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Breast Augmentation Scottsdale


Email Scottsdale Plastic Surgeon Dr. Lille

Breast augmentation can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or create completely symmetrical breasts. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look.

Types of Breast Implants

A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline.


All Breast Implant Surgery carries some uncertainty and risk

Breast augmentation is relatively straightforward. But as with any operation, there are complications associated with this procedure.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.
There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body.

If a break occurs in the more recent advanced gel implants, the gel will stay within the breast pocket. Often, there will be a capsule that the body forms around the leaking gel. The gel material is pretty firm and will likely not leak to surrounding tissue like the older version. There may be a change in the shape or firmness of the breast. Any break will require a second operation and replacement of the leaking implant.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as “connective-tissue disorders” and the gel implants Dr. Lille utilizes in his practice are FDA approved.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound or MRI examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

In addition, there is a chance for implant exposure through the incision. The treatment can include closing the wound in an uncomplicated case or replacing the implant in a delayed approach.

The chance of all these complications are very small.

Capsular Contracture is not a complication but a risk. It is likely caused by a trigger effect from bacteria or blood on a gene that produces excessive scarring around the implant causing a misshapen and firm breast. The treatment is surgically removing the omplant and the scar and replacing it with a new implant.

Planning your Breast Augmentation (Implants) Surgery

In your initial consultation, Dr. Lille will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift.

Preparing for your Breast Augmentation (Implants) Surgery

Dr. Lille will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed. Picking the size of the implant will depend on the looseness of the breast skin and the width measurements of the breast. Final size choice will be made by the patient within the anatomic range chosen by Dr. Lille

Types of anesthesia for Breast Implant Surgery

Dr. Lille utilizes general anesthesia, so you’ll sleep through the entire operation.

The Breast Augmentation (Implants) Surgery

The method of inserting and positioning your implant will depend on your anatomy and Dr. Lille’s recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or endoscopically in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.
You’ll want to discuss the pros and cons of these alternatives with Dr. Lille before surgery to make sure you fully understand the implications of the procedure. The surgery takes less than an hour to complete. Under the skin stitches are used to close the incisions. A gauze bandage may be applied over your breasts to help with healing.

After your Breast Augmentation surgery

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. You should wear it as directed by Dr. Lille. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

Getting back to normal after Breast Augmentation Surgery

You should be able to return to work within a week, depending on the level of activity required for your job. Return to the gym will be around 3 weeks, although returning to a running regime will be around 6 – 8 weeks. Implants take approximately 3 – 4 months to settle.

Your new look after Breast Augmentation Surgery

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help ensure that any complications, if they occur, can be detected early and treated.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.
 

Breast Augmentation Q&A

1) What implants are available for breast augmentation procedures?

There are three types of implants available. The first is a saline which is comprised of salt water fluid inside a silicone gel shell. The second is silicone gel implants. These implants have the same silicone shell but contain a form stable cohesive gel inside, more consistent with the feel of a real, natural breast. The third kind of implant is a Double-Lumen which combines both a silicone gel and saline inside a silicone shell, also called the “gummy bear” implant. Unfortunately you don’t get the advantages of either, so they have fallen out of favor.

2) What are the advantages of a saline implant?

The advantages are several. First, you know when the saline implant ruptures. In addition, it is less expensive and you achieve slightly more volume symmetry between the breasts. The fourth advantage is that saline implant, when containing a significant amount of cc’s, is significantly lighter than there counterpart volume in silicone.

3) What are the disadvantages of saline implants?

There is a higher rate of rupture with approximately 12-20% in ten years. It does indeed look more fake with a greater potential for ripples. It can appear more like a bowl or a “posted” look, especially in those patients that present with an A or B cup with very thin skin. It can feel more unnatural.

4) What are the advantages of a silicone implant?

Silicone implants tend to look more natural, as a result of seeing the shape of the implant less. They also feel more natural with less rippling and wrinkling with a lower rupture rate of approximately 8-10% at ten years time.

5) What are the disadvantages of silicone implants?

Silicone implants are significantly more expensive than saline and the patient does not know when it ruptures. In addition, with larger volume cc implants they are heavier that their saline counterparts.

6) How do I know when a silicone implant ruptures?

Unlike a saline implant, the gel inside a silicone implant is not absorbed in the body. It stays within the breast pocket. Often times the body slowly forms a thickened hard scar around the implant called a capsular contracture. This can misshape the breast and make it more firm. In additional, current mammographic techniques including a mammogram or an MRI with an ultrasound can help detect a ruptured silicone implant. Although they are not 100% sensitive, taken together they increase the possibility of picking up a fractured implant.

7) What are the options available to pick up silicone ruptures?

The manufacturer recommends getting an MRI every 3-4 years, however, this can be very expensive to many patients. In some cases, insurance may pay for a MRI or breast evaluation if there is a significant family history or personal history of breast cancer/breast pathology. Many patients obtain screening mammograms which are often covered by insurance, although mammograms at this stage are only 60-70% sensitive for picking up silicone rupture. However, in ten years time with further development and advancement of mammogram technology the pickup rate is likely to be in the 80% to low 90% accuracy rate. Whatever the imaging technique, it is unlikely it will achieve 100% sensitivity. I, therefore, recommend obtaining a screening evaluation of the device covered by insurance within the ten years. If this is positive, the warranty will provide $3500.00 financial assistance with the implant exchange and a free set of implants. After the first ten years, the warranty will only provide the new implants. If the imaging results are negative, it is up to the patient whether they want to change their implants or wait anywhere between 10-15 years to change the implants. It is always better to change the implants before they are ruptured. An exchange of ruptured implants requires more surgery, more down-time and more expenses.

