Breast Enhancement Surgery

Nowadays, breast enhancement surgery comes in many forms including breast augmentation, mastopexy (raising the sagging bust), and reduction mammaplasty (decreasing its size).  And while each kind uses different techniques, their goal is the same: to improve the appearance of the bosom.

In 2011, breast augmentation was the most popular cosmetic surgery in the US, with about 307,000 procedures performed during the period.  Currently, the Food and Drug Administration has only approved saline and silicone breast implants for this surgery.

As its name suggests, breast augmentation is traditionally used to increase the bust, but with the introduction of new implant designs, it has become possible to use the procedure in creating a more prominent cleavage, and address certain types of breast deformity such as pigeon chest.

In some cases, breast implants are used to reconstruct the breasts after mastectomy or cancer surgery, although they can only be helpful if there is an ample amount of tissue left.  By using the devices, women can avoid unfavorable scarring associated with tissue-based breast reconstruction, and weakening of the donor site (e.g., buttocks, abdomen, back).

Another type of breast enhancement surgery is mastopexy in which the sagging breasts are raised to make them appear more appealing and youthful.  Contrary to popular belief, the procedure is not only popular among aging women but also on massive weight loss patients who often develop sagging, elongated breasts.

For some, mastopexy involves reducing the size of areola (pigmented part of skin surrounding the nipple) to complement the “perky” and youthful appearance of the breasts.  Doing this additional procedure does not necessarily mean more scars because doctors simply use the peri-areola incision.

While mastopexy can lift the sagging breasts, patients should take note that it cannot create volume especially in the upper and medial cleavage.  For this reason, many plastic surgeons suggest breast implants as a way to further enhance the appearance of the bosom, resulting to a prominent cleavage.

Brest reduction is another type of breast enhancement surgery, although women with medical problems caused by extremely large bust size will more likely see this as a reconstructive procedure.  If performed as a way to improve body function and address discomfort, insurance reimbursement is possible.

By contrast, breast reduction which is performed purely to enhance one’s appearance is not covered by insurance, as with any cosmetic surgeries.  In fact, most insurance companies require at least 300 grams of fats and tissue to be removed from each breast before the procedure is considered reconstructive. 

Are Sientra Breast Implants Better?

Just recently, the US Food and Drug Administration has approved a new brand of silicone breast implant; the device, which is made by California-based Sientra, can be used in breast reconstruction following cancer surgery, and cosmetic breast augmentation.

Dr. Tarick Smaili, one of the leading Los Angeles plastic surgeons, believes the FDA’s approval clearly shows the “reasonable safety of silicone breast implants, despite potential risks such as implant failure and hardening of the tissue or capsular contracture.”

“Any type of breast implant does not guaranty to last a lifetime, although modern designs can accommodate greater force and are quite resistant to the elements that are causing natural wear and tear,” Smaili said.

The plastic surgeon added that implant from Sientra is just like other brands already sold in the US market, thereby patients who will choose the new silicone implant are “technically choosing a technology that has been tried and tested for many years.”

“In fact, silicone breast implants have been subjected to the most rigorous, comprehensive clinical trials and surveys that would allow patients to make a good decision and understand the potential risks and limits of the devices,” he said.

Meanwhile, the plastic surgeon believes that Sientra breast implant is neither inferior nor superior to other brands manufactured by Mentor and Allergan, which used to be the only two companies allowed by the FDA to sell silicone and saline breast implants.

In 1992, silicone breast implants were banned in the US over concerns that they may increase the risk of cancer and many forms of systemic disease.  But in 2006, the FDA has lifted the moratorium based on facts that no study has proven the link between the devices and serious illnesses.

After the lifting of the 14-year ban, silicone breast implants are increasingly becoming more popular than saline implants because they provide a natural feel and look.  In addition, many doctors believe they are less likely to fail because the cohesive gel filling prevents wrinkling, a problem that can eventually lead to shell failure.

By contrast, saline implants—which are filled with a sterile mixture of salt and water—are relatively prone to “folds” that may rub each other, thereby increasing the risk of implant failure.

