Why choose Dr. Reagan of San Diego for Breast Augmentation
I most commonly use smooth, round, silicone or saline breast implants placed under the muscle. The key to a successful outcome is precisely creating the space for the implant to sit. Under dissection results in implants positioned too high and too lateral. Over dissection results in implants too low or rippling medially. I release the muscle inferiorly and partially medially to yield excellent positioning immediately. I do not rely on the implant to “Fall with time”. Sometimes a breast lift must be performed at the same time if the breasts are droopy (ptotic).
BREAST AUGMENTATION PROCEDURE
Breast Augmentation remains one of the most commonly performed cosmetic procedures in the United States (290,000 in 2013, ASPS) . At True Beauty San Diego, Dr. Reagan is an expert in performing natural Breast Augmentation/Enhancement. You will meet Dr. Reagan at one of his convenient San Diego locations ( La Jolla or Carlsbad / La Costa) for an unrushed, private consultation. Your health will be discussed, an examination will be performed, and before/after results will be reviewed. An operative plan will be tailored specifically for you. An honest discussion of expected outcomes, recovery, and associated risks will be conducted to assure that you are well informed and can make the best decisions regarding your surgery. Dr. Reagan performs all portions of the procedure. He will personally see you in the post-operative phase to assure the best outcomes. At True Beauty San Diego, our mantra is simple: True Expertise, True Service, True Satisfaction!
INDICATIONS FOR BREAST AUGMENTATION
There are many reasons why women seek Breast Augmentation. Hypomastia (Small Breasts) is the most common indication for Breast Augmentation. A likely scenario is a woman with an A or B cup breast who wishes to increase by one or two cup sizes. In some cases, simply achieving more superior fullness is desired. Improving body proportion and self-esteem is the ultimate goal. Lifting a droopy breast (Breast Ptosis) is another indication for Breast Augmentation. Proper selection and placement of a breast implant can lift the nipple-areolar complex approximately 1-2 cms. For breasts that need more lifting, a formal Breast Lift (Breast Mastopexy) will be necessary (see below) Finally, Breast Asymmetry (uneven breasts) can be improved with Breast Augmentation. In this scenario, different size implants will be utilized to achieve more uniformity of breast size.
BREAST AUGMENTATION WITH IMPLANTS
The use of a breast implant is undoubtedly the most predictable approach to increasing breast size. While the uses of supplements or suction devices (BRAVA) have been touted as alternatives, no clear data exists to support these claims. Use of Autologous Fat Transfer to the breast may be of benefit for small increases in size, but the technique is relatively new and is still somewhat unpredictable. Many questions still exist regarding the safety of this approach. This topic will be discussed below in further detail.
The 3 Fundamental Questions to be Answered regarding Breast Augmentation
You will receive a seemingly overwhelming amount of information during your consultation. While all the information is important, your attention should be focussed on 3 fundamental questions regarding the actual surgery:
1) What Implant will be used?
2) Where will the Implant be placed (Above or Below the Muscle)?
3) What Approach (Scar) will be used?
CHOICE OF IMPLANTS
Considerations: Saline vs. Silicone, Round vs. Anatomic, Smooth vs. Textured
Saline vs. Silicone
The discussion on choice of implant typically begins with deciding whether to use Saline or Silicone. It is important to appreciate that both are excellent devices, each with its own advantages and disadvantages. At True Beauty, we use both Saline and Silicone implants, and the selection of the implant with be determined after the consultation based on many factors.
The main advantage of Silicone is its more natural feel. This is especially true when the patient possesses little breast tissue (A Cup). The patient must be 22yrs or older, and the companies typically recommend some form of surveillance (UTZ, MRI) every few years to ensure the outer shell is intact. Thus, the disadvantage of Silicone is the recommendation for surveillance. Women approaching 40yrs will likely be getting mammography, but much younger women will need to factor the potential cost of surveillance in their decision making. Silicone is more expensive than Saline. Finally, since Silicone comes pre-filled, the incision to place the implant is generally a little bigger than when using Saline.
The quality of silicone used today in implants is much different (and better!) than 20+ years ago. Previously the silicone grade was less viscous (more liquid like). In cases of rupture, the silicone was more capable of spreading. In current versions, the silicone is much more viscous and will not migrate. Terms used to describe today’s silicone implants include “Gummy Bear”, “Cohesive”, and “Form Stable”.
