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Questions about Breast Augmentation?
Visit our website dedicated to information on Breast Augmentation. Find more information about breast implants, breast augmentation recovery, fat grafting to the breast and costs.
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Types of Breast Implants
At this point in time, there are two types of breast implants available: saline filled implants and silicone gel filled implants. Both implants have a silicone 'shell' that can either be smooth or texturized. In the US market, both Mentor and Allergan manufacture breast implants and have FDA approval for use in breast augmentation patients.
Saline Breast Implants
The saline implant has been on the market for many years, and is an excellent implant device. Its advantages include a proven track record for implant safety, since it has been used in the USA for over 10 years. Saline implants tend to be less expensive than silicone implants. When a saline implant is placed in a patient, the implant is 'empty', and therefore the saline implant can be placed through very small incisions beneath the breast, armpit or areola (more on incision placement later in this page). If the implant leaks, the saline (salt water) is absorbed by the body. The fact that the implant has leaked is obvious (the breast looks deflated), and the implant can be replaced. For most patients, the saline implant appears to perform better and last longer when it is placed behind the pectoral muscle. The disadvantages to saline implants are few. In women with very little of their own breast tissue and sub-cutaneous fat, there can be issues with visible wrinkling of the breast implant. The consistency of a saline implant is less 'breast like' when compared to the silicone alternative. Saline implants are slightly heavier than silicone implants.
A saline implant standing vertically on edge, note wrinkling of implant shell
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Silicone Breast Implants
Silicone breast implants are safe. The current generation of cohesive gel implants (we use both Mentor MemoryGel and Allergan Natrelle breast implants) was approved by the FDA in November 2006. The current generation of silicone breast implants are the most carefully scrutinized medical devices in recent history. There was a multi-year pre-market approval study conducted by the FDA that has established the safety of Mentor and Allergan silicone breast implants. Years prior to this study, the safety of silicone shell/ silicone filled implants was clearly established by rigorous Institute of Medicine studies that did not demonstrate a link between silicone breast implants and systemic health issues in patients.
The cohesive silicone breast implant has been on the market since November 2006, and it is an excellent implant device. Its advantages include a more 'breast like' consistency compared to saline implants. Because of the thicker silicone implant shell and cohesive silicone implant material, there is less visible wrinkling of the silicone implants, especially when placed behind the pectoral muscles. Due to the cohesive nature of the silicone gel, if the implant shell were to fail, the silicone inside would not flow out of the implant shell into the breast tissue. By volume, the silicone implants are slightly lighter in weight than saline implants.
It's been my experience that most patients prefer silicone implants for their breast augmentations. Disadvantages of silicone implants include cost- they are about $500-800 more per pair of implants than saline devices. When silicone implants are placed, they require a slightly longer incision (4-4.5 cm in length) to place. This is because silicone implants are pre-filled to a particular volume and a larger incision is needed to place them. For peri-areolar and axillary incisions, the size of the silicone implant that can be placed is limited (275-300 cc) due to the smaller incisions that must be made in these regions.
A silicone implant standing vertically on edge, note less wrinkling of implant shell
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Form-stable (gummy bear) breast implants
There is a new generation of form-stable cohesive silicone breast implants that will revolutionize the way that we currently perform breast augmentation surgery. These new form-stable 'gummy bear' implants are not yet approved by the FDA, so are not available for use outside of study protocols. These new implants are called the Mentor CPG and Allergan style 410. The new form-stable implants have a defined shape, with increased volume in the lower pole of the implant. The implant has a stable shape and surface texturization, and transmits its shape to the breast tissues. Accurate biometric sizing and exact pocket dissection are critical to the success of these implants. What is exciting about these new implants is their very low rate of capsular contracture (scarring around the implant), and implant rupture rates, which are much lower than our current silicone gel breast implants. The devices have been used in Europe for many years, and have an excellent safety record. Form-stable implants will be especially useful in patients with constricted lower breast pole and tuberous breast issues.
A form-stable 'gummy bear' implant on the left and a current generation silicone implant on the right
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Implant type and position
Saline and silicone implants can be placed under or over the chest muscles (pectoralis muscle) depending on your breast anatomy and the 'look' that you are interested in achieving. Close to 97% of women in my practice have implants placed below the muscle. I believe implants perform better over a longer period of time in this protected submuscular location.
Muscle and implant relationship - the implant can be placed over the muscle (left) or under the muscle (right)
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Implant Replacement
Many women who have had previous breast augmentation procedures using older style implants are interested in implant replacement with one of the new type of breast implants. This procedure is referred to as an implant exchange. The old implant is removed along with any adjacent breast scar. The new implant is put in its place. The procedure can be combined with a breast lift to correct any of the natural breast sagging that has occurred over time.
Breast Augmentation Photo Gallery
This photo gallery contains representative before and after images of cosmetic breast procedures. Click on any of the thumbnails to enter the slide show. The text accompanying the photos describes the details of the procedures performed.
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Click on thumbnail to begin viewing slide show.
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I am interested! What do I do next?
If you are considering this procedure we encourage you to schedule a consultation with Dr. Gottlieb. During this visit he will listen to your concerns and discuss your options. He will tell you whether you are a suitable candidate for a breast augmentation procedure and inform you of the potential risks of the procedure. There is a great variety in breast shapes and features and each breast implant procedure must be custom tailored for the patient to get the best possible result. You will also have a chance to view before and after photo albums of his patients who have undergone procedures similar to what you are considering.
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