Over the past few years, breast augmentation via silicone and saline implants has been the most popular cosmetic surgery in the US.  In fact, about 307,180 procedures were conducted in 2011 alone. 

Botox for Faster Recovery After Breast Augmentation?

Breast augmentation surgery involves pain and discomfort during recovery.  However, plastic surgeons have come up with different techniques to shorten the healing time and reduce soreness and other postoperative symptoms.

One possible way to shorten the recovery is Botox injection; plastic surgeons use this treatment “off-label” to encourage the pec muscle to relax and allow the high-riding breast implants to settle downward quicker.

“Off-label” means using a treatment or drug beyond its real purpose.  For instance, Botox has been approved by the US Food and Drug Administration to remove certain types of facial wrinkles and address muscle spasm, although some doctors use it to encourage the implants to settle quicker into their natural position. 

After breast augmentation surgery, it is normal for the implants to appear unusually high off the chest wall.  This appearance generally lasts two months, although some women have to wait for as long as four months, as it takes time for the implants to drop and settle to a more natural place.

By relaxing the chest muscle, advocates of Botox believe the treatment can also speed up the recovery of patients.  And because the muscle is partially paralyzed, they also claim that there is less spasm and pain.

Crampy spasm following breast implants surgery commonly lasts several weeks or even months for some patients.

However, patients should realize that not all doctors recommend Botox injection to shorten the recovery after breast augmentation.  This is because other postoperative procedures have also been proven effective in minimizing pain and discomfort, and encouraging quicker healing.

For instance, some doctors recommend breast massage with compression exercise which can lead to faster recovery and encourage the implants to settle more naturally.  But when doing the procedure, patients should do this carefully and should avoid pinching the shell as it may affect the stability of the device.

Real Housewives Star Admits Plastic Surgery

While most celebrities deny having plastic surgery even if the result is too drastic and blatant, Real Housewives star Brandi Glanville has no qualms admitting going under the knife to improve her appearance.  In fact, she even said that in a town where “everyone is perfect, it is important to look good.”

In a previous interview, Glanville, 39, said she had breast augmentation surgery, a procedure necessary to regain the volume loss associated with pregnancy, in addition to increase her bust size.  And aside from breast implants, the star also admitted having regular treatments of laser to address her skin problems including “adult acne” and Melasma, a condition in which the skin produces too much pigmentation.

The TV personality also admitted to be receiving weekly spray tan to maintain her skin’s glow without damaging it, in addition to Botox injection and fillers to fight the early signs of aging.

Because she grew up modeling, she said that she is extremely aware of her physical appearance and knows the areas which need some improvements.  Another reason for her penchant for plastic surgery is the fact that she is now back in the dating scene.

To Glanville’s detractors who called her “plastic,” she said that “everyone has the right to do anything that can make her feel good.”

The good thing about Glanville is that despite having several cosmetic procedures, both surgical and non-invasive in nature, she looks naturally beautiful.  This is probably due to her belief that “less is more” which is her approach in plastic surgery.

Her breast augmentation is a clear example of Glanville’s “less is more” approach in plastic surgery.  While many celebrities have chosen large breast implants that gave them the “heavy top” look, she opted for smaller ones that perfectly fit her slender frame, thereby the result is a very natural appearance.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili, who did not treat Glanville, said he is noticing a shift to a “more natural appearance.”

“Celebrities nowadays are choosing smaller breast implants that will give them a more natural, sexy look.  For example, Kate Hudson and Victoria Beckham have been rumored to have had breast augmentation using smaller implants, while Dolly Parton and Denise Richards have downsized their implants,” Smaili said.

Aside from giving a natural appearance, the renowned plastic surgeon also cited other advantages of small- to medium-sized breast implants including faster recovery, lower risk of downward displacement and sagging, and less chance of developing stretch marks.

Rebecca Linares Breast Augmentation with Dr Smaili

Breast Asymmetry and Implant Surgery

To some degree, both breasts are usually different in size although it is very minute that no one would even notice.  However, some women have pronounced asymmetry that makes it hard for them to choose clothing that would hide this aesthetic problem.

