Breast augmentation is the most popular cosmetic surgery procedure done in the United States. Over 100,000 breast augmentations are done every year, and in Hawaii, breast augmentation is just as popular as it is on the Mainland. Breast augmentations improve the size and shape of a woman’s breasts. They are sometimes done in conjunction with a breast lift.
When choosing a plastic surgeon to perform your breast augmentation, one should always choose a Board Certified plastic surgeon that has privileges to do breast augmentations at a local hospital. Cosmetic surgeries, to include breast augmentations, are usually done in surgicenters, and not in hospitals. I am a Board Certified plastic surgeon with cosmetic surgery privileges at Queen’s Hospital, but I do the surgeries at my new surgicenter at Hale Pawaa.
Hawaii Breast Augmentation: Patient Decisions
There are several decisions that patients must make prior to having breast augmentation. The following is a list of breast augmentation decisions:
There are three breast implants available in the United States: Allergan, Mentor and Sientra. All three are FDA approved. Sientra is a Brazilian company, and plastic surgeons and their patients have learned, when something goes wrong with a product made by a foreign company, they are not there to help the patient.
The outside of all breast implants is a silicone shell. The insides are either saline or silicone. During the implant controversy of 1991, we were unable to use silicone implants for over 15 years. During that time, we used saline implants and discovered there were many problems associated with saline: 1) they tend to ripple; 2) they have a valve, and anything you fill during surgery has the potential to leak; and 3) they have a different feel both to the person wearing them and the person touching them. All in all, I do not like saline implants and I do not recommend them to my Hawaii breast augmentation patients. Silicone breast implants are softer to the touch and when the patient lies on her stomach, it does not feel like one is lying on two water balloons. While all implants have the potential to ripple, silicone breast implants ripple less, and since Allergan has a thicker shell, it also has less propensity to ripple. Silicone implants, because they have no valve, can literally last forever, and because the new silicone filler is no longer liquid but a semi-solid, the danger of leakage from breast implant damage has been pretty much eliminated.
Covering of Implants
There are two types of breast implant coverings: textured and smooth (kind of sounds like Skippy peanut butter, doesn’t it?). Textured implants were invented in 1991 by both Allergan and Mentor. Each manufacturer has a different style of texturing; the theory behind textured implants was that the body would form a scar around each little bump, the scars would not line up and it would keep the implants from getting hard. This, unfortunately, has not proven to be true. Textured implants a) lead to significant rippling on the skin; and b) very often go hard as a rock. Therefore, I am a big fan of smooth implants and they are what all of my Hawaii breast augmentation patients receive.
There are two shapes of implants: teardrop (aka anatomic), and round. Teardrop implants, on the face of it, would be fantastic if they would only stay in place. Unfortunately, they tend to rotate, and no one has ever thanked me for a diagonal breast. All teardrop implants have a textured covering; therefore they not only rotate, but also go hard. Round implants become teardrop when they are partially under the pectoralis muscle. The muscle pushes on the upper 2/3s of the implant and the lower 1/3 which is not covered by the muscle bulges; therefore, on profile, they look like a teardrop or anatomic shaped implant and because they are round, no matter how they turn, they are always teardrop. Therefore, I prefer to use round implants.
Route of Entry
There are five basic routes of entry to place the implant into the breast: 1) through the belly button; 2) an incision below the breast; 3) an incision below the nipple; 4) around the inferior aspect of the areola; and 5) through the armpit. Each route of entry has its pluses and minuses, but I feel that breast augmentations through the armpit give the surgeon the greatest ability to make the position of the implant totally appropriate for the patient while at the same time leaving little to no scar. I have done over 3,000 breast augmentations through the armpit using an endoscopic technique. Although I have tried all other techniques, I have found the armpit to be the most effective route of entry for my Oahu breast augmentation patients.
Breast implants can be placed above or below the pectoralis muscle, and at times partly above, and partly below. Each patient has a different requirement; however, implants below the muscle are always preferred because the implants stay softer, the patient gets a better mammogram, partially subpectoral silicone implants appear to be teardrop and there is less chance of rippling even in the most slender women.
Types of round implants
There are three types of round implants; the difference between the three is base width versus projection.
- moderate implants are very wide with minimal projection,
- moderate plus implants are in between and,
- high profile implants have narrow base and the greatest projection.
My preference is the high profile implant because, once they settle, they give the most breast-like appearance in profile.
This is possibly the most difficult category to discuss with my Hawaii breast augmentation patients because, unfortunately, there is no standardization in the bra community. Cup sizes A, B, C, and D or D+ tend to have very little meaning today, because at one store, a B is a B and another store, a B is a C. With this in mind, a patient seeking a breast augmentation should go with the visual appearance of an implant in her bra and not worry significantly over which letter is associated with it since one can get a different letter at a different store.
Above are some of the most important decisions the pre-operative breast augmentation patient must make. It is the surgeon’s obligation to point these out to the patient, discuss them at length, give the pros and cons and allow the patient to make an informed decision.
To learn more regarding your options as a Hawaii breast augmentation patient, contact Oahu Plastic Surgery Center today to schedule an initial consultation at our office in Honolulu. Dr. Schlesinger will be glad to speak with potential Hawaii breast augmentation patients during that time.