Breast augmentation is the surgical procedure to help enhance breast size and appearance. Many changes will occur to the breasts due to the affects of time, pregnancy, and genetic factors. Surgery can correct and improve many of these factors. The breast augmentation procedure focuses on restoring or adding volume to the breast tissue. An ideal individual has good support and basic positioning of breast tissue but desires more volume. This patient will likely experience highly desirable results from breast augmentation in Bellevue.
Breast augmentation surgery alone will not fundamentally change basic defects, major asymmetry, or droopiness. Other procedures may address these concerns. If there is more than mild or modest droopiness of the tissue (ptosis), then Dr. Allegra will likely recommend a breast lift for the best results.
Breast augmentation is a safe procedure that generally produces pleasing and satisfying results. Refinements in technique and implant technology have minimized most of the older problems and concerns. Patients who will benefit the most will be those who have realistic expectations and are psychologically stable. Overall, breast augmentation mammoplasty is a safe and effective cosmetic enhancement option with a highly satisfactory outcome.
Modern implants are of dramatically better quality and stability than in the past. We predominantly utilize silicone gel implants as these result in the most natural outcomes with a very normal “feel” to the breast tissue. It is typical to not be able to feel an implant at all-just normal breast tissue.
The gel implants we utilize are from Mentor Corp which are the only implants manufactured in the United States. The company also offers comprehensive warranties and guarantees.
There are 3 types of gel with the key difference being the “cohesiveness” of the gel-basically the “firmness”. The most recent choice is the “XTRA” implant that has a moderately cohesive gel offering slightly better, more youthful “fullness”. The other choices are the regular (somewhat softer) gel, and lastly the firmer gel (Gummy Bears). These are reviewed with you in detail at the time of consultation.
The saline implant has a long track record of overall safety and offers some advantages in incision size considerations. As the implant is inflated once positioned, Dr. Allegra can use a smaller incision. Additional advantages include the complete absence of any risk from leakage as deflation poses no risk to the body. It is likely as much as a 1% yearly volume loss with saline implants. Unlike silicone, saline causes no tissue inflammation or other problems occasionally associated with older silicone implants. New silicone breast implants have dramatically reduced the occurrence of these issues.
Saline implants are best suited for those who have somewhat more breast tissue for coverage to help reduce the tendency to see rippling of the implant. In most cases, a saline implant may not have as “natural” a feel or appearance as compared to silicone gel; this would be particularly true for someone who has relatively small amounts of natural tissue.
Silicone implants have undergone immense study and review prior to their returned availability on the market. They now represent a safe and desirable alternative. Silicone gel is ideal in terms of feel, softness, and reduced rippling tendency. It represents an ideal choice for a thin individual with little natural tissue. The risk of leakage has been dramatically reduced and the silicone is a very thick gel rather than the more liquid prior implants which limit the problems even in the unlikely case of leakage. Modern silicone gel implants are the gold standard in terms of achieving reliable, natural, and great outcomes. We use Mentor breast implants.
We offer three types of silicone implants that differ in the “cohesiveness” of the gel. These are: the standard gel, the “XTRA” gel, and the cohesive gel (AKA “gummy Bear”). A good analogy is to consider these like soft, medium, or firm jello.
What is the right size? Many factors will play a role in decision making. It is inaccurate to think of size by a bra cup size as one manufacturer’s “C” may be another’s “D”. It is better to think of the degree of volume added in cc’s and what will this actually look like in you. A given size implant will often appear different from one patient to another given differences in one’s body size and shape. It is of little value to assume that the same size implant in one individual will yield similar results in another.
We have addressed this issue by offering the most accurate sizing option available–the Vectra XT 3D imaging system.
Your consultation will include the use of this great tool allowing us to see in real time the appearance of various implants as well as the possible changes from a lift or reduction option.
Patients are rarely dissatisfied with size after the decision making process as noted above. It is, however, possible to adjust up or down although at an additional cost.
We see many patients who are seeking to achieve youthful and natural breasts but are uncertain if they need a lift. If there is some droopiness there is a general misconception that breast augmentation alone will achieve a great result. Worse, there some surgeons claim that simply putting an implant above the muscle and/or a bigger implant will solve the problem. Unfortunately, this usually results in big droopy breasts! A larger implant may create fullness but the natural tissue then seems to “fall off” and droop. Not a great outcome.
So, generally speaking, the answer is no; however, there are some exceptions.
As we all know breasts come in many shapes and sizes. Multiple factors determine whether or not they become “droopy”
The classic grading of ptosis is in 4 classes: 1-4.
For grade 3 or 4 ptosis, a lift is essential to achieve an aesthetically pleasing result. In grade 2 ptosis, it depends and there are exceptions. There are individuals with minor ptosis who will have nice outcomes without a lift. These are the individuals who may find that having some minor residual droopiness is a reasonable tradeoff with not having visible incisions. This is particularly true with those who have predominantly undergone a “deflation” of the skin envelope with predominant upper pole loss. For these individuals augmentation alone may be an excellent option.
If there is “pseudoptosis” then augmentation with the restoration of upper pole volume and improved projection is often a great option.
If you can easily “hold a pencil” then probably you would benefit from a lift.
High profile implants may be a great choice for a given individual resulting in better projection with less “widening” of the breasts. If there is mostly loss of upper pole volume and minimal droopiness then the results may be excellent. But they will not truly correct droopiness.