One way to address a noticeable case of asymmetry is through breast implant surgery.  In this procedure, a plastic surgeon will use either a saline- or silicone-filled implant to augment the smaller breast, which in turn leads to balance.

However, breast implant surgery is only ideal for patients who have no problem increasing their bust size; on the other hand, women who think that their asymmetrical breasts are too large can opt for reduction mammaplasty in which the tissue and fat of the larger breast are excised to make it smaller.

The advantage of using implants over performing breast lift is that it is possible to use less and shorter incisions, thereby the risk of visible scarring is almost not a concern. 

While it is possible to make an incision in the underarm and within the navel’s rim during breast implant surgery, these incision sites are not ideal when dealing with existing breast deformity.  This is because doctors have to work far away from the breasts, making it more difficult to create a balance appearance.

When dealing with asymmetry, it has become sacrosanct to use the peri-areolar technique in which a U-shaped incision around the edge of areola (dark pigmented skin around the nipple) is made; or breast crease approach in which a hidden incision is made within the skin fold where the breasts and chest meet.

In some cases, breast implant is performed in conjunction with breast lift particularly if there is some obvious sagging in one or both breasts.

The implant surgery, with or without breast lift, usually requires one to two weeks off from work.  However, patients should always bear in mind that residual swelling and tenderness often takes several months before they completely subside.

To support the new contour, most patients are required to wear a surgical support bra for several weeks.  This special garment also encourages quick recovery, leads to better contour, and minimizes swelling.

For at least two to four weeks, patients should avoid heavy lifting, pushing, arm extension, and rigorous activities.  However, it does not mean that they should remain sedentary during the entire recovery as doing so can exacerbate the swelling and may prolong the healing time.

As soon as possible, patients should take a gentle, short walk every day to encourage quick recovery and minimize swelling.

Which Is More Popular, Saline or Silicone Breast Implant?

Breast augmentation is either performed using saline- or silicone-filled breast implants, devices which not only increase the bust size but also regain the lost volume after childbirth.

In terms of popularity, silicone breast implants are almost outpacing the saline version.  This is not surprising because they provide a more natural result since they are filled with a cohesive gel that is designed to replicate the feel of breast tissue and fat.

The growing popularity of silicone breast implant can be attributed to the FDA’s decision to lift the ban in 2006 after several studies have suggested that there is no link between its use and cancer risk and systemic diseases.

Another reason why silicone implants are more popular than saline is that they are very ideal for women with little tissue and fat in their breasts.  And not surprising, a significant number of patients seeking breast augmentation have this anatomical feature.

On the other hand, saline implants can provide a natural appearance only if there is a moderate to significant amount of tissue and breast plastic surgeons can work with.

Meanwhile, a 2009 survey released by the American Society of Plastic surgeons revealed that 50 percent of breast augmentation patients had chosen silicone implants. 

Right after the lifting of the 16-year ban, silicone implant is gaining on saline version every year.  In 2007, 35 percent of breast implants used in surgery were silicone and they jumped by 47 percent a year after.

Difference Between Saline and Silicone Implants:

* Saline implants are filled with a sterile salt and water solution while the silicone version is filled with a cohesive silicone gel.

* Saline implants are prone to sloshing, which in turn results to higher risk of downward displacement than silicone with the same size.  For this reason, some doctors intentionally overfill the saline implants.

* Silicone implants need longer incision than the saline version, unless they come in a very small size.  By contrast, saline implants require a short surgical cut because they are placed empty inside the breast pocket before they are inflated with a sterile saltwater solution.

* Silicone implants can maintain their volume for years (except if there is a leak or implant failure) unlike the saline ones which have a natural deflation rate of 1 percent every year.

* For patients with a little amount of breast tissue, saline implants often result to unflattering, dome-shaped breasts while the silicone implants can provide a more natural result. 

However, saline and silicone implants provide almost the same aesthetic result for women with moderate to significant amount of breast tissue.

