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About Breast Implant Placement
Accurate Bra Sizing And Measurement
Antibiotics-Do I Need Them To Get My Teeth Cleaned?
Arnica-What is it?
Body Building/Working Out Issues
Bottoming Out
Breast Implant Registry-How Do I Get Registered?
What Is Implant Valve Failure? What If a Breast Implant Leaks?
Breast Lift And Mastopexy
Breastfeeding With Implants-Safe?
Capsular Contracture-What Is It?
Children-Is It Necessary To Wait Until After Having Children Before Having Breast Enlargement?
Cohesive Gel Implants-Tell Me About It
Double-Bubble
High Profile Implants
Implant Valves Failure and Leaks?
Incision Locations-Which Is Best For Me?
Inverted Nipples And Inverted Nipple Repair
Manufacturers Of Saline Implants
Mondor's Disease Aka Mondor's Cord
Noises-Can Implant Slosh, Gurgle, Or Make Other Sounds?
Overfill?-Please Fill Me In
Ptosis-What Is It?
Scarring-What Can I Do About It?
Silicone Breast Implants-Who Qualifies?
Smooth Versus Textured-What Should I Choose?
Warranty On Breast Implants?
Weight Of Breast Implants?
Massage After Surgery-How Is It Done And Why?
How Long Will It Take To Achieve The Desired Result?
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About Breast Implant Placement: Most saline implants are placed beneath the pectoralis major muscle to prevent or lessen the chance of any visible wrinkling through the skin. The muscle provides an extra layer of tissue between the implant and the skin to provide a more natural appearance. Silicone implants can also be placed beneath the muscle, but this is not universally necessary. Access to the space beneath the muscle can be made through any of the acceptable surgical incisions.
Accurate Bra Sizing And Measurement: The actual cup size does not always correlate with the volume of the implant. The bra size is a measurement between the circumference around the most full part of the breast and the ribcage beneath the breast. This varies depending on the patient's height and weight. A general rule of thumb is that one-cup is approximately 250 cc. This is for the average sized female. Accurate breast implant sizing can be done in our office with the use of the breast implant sizers and a form-fitting bra. We would be happy to assist you in making a reasonable estimate of desired breast size.
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 Antibiotics-Do I Need Them To Get My Teeth Cleaned?: All the patients with breast Enlargement receive prophylactic antibiotics before, during, and after their surgery. There is a slight chance that breast implants could become infected at a much later date, if there is a source of infection elsewhere in the body. One of these can be from the mouth. If a teeth cleaning or root canal is to be done, we typically recommend prophylactic antibiotics. A routine teeth cleaning, however, does not require antibiotics.
Arnica-What is it?: Arnica is a herb that is used in holistic medicine, but can also be used in conventional medicine and plastic surgery for the prevention of and treatment of bruising. Arnica does not prevent the bruising, but it facilitates the disappearance of bruising faster than would normally we expect. The bruising with breast Enlargement is minimal and Arnica is not necessary. Arnica is typically used for facial surgery.
Body Building/Working Out Issues: Since the implants are typically placed beneath the pectoralis major muscle, this puts excessive stretching on the muscle and physical activity with this muscle should be minimized until healing is complete. Passive range of motion of the arms to stretch and help relax this muscle is advisable after 24 hours from surgery, but heavy lifting and bodybuilding should be postponed until complete healing has occurred typically four to six weeks after surgery.
Bottoming Out: Bottoming out is an unusual phenomenon that typically occurs months to years after breast Enlargement when the position of the implant becomes too low in relation to the breast itself. This is a correctable problem, but would require another operation. The operation to correct this would require removing the implant, tightening the capsule that has surrounded the implant along the fold, and replacing the implant to higher position. Typically, this is very successful and long lasting.
Breast Implant Registry-How Do I Get Registered?: All breast implants are registered with a serial number and lot number. After surgeries, you will be given a registration card, which has this information. This information is also kept in our office in a computer program and in your physical record. If you choose to purchase with an extended warranty, these numbers are used on the application for this warranty and the company will issue a certificate to you indicating this warranty.
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What Is Implant Valve Failure? What If a Breast Implant Leaks?: All saline implants are filled through a valve by a fill tube at the time of surgery. Once the fill tube is removed, the valve seals. It is possible for this valve to leak, especially if tissue grows into it at a later date. The valve failure is extremely rare and when an implant leaks, it is most often due to a physical breakdown of the portion of the shell away from the valve.
Breast Lift And Mastopexy: Occasionally, breast Enlargement alone is not sufficient to fill out the skin envelope that has resulted from weight loss or breast-feeding. If the nipple has descended below the fold under the breast, then a breast lift may be necessary. This is called a mastopexy and would require additional cutting and would result in additional scars typically around the nipple.