A shaped implant offers no help in correcting droopiness.
A lift basically addresses the position and size of the areola and will reduce the droopy tissues in the lower pole. Unfortunately, a lift does not restore the loss of upper pole fullness and roundness. The majority of lifts I perform include a well-sized implant to restore the upper pole giving us great results.
Ultimately, there are many factors that must be carefully considered and balanced in order to achieve great outcomes. During the consultation, we review your specific anatomy and changes that have taken place in order to determine the potential need for a lift.
We utilize the Vectra XT™ imaging system which will allow us to accurately simulate a lift and/or augmentation. This system uses remarkable technology to capture a 3D image allowing us to accurately visualize multiple surgical options. You can then best understand and make the appropriate choices resulting in a great outcome.
No one has perfect symmetry and it virtually impossible to achieve perfect symmetry with any breast surgery. However, symmetry is usually good within the parameters of what is possible given the basic anatomy.
The degree of cleavage possible is highly individual. It is generally dictated by the basic position of the nipples and natural breast tissue. The chest contour also plays a significant role. Implants need to be centered with the nipple to look normal and not result in a “walleye” or “cross-eyed” breast look. This is the greatest factor in how much cleavage is possible. A larger implant may allow for more cleavage within limits. If there is a need to correct the nipple position there is also the opportunity to improve cleavage.
There are four choices of incisions for placement of breast implants.
Although commonly utilized, this incision (armpit) may be more visible in a given individual than alternatives. Most commonly used with saline implants, it is less desirable with silicone implants given the larger incision necessary. Other limitations include reduced visibility of the area of implant placement with a more limited ability to precisely control the position and minimize bleeding and bruising.
This incision is the most commonly utilized. Dr. Allegra places the incision in the crease of the breast fold and it is well hidden. It offers excellent access for the placement of implants. There is also complete visibility of all areas allowing for precision. This approach also allows for a gentle procedure with the added ability to precisely release some areas of breast tissue from muscle allowing for the best appearance after under the muscle placement. We believe that, for most, this is the least visible incision option.
Dr. Allegra places this incision at the margins of the areola. It allows good access for implants as well as other possible corrective surgery. It is often well hidden in a given individual; however, there is a visible line at the transition of the areola to the skin which may be evident. This approach does mandate some dissection through breast tissue in order to create the implant pocket. Thus, there is a small potential for sensory changes with this. Lastly, there is a small added risk of contamination of the implant from bacteria at the nipple that cannot be completely sterilized.
This is the approach to implant placement via a belly button incision. It is limited to saline implants only but results in a minimal scar for most patients. We do not offer this approach as we feel that the limitations tend to outweigh any benefits of consequence.
There are four choices for implant placement divided into two categories–above and below the muscle. The above muscle option is “submammary” or “subfascial”. The below muscle options are “subpectoral” or “total submuscular”.
Placement above the muscle would be most useful for an individual desiring a very “augmented” look. This approach is also useful for someone who is a bodybuilder as a placement under muscle could result in a flexion deformity problem (creasing of the breast appearance with the flexing of the chest muscles).
Placement below the muscle is generally the preferred location as there is an added layer of tissue that helps to create a natural appearance and feel.
This is a rare problem and is one of the specific reasons we will plan on seeing you the following day. If there is a hematoma it will likely need draining. Treatment might require implant removal and replacement at that time. If there has been a hematoma there is a somewhat increased risk for capsular contracture in the future. To date, we have not had this occur.
Postoperative infection is very rare but potentially serious. Treatment may involve antibiotic therapy and implant removal. Once resolved the implant can be replaced generally after 3 months. We treat all our patients with antibiotics to help minimize this possibility. To date, we have had no infections.
There is a possibility of a temporary decrease in nipple sensation. This generally improves over a period of several weeks to months. A significant permanent decrease is rare. It is possible to at least temporarily experience an increase in nipple sensation.
There is a normal and necessary capsule that will form around an implant. In some cases, this capsule becomes thickened and contracted in an adverse fashion. The degree of the problem varies considerably. From the minor cases, which may not need treatment to more significant cases that require breast revision. Signs of significant contracture may include firmness, distortion, displacement, traction, and occasionally some pain.
The risk of contracture is approximately 1% per year for several years. Some surgeons have reported higher incidences. Evidence suggests that smooth sound silicone gel implants placed under the muscle may be less prone to contracture. Form stabilized (gummy bear) implants may be associated with a slightly lower capsule rate. Repair of contracture may require release or removal of the capsule and then replacement of the implant possibly in a different pocket.
Northwest Face & Body has served the Bellevue and Kirkland areas since 1983. Providing the gold standard in surgical and non-surgical cosmetic procedures, our Bellevue and Kirkland plastic surgeons are breast surgery experts. With decades of combined experience and hundreds of surgeries performed every year, we offer the best breast augmentation in Bellevue and Kirkland.
Dr. Ludwig Allegra is an accomplished plastic surgeon who is a specialist at providing the best breast surgery. He bridges the gap between the technical and the scientific. With a deep understanding of aesthetics and symmetry, Dr. Allegra uses cutting edge technology, experience, and skill to perform the best breast augmentation in Bellevue and Kirkland.
Located conveniently in Kirkland, minutes away from downtown Kirkland and Bellevue, Northwest Face & Body is accessible from both major Eastside cities. To schedule a consultation, call us at 425-576-1700. You can also contact us online via the contact form or Price Simulator™.