Breast Lift and Different Degrees of Ptosis (Sagging)

Because of the different degrees of breast sagging, plastic surgeons are using various types of mastopexy or what is more commonly referred to as breast lift.  In this way, they can address the problem using the shortest incisions possible.

Most doctors categorize breast sagging in three types: ptosis, empty sac syndrome, and pseudoptosis.

* Ptosis

This is the only condition that warrants breast lift surgery.  This happens when the breasts droop far enough that the nipple is at the same level or has even sagged below the breast crease.  Usually, this is often associated with the lack of volume in the upper poles and cleavage that the bosoms appear elongated.

Ptosis comes in three categories: mild ptosis in which the nipple has dropped to the level of the breast fold; moderate ptosis in which the nipple has dropped beyond the level of breast crease; and advanced ptosis in which the nipple is pointing toward the floor.

Advanced ptosis is often treated with full mastopexy, which is also known as an inverted-T or anchor lift due to the shape of its incisions.  Plastic surgeons create an excision that starts at the base of areola and travels to the breast crease, and then cut out a crescent-shaped amount of skin along the breast crease.

Full mastopexy also involves repositioning the areola complex so it sits in a more youthful position.

On the other hand, mild and moderate ptosis can be corrected with less invasive forms of mastopexy.  For those who need the least amount of correction, the Benelli or donut breast lift is often enough to address the sagging by simply making an incision around the areola complex.

But for those who need a little more correction, the lollipop breast lift or vertical mastopexy is a good option.  This technique involves an incision around the areola and another one that travels to the nipple down to the breast crease, resulting to a lollipop-shaped scar.

* Empty Sac Syndrome

This condition can be treated with breast augmentation surgery alone since the areola and nipple have not yet fallen at the same level or beyond the breast crease.  Implants are enough restore the lost volume associated with aging and pregnancy.

* Pseudoptosis

This condition, like the empty sac syndrome, is best suited for breast augmentation rather than breast lift.  Women with pseudoptosis have breasts that have fullness below the nipple but the upper portion appears somewhat “deflated.”

Film School in China Bans Students Who Had Plastic Surgery

With the growing popularity of plastic surgery in China, a film school has made it clear that anyone who alters his or her appearance will likely be disqualified from the entrance examination.  Officials from the illustrious performance institute of Beijing Film Academy said that “changes in the faces and other body parts might affect the acting of students.”

Even students with tattoos may be disqualified from entrance examination.

Surprisingly, many people think the decision to ban those who had plastic surgery is “fair,” arguing that actors who had “surgical enhancements” are somewhat cheating.

Some people even say that plastic surgery is a fraud.

However, what they fail to realize is that plastic surgery is not all about looking better than others.  For some people, this may be their only way to live a normal life, improve body functions, and repair deformities caused by illness and accidents.  Does it mean individuals who had reconstructive plastic surgery are also banned from the film school?

One student’s parent even said that she agrees with the plastic surgery ban because “what matters is the performance and acting, not how a person looks.”  With this argument, what is the point of excluding those who had “cosmetic enhancements” when their talent is the most important thing rather than their appearance? 

And not to mention the freedom of choice.  The choice to undergo “surgically-assisted beautification.”

Another potential loophole is that how on earth the film school’s officials can determine if someone had surgical enhancements or not?  What kind of criteria they are going to use?  Perhaps it would be too tedious to conduct background check for the sole purpose of determining if a student had plastic surgery or not.

Currently, eyelid surgery is one of the most common cosmetic plastic surgeries in China.  And with 94 percent of the population consisting of Han people who usually lack a prominent eye crease, individuals with this feature may end up being accused of having “surgical enhancements” even if they did not.

The issues surrounding plastic surgery are somewhat analogous to guns.  Guns are neither bad nor good as the situation depends on who will use them.  The same thing is true in cosmetic surgical enhancements. 

But perhaps the plastic surgery ban imposed by the prestigious film school has its own merits.  According to the country’s health ministry, about 70 to 80 percent of those who seek cosmetic surgical enhancements are high school and college students who are too young to understand the ramifications of their decision.

Also, another concern is that teenagers are not yet physically mature to undergo cosmetic plastic surgery.