Are you considering breast augmentation surgery in San Diego? Dr. Brian Reagan is a breast augmentation expert, and he invites you to visit his office in La Jolla for a breast implant consultation.
Why choose Dr. Reagan of True Beauty San Diego for Breast Augmentation
Breast augmentation remains one of the most commonly performed cosmetic procedures in the United States. At True Beauty San Diego Aesthetic Surgery & Medicine, Dr. Brian Reagan is an expert in performing natural breast augmentation/enhancement and is known for his meticulous and patient-based approach. You will meet Dr. Reagan for an unrushed, private consultation. Your health will be discussed, an examination will be performed, and before-and-after results will be reviewed. An operative plan will be tailored specifically for you. An honest discussion of the expected outcomes, recovery and associated risks will be conducted to ensure 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 ensure 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 breasts who wishes to increase by one or two cup sizes. In some cases, simply achieving more breast fullness is desired. Lifting a droopy, sagging breast (breast ptosis) that is also shapeless or deflated is another indication for breast augmentation. Proper selection and placement of a breast implant can lift the nipple-areolar complex approximately one to two centimeters. For breasts that need more lifting, a formal breast lift (mastopexy) will be necessary (see below). Finally, breast asymmetry (uneven breasts) can also be improved with breast augmentation. In this scenario, different sized implants will be utilized to achieve more uniformity in breast size.
The Three Fundamental Questions to Be Answered Regarding Breast Augmentation
You will receive a seemingly overwhelming amount of information during your consultation. While all information is important, your attention should be focused on three fundamental questions regarding the actual surgery:
- What type of implant will be used?
- Where will the implant be placed (above or below the muscle)?
- What incision approach will be used?
Breast Augmentation with Implants
Dr. Reagan commonly uses smooth or round breast implants with either silicone or saline filling for breast augmentation. In either case, the implants are 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. Dr. Reagan releases the muscle inferiorly and partially medially to yield excellent positioning immediately. Sometimes a breast lift must be performed at the same time if the breasts are droopy (ptotic).
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 benefit women who desire a small boost in size, but the technique is relatively new and is still somewhat unpredictable.
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 will be determined after the consultation.
The main advantage of silicone is its more natural feel. This is especially true when the patient possesses little breast tissue (i.e., A cup sized breasts). Women must be 22 years old or older in order to have silicone breasts implants placed. A downside to silicone breast implants is that ruptures and leaks can only be detected through breast imaging exams, such as mammograms or MRIs. For this reason, women with silicone implants are advised to undergo some form of imaging exam every few years to ensure the outer shell is intact. Women approaching their 40s will likely be getting a mammograms, but much younger women will need to factor the potential cost of breast imaging exams in their decision making. In addition, silicone is more expensive than saline. Finally, since silicone implants come pre-filled, the incisions created to place the implant are generally a little bit bigger than those used to place saline implants.
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 modern versions, the silicone is much more viscous and will not migrate to other parts of the body. 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 specifically look at the safety of silicone and saline implants. After many years and thousands of cases, the data suggests the following: Silicone implants do not cause breast cancer, nor do they delay the detection of breast cancer, and silicone implants do not cause autoimmune disorders. Dr. Reagan routinely recommends silicone implants to his own 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 to use saline implants in younger patients (25 years and younger), especially if they have a moderate amount of breast tissue (B cup breast size). 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 under-filled 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 noticeably deflated.
Round vs. Anatomic
Breast implants can either be round or anatomic (“pear-shaped”). Both types work well. The ultimate choice should depend both on the patient’s characteristics, personal preferences 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 textured implants. 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 patients with more droopy (ptotic) breasts 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 ’90s 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 in 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 contracture rate may be lower with anatomic implants. Dr. Reagan prefers anatomic implants for breast cancer reconstruction, and for select cosmetic breast augmentation patients.
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 contracture 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 comes with a higher incidence of rippling and capsular contracture. Emerging data suggests that bacteria in the breast tissue may contribute to “biofilms” around the implant that can lead to chronic problems. With the arrival 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
There are multiple approaches for placing an implant. The two approaches that Dr. Reagan prefers are the inferior areola or the inframammary 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 marketing pitch of “no scar on the breast,” the inherent disadvantages of this approach subject the patient to a higher complication rate of implant malposition and future capsular contractures.
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 the 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, as it is an extra step that requires time. But Dr. Reagan feels this is time well spent to deliver optimal results