Breastfeeding With Implants-Safe?: Breastfeeding is commonly done after breast Enlargement. There possibly could be difficulty if the incisions had been made around the nipple and this case some of the milk ducts would have been cut at the time of the breast Enlargement. To assure best success with breastfeeding, it is recommended to place the surgical incision in the fold or through the armpit.
Capsular Contracture-What Is It?: Capsular contracture is a rare phenomenon that occurs when a layer of scar tissue, which normally forms around the implant, begins to tighten round the implant. In most cases, this capsule is kept loose by massaging techniques, but in some instances, this capsule can contract causing the entire breast to feel very firm and abnormal. This can also occur when the breast implant is ruptured; typically a silicone implant can stimulate capsular contracture, if it is ruptured. There is a treatment for capsular contracture, but it would require a surgery to remove the implant and the capsule and replace another implant. In these cases, the results are very satisfactory.
Children-Is It Necessary To Wait Until After Having Children Before Having Breast Enlargement?: About 50% of patients who have breast Enlargement do so before having children. In these cases, the overlying skin is much tighter than a woman who has had previous children and the recovery may be more difficult. It also is possible that after having children, the new breasts will descend and become much lower possibly resulting in a need for breast lift. When a woman has had children and lost breast volume and then undergoes a breast Enlargement, the results are typically better because the implant is replacing the loss of volume and the skin is not excessively tight.
What are Cohesive Gel Implants?: Between 1992 and November 17, 2006, the FDA restricted the use of silicone gel implants to breast reconstruction, rather than cosmetic breast augmentation. During those 14 years, much work was done on improving silicone gel implants, as their tendency to rupture and leak had concerned many people during the 1970s and 1980s. Some had thought there might be a cause-and-effect connection between such leakage and various diseases. However, the research done since 1992 has failed to establish any connections whatever between silicone gel implants and any diseases.
Cohesive gel implants were developed during the research of the past 14 years, as efforts were made to improve both the implant shell and the silicone. In past years, a more liquid form of silicone was used, but the cohesive gel implants use a thicker gel, resembling Jell-O. Hence their nickname of “gummy bear implants”. Mentor Corp. makes an implant known as Memory Gel™ implants, which are cohesive, and the Mentor website states that all Mentor implants are ‘cohesive’.
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Double-Bubble: Double-bubble can occur in a patient who has a very short distance from the nipple to the fold beneath the breast. In these cases, the fold needs to be lowered when a breast implant is placed. If the fold is very deep and well defined, then it can result in a crease along the lower aspect of the breast creating a double-bubble deformity. The surgical means of correcting this is by cutting the breast tissue internally to release the old fold and typically with time, this will resolve by itself. Occasionally, a breast lift is necessary to probe the shape and form of the breast, if the double-bubble occurs.
High Profile Implants: In the last few years, advancements have been made in the development of different profiles of implants. Both INAMED and Mentor make implants of various profiles. Typically, there are three profiles, a low profile, a moderate, and a high profile implant. The profile relates to the measurement of the projection of the implant in relationship to its width. Since there are many sizes and profiles to choose from, it is much easier now to find an implant that fits the patient's body without being extensively wide.
Implant Valves Failure and Leaks?: All saline implants are filled through a valve by a fill tube at the time of surgery. Once the fill tube is removed, the valve seals. It is possible for this valve to leak, especially of tissue growth into the valve at a later date. The valve failure is extremely rare and most often when an implant leaks, it is due to a physical breakdown of the portion of the shell away from the valve.
Incision Locations-Which Is Best For Me?:
The three acceptable incisions for breast Enlargement are:
Around the lower edge of the nipple
In the fold beneath the breast, or
In the armpit.
We typically allow the patient to choose the location, after discussing it with Dr. O’Toole. Several factors would affect the decision, such as the patient’s anatomy, any hopes of breast-feeding later on, the color of the skin and nipple, and that patient’s characteristic type of scarring.
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Inverted Nipples And Inverted Nipple Repair: If the nipple is inverted occasionally, placement of an implant will correct this problem. If this does not correct the problem, releasing an inverted nipple can be done at the time of her breast Enlargement. This is done by cutting the ducts leading to the nipple and allowing it to project in a normal manner. The patient should be warned that correction of an inverted nipple would make it improbable that nipple will be successful in future breast-feeding.
Who Makes Breast Implants?:There are two main manufacturers of breast implants in this country today. The Federal Drug Administration (FDA) has required extensive documentation of research and development for various breast implants and only two companies have fulfilled these requirements. They are Allergan Corporation (formerly called INAMED and McGhan) and Mentor Corporation. Both of these companies make excellent implants, both saline and silicone gel, of various sizes and styles to fit every need.
What is Mondor's Disease or Mondor's Cord?:A Mondor’s cord is a long, hard line, felt as a cord, which begins at the breast and extends down onto the abdomen. It occurs after breast surgery and is very rare. It is usually invisible, but the patient can feel it. Typically, it resolves completely with time and no treatment is necessary.
Noises-Can Implant Slosh, Gurgle, Or Make Other Sounds?:
After surgery, it is common for the breast implant to make some sounds when massaged or manipulated. Breast implants are placed into a pocket created beneath the muscle. When that pocket is created, some air enters it. This can cause some sounds after surgery, but they will disappear after a few weeks.
Can Breast Implants Be Overfilled?:Saline breast implants come with a range of recommended fill volumes. The manufacturers allow us to fill an implant to between 30 cc and 50 cc of its documented size. Dr. O’Toole typically fills implants to the maximum allowed volume, in order to lessen the chance of visible or palpable wrinkling. It is possible to overfill implants, but if this is done, the implants will be much firmer to the touch and the warranty may be voided.
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Ptosis-What Is It?: Ptosis is another term for breast sagging. It typically occurs with aging, with weight loss, and with breastfeeding. There are various types of ptosis and occasionally, it can be corrected by placing an implant alone, but most commonly, it will require a breast lift.
Scarring-What Can I Do About It?: In all surgeries, incisions are made in the skin, and all incisions become scars when they heal. Scars are permanent, but people scar in different ways, partly depending on heredity. Some people end up with very small and pale scars. Others retain the thicker, raised, and even red scars that form early in their recovery time.
The scars from breast enlargement are approximately one inch long. They can be hidden very well in the breast crease, within the armpit, or beneath the nipple where the dark and the light skin meet. They can be minimized by correct surgical closure of the incision, and after surgery can be treated by massage therapy, topical application of silicone gel products, and vitamin E.
Silicone Breast Implants-Who Qualifies?:Every woman over 22 years of age. On November 17, 2006, the FDA approved silicone gel implants, after keeping them restricted since 1992. Before 1992, the silicone implants used at that time sometimes ruptured and leaked. Some people wondered if the leaking was connected to any diseases. But none of the safety studies done since 1992 have established any link at all between silicone implants and any disease. There are two companies whose silicone gel implants have been approved: Allergan Corp and Mentor Corp.
Smooth Versus Textured-What Should I Choose?: Although textured implants were quite common in years past, they are very rarely used today. The texturing on the implant was done in an attempt to minimize rotation of the implant and this was very important when teardrop shaped implants were used. Today, most implants are round and smooth and texturing is not necessary, since a round implant can rotate freely and it will always maintain a same shape and form.
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Warranty On Breast Implants?:Both breast implant manufacturers, Mentor and Allergan, give lifetime warranties on their implants. They provide financial reimbursement for most costs, if the implant ruptures within 10 years of the surgery. They also cover the implant itself for its lifetime against any natural defect which might result in a rupture.
Weight Of Breast Implants?: Breast implants weigh approximately the same as normal breast tissue. Water weighs one kilogram per liter. In other words, 1000 cc equals 2.2 lbs. Therefore two 500 cc implants combined would weigh 2.2 lbs. Silicone gel implants weigh a little less for each size than saline implants.
Massage After Surgery-How Is It Done And Why?: We typically recommend breast massage after surgery, starting after one or two weeks when the pain has faded enough, and continuing daily for six to twelve months.
The purpose is to make the implant’s pocket larger than the implant so as to minimize tightness after surgery. The technique is to press the implant between the thumb and fingers, forcing it up under the collarbone, and then to squeeze it downward in a similar fashion. This moves the implant within its pocket and enlarges the pocket, so that when you move your body in any way at all, the implant will move with you. If it appears to be attached to the chest wall it would look artificial. Dr. O’Toole will teach massaging techniques to you during your postoperative visits, typically at one to two weeks after surgery.
How Long Will It Take To Achieve The Desired Result?: The end result can take three to four months. Occasionally, the patients who use smaller implants and have excess skin, especially after having breast-fed children, will get a much more natural look at her earlier date. The younger patients with small breasts who choose large implants will appear very tight at first and will eventually relax and loosen three to four months later and look natural at that time. Most patients look quite natural in clothing very early after surgery.
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For more information on breast
Enlargement, call Pasadena Cosmetic Surgery at 626-377-9420.
626-377-9420
Contact
Us
10 Congress Street
Suite 502
Pasadena, CA 91105
626-377-9420
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