic Surgery Journal 1992
2. Augmentation Mastopexy using Adjustable Implants with External Injection Domes - Aesthetic Surgery Journal - November 2006

Becker Adjustable Implant

Now you can change the size of your breasts without additional surgery.

The adjustable breast implant, which was developed in 1985 by Dr. Becker, is used in this procedure. The implant consists of a membrane that is filled with saline via detachable dome. Saline (salt water solution) is added or removed from the implant post-operatively by inserting a thin needle through the skin into the injection dome. Once the patient is satisfied with the size and shape of her breasts, the dome is removed usually three to six months post-operatively. The implant seals at the self-sealing valve. alternativly the injection dome may be exteriorizied and removed one week later.

If the patient wishes to enlarge (or decrease) the size of her breasts after surgery, a needle is placed through the skin into the injection dome. Saline solution is then injected (or removed) to adjust to the size (and shape) of the breast. When the patient is satisfied with the result, the injection dome can be removed under local anesthetic.

It is the ability of the adjustable breast implant to correct or improve difficult breast problems such as ptosis, tubular and unilateral breast development that makes this implant so unique. The adjustable-fill breast implant is useful in expanding underlying tissue and generating more breast tissue to create a more natural and symmetrical breast shape. Because these implants can be filled gradually over a period of several months, discomfort is minimized while the skin slowly stretches. In order to avoid the unnatural, hard-looking appearance of some augmentations, especially the upper fullness. Adjustable breast implants can be overfilled, then the volume reduced, allowing the breast to relax, producing a more natural appearance.