8) What are the different incisions used in breast augmentation surgery?

Dr. Lille uses three different incisions: the axillary, the peri-areolar and the infra-mammary fold which is in the fold underneath the breast. The three incisions are used for saline implants; however, Dr. Lille prefers using the infra-mammary fold for silicone implants. The endoscopic equipment is used to perform the axillary or armpit incision.

9) Are there any greater risks between the different types of incision?

There is no significant difference in the risks between the different types of incisions and so it largely depends on the patient’s preference of where they want the incision to be located. Although certain studies have shown that the loss of sensitivity to the nipple can be higher in the infra-mammary fold there are also other studies that show that other incisions can lead to the same potential loss of sensation. Some studies have shown are greater preponderance of capsular contracture with the armpit incision.

10) Where are the implants placed?

Implants can be placed either above the muscle, but below the breast tissue; or below the muscle. Implants placed below the muscle usually generally have more camouflage over the implant and; therefore, tend to look less round and less circular and more natural. There are patients that cannot afford to have release of their pectoralis major muscle which is required when going below the muscle; such as, body builders and professional athletes. In those patients, placing the implants above the muscle is mandated. There is also a segment of the population that has very strong and thick pectoralis major muscles. In these cases, the muscle is too strong and to restrictive to put an implant in and may increase the risk of having the implant open up the incision or significantly increasing the risk of implant migration out of the breast pocket.

11) How does Dr. Lille pick the size of the implant specific for me?

Measurements are performed along the breast width, as well as, evaluating the looseness and texture of the overlying breast skin. There is a range that is chosen based upon these measurements and the patient can choose within that range. Outside of the range, is something that Dr. Lille will strongly advise against.

12) Are any drains used in the surgery?

No drains are used in the surgery for a straight forward breast augmentation. If a significant revision is done that includes removing a capsule or doing a full breast lift with an implant, drains will be used.

13) Is there any pain associated with the procedure?

Patients will be given pain control pills for their post operative recovery. They are both narcotic and non narcotic in nature. Ibuprofen will also be used approximately 5-7 days after the surgery to help lessen the swelling. Dr. Lille places a pain a special pain cocktail in the patient’s breast pocket during the time of surgery which significantly reduces discomfort within the first six to eight hours after surgery. With patients that are young and have very tight skin tend to have more discomfort than those that have looser skin and feel a significant amount of pressure in addition those patients that get larger implants may experience more discomfort.

14) What is the general recovery following breast augmentation surgery?

Patients do not usually return to a desk job for five to seven days. They are not allowed to return to the gym with full upper extremity workouts for a full three weeks. Running, bicycling and hiking should be refrained for six to eight weeks and swimming can be resumed at approximately five to six weeks. It takes approximately a full three to four months for the implants to settle and the vast majority of swelling will be resolved by that time. Full resolution of swelling will not be achieved for 9-12 months after surgery.

15) What are the complications of breast augmentation surgery?

Possible complications include bleeding, infection, scarring, damage to the deep underlying structures such as nerves arteries, muscles, lungs, loss of sensitivity to the breast including nipples, implant rupture, implant migration, implant exposure and potential risks include capsular contracture.

16) What is capsular Contracture?

Capsular contracture is a thickened scar that can form around the implant. Patients usually possess a gene that can be triggered by bacterial colonization, or inflammation caused by blood pooling. Capsular contracture can distort the position and shape of the breast and cause pain or discomfort. Treatment for early development of capsular contracture includes medications, and in those that are recalcitrant to medications surgery will be required.

17) What are Dr. Lille’s outcome studies for his breast augmentation procedures?

Dr. Lille has performed over two thousand breast augmentation procedures in this 14 year of private practice. His overall complications rate is approximately less than 1%. The risk of capsular contracture nationwide is approximately 10-15%, however, Dr. Lille’s rate of capsular contracture in his patients is close to 1/2%.

18) My friend has a 350 cc implant and I like the way they look, should I get a 350 cc implant?

Everyone’s canvass, that is their breast width and size and dimensions, are different from one person to another. In fact, one breast is always different in characteristics compared to the other side. As such, an individual that has a certain amount of volume or cc’s in one patient will not look the same as another; and therefore, all people must be individually evaluated to the minute detail to determine which size implant will be optimal for their canvas.

19) What do I need to do to prepare for the surgery?

Make sure you have refrained from taking any substances that can thin out the blood like aspirin, ibuprofen, alleve, advil and other similar medications. Bleeding complications or excessive bruising can result. Also, it is best to refrain from naturopathic substances that have excessive vitamin E/C or contain glucosamines. A list of refrained medications will be given during the initial clinic visit. Also, if the patient is older than 45 or has concurrent medical issues, a medical clearance test from your primary medical doctor may be required. In some cases, depending on certain factors associated with the patient, only tests without seeing the primary doctor can suffice.

20) What is the process if I want to schedule surgery after the initial consult?

After the initial consult, a surgery date that is convenient to the patient along with a another clinic appointment to go over pre-operative issues such as medication list, obtaining photos, consents, along with pre-op and post op instruction direction documents.

21) Is smoking harmful for breast implant surgeries?

Tobacco ingestion either with smoking or chewing has shown in studies to slightly increase the risk for capsular contracture. We do not know the exact time to reduce this risk to normal, but a 6 week cessation before the surgery MAY be effective.

22) What types of anesthesia are available?

Dr. Lille likes to use only general anesthesia. This method is strongly preferred since the muscles that are split when creating a below the muscle pocket respond better to the procedure with less bleeding when full paralyzed. As a result, a breathing machine is required. All anesthesiologists are board-certified and use a rubber insertion device inserted inside the back of the mouth to reduce any discomfort that may result from general anesthesia.