Silicone implants are safe to use. In 1992, the FDA began a study to look specifically look at the safety of silicone vs saline implants. After many years and thousands of cases, the data suggests the following: Silicone Implants do not cause breast cancer, Silicone Implants do not delay the detection of breast cancer, and Silicone Implants do not cause AutoImmune Disorders. Dr. Reagan routinely recommends silicone implants to friends and family. The majority of his cases are performed with Silicone implants.
Saline implants are also an excellent option for Breast Augmentation at True Beauty. Dr. Reagan prefers Saline in younger patients (25 yrs old), especially if they have a moderate amount of breast tissue(B Cup). Given that Saline implants are placed “deflated” and subsequently filled to desired volume, slight asymmetries between breasts can be corrected at the time of surgery. Dr. Reagan does not believe in “overfilling” the implant to a large degree as this can lead to an undesired hardness. Conversely, Saline implants should not be underfilled as this can increase the chances of rupture (“fold flaw”). In the case of a saline implant rupture, the body will absorb the saline and the breast will become deflated.
Round vs. Anatomic
The shape of implants can either be round or anatomic( “pear shaped”). Both types work well. The ultimate choice should depend both on the patient characteristics and the experience of the surgeon. At True Beauty, Dr. Reagan has expert experience using both types of implants.
Round implants are the most commonly used implants. They are more easily placed, and rotation of implants in the pocket is not an issue. Round implants can be either smooth or textured. Dr. Reagan typically uses smooth implants. If a capsular contraction occurs, then Dr. Reagan may shift to using a textured implant. Round implants come in slightly different shapes- moderate profile, moderate plus, and high profile. Dr. Reagan typically uses moderate plus profile implants as he believes these give the best dimensions for most patients. He does use the high profile implants in more droopy (ptotic) patients that will not be undergoing a lift (mastopexy).
Anatomic implants have an interesting history. They were available in the United States as recently as the 90’s and early 2000’s, but then were “unavailable”. They became available again in 2013. In Europe, anatomic implants have been continuously available and very popular. Proponents of anatomic implants speak of a more natural shape, especially of the upper pole. These implants are firmer than the typical round implant, and they require a larger incision to place. Creation of a precise pocket is critical, since any rotation of an anatomic implant will be noticeable. Data suggests that the capsular contraction rate may be lower with anatomic implants. Dr. Reagan prefers anatomic implants for breast cancer reconstruction, and for select cosmetic breast augmentation patients. For more information, please visit Dr. Reagan at True Beauty for your complimentary consultation.
Smooth vs. Textured Surface
Smooth implants have a “smooth surface”. There is no tissue integration into the implant. Thus, the implant can move within the pocket. This is overwhelmingly the most popular choice of implant surface used in the United States. A textured surface supports tissue integration. Some data suggests the capsular contraction rate is reduced by using textured implants. All anatomic implants are textured.
Location of Implant
Implants can be placed either Above or Below the pectoralis muscle. Historically, the preferred location of placement was above the muscle ( directly under the breast tissue). While this position can more directly lift the breast tissue, it is fraught with a higher incidence of rippling and capsular contraction. Emerging data suggests that bacteria in the breast tissue may contribute to “Biofilms” around the implant that can lead to chronic problems. With the advent of the saline implants the preference of placement shifted towards the submuscular space. Placement in the submuscular space appears to reduce some of the complications seen with subglandular placement. At True Beauty, Dr. Reagan strongly prefers to place implants in the submuscular space. Dr. Reagan may consider using the subglandular space in select patients that already have implants in this position and need implant replacement.
Approach of Surgery(Scar)
There are multiple approaches for placing an implant. The two approaches that Dr. Reagan prefers are either the inferior areola or the infra-mammary fold. As with all surgery, precision and control of the operation is critical. For this reason, Dr. Reagan strongly urges against the use of the umbilical approach (belly button). While this approach can offer the cleave marketing pitch of “no scar on the breast”, the inherent disadvantages of this approach subjects the patient to a higher complication rate of implant malposition and future capsular contractions.
Getting It Right! Size Matters, and So Does Position.
Getting Breast Augmentation “Right” requires two simple steps. First, give the patient the size they request. Often Dr. Reagan sees patients who express frustration with being made “too big” by another surgeon during the first surgery. At True Beauty, we rarely have patients that are unhappy with their post-operative size.. “ What do we do differently” you may ask. The answer is twofold. The first thing is good communication. An honest, unrushed discussion will be conducted regarding the patient’s goals and desires. Photos of previous patients will be examined.. Sometimes patients will bring in magazine photos that they like. All of this is done to ensure that Dr. Reagan and the patient are communicating effectively regarding desired final size. Second, a sizer will be used intra-operatively to select the implant that gives the desired end result. A sizer is an empty implant that is placed intra-operatively and filled with saline until the desired breast size is determined. Not all surgeons use sizers, its an extra step that requires time. But Dr. Reagan feels this is time well spent to deliver optimal results. In addition, Dr. Reagan has a consignment of implants at his surgical center. This means he has all the sizes available for implantation so that you wake up with the breast size you requested.
Correct positioning of the implant is the second step that leads to a successful result. Surgery is about precision, and breast augmentation is no different. Correct positioning of the implant requires precise creation of the submuscular pocket. If the pocket is too large, the implant will fall laterally. If the pocket is too small, the implant will ride too high. Use of a sizer allows Dr. Reagan to assess his pocket with the correct volume of implant in place. The sizer can be removed and adjustments to the pocket can be made. Only after these pocket adjustments are made does Dr. Reagan introduce the permanent implant. Thus, Dr. Reagan positions the implant correctly at the time of surgery. He does not rely on “falling of implant” through gravity or implant manipulation to achieve the desired results. The positioning will look great immediately! The patient will wear a band for 2-4 weeks across the chest to keep the implants in their desired position.
BREAST LIFT (MASTOPEXY)
Breast tissue can sag or droop with aging. When this occurs, the breast is described as being “ptotic” or “breast ptosis”. Other causes of breast ptosis include post-partum and significant weight loss. An important anatomic relationship in evaluating breast ptosis is the location of the nipple-areolar complex to the infra-mammary fold. When the nipple is “at or below” the infra-mammary fold, then some degree of ptosis exists. Remembering from the discussion on breast augmentation, a youthful breast is described as having the breast mound mostly above the IMF with the nipple centered over the mound.
When a small amount of breast ptosis exists and the patient wants to be larger, a breast augmentation alone can sometimes lead to a satisfactory results. However, in cases with more breast ptosis, a breast lift (mastopexy) will be necessary.
There are 3 different mastopexy options. The simplest form is a Peri-areolar Mastopexy. As the name describes, the incision is confined to around the areola. Essentially a doughnut of skin is excised and the nipple is elevated. The advantage of this approach is a limited scar around the areola. The disadvantage of this technique is that only minimal nipple elevation can be achieved, so its indications are limited. A crescent mastopexy is simply a superior ½ peri-areolar mastopexy.
Dr. Reagan’s preferred treatment for breast ptosis in the Vertical Mastopexy. While this technique results in a “lolli-pop” type scar, the resulting shape is superior to that of a peri-areolar mastopexy. Finally, a Full Mastopexy may be indicated is cases of severe ptosis and extensive skin redundancy (massive weight loss). The resultant scar will be an “anchor or inverted-T”.
A note about Mastopexy. The traditional approach to lifting the breast tissue is to use the skin as a brassiere. Essentially a pattern is excised and the skin is repositioned, bringing the breast tissue with it. With this approach, more tension is placed on the skin closure resulting in worse scars and recurrence of drooping. The skin is not meant to hold the weight of the breast tissue. In 2008, Dr. Reagan adopted a new, better way of performing a mastopexy. The re-arrangement is done directly to the breast tissue. A flat, droopy breast is actually sculpted into a more perky breast. The skin is redraped passively, resulting in better scars with a more predictable and lasting result. Notice how good Dr. Reagan’s results look early in the post-operative period.( see photo gallery) With the vertical mastopexy there will be some redundant skin inferiorly that will contract over 4-6 weeks to reveal an excellent shape. Rarely does Dr. Reagan need to perform a full-mastopexy anymore. Great results, less scarring, less recovery- that’s the True Beauty way! True Expertise, True Service, True Satisfaction!
BREAST AUGMENTATION AND LIFT (Augmentation/Mastopexy)
In cases of mastopexy when the patient desires a larger size or more superior fullness, a breast augmentation can be performed simultaneously. In most cases, Dr. Reagan will place the implant under the pectoralis muscle. A vertical mastopexy is usually sufficient. Prior to adopting a new strategy for mastopexy in 2008, the “augmentation/mastopexy” procedure was somewhat unpredictable. Often the scars were prominent. Now, simultaneous augmentation/mastopexy is one of Dr. Reagan’s favorite procedures. The immediate results look great. The healing process is easy and predictable. Drains are not typically used. This procedure is testimony to the dedication that Dr. Reagan has towards improving outcomes and offering his patients the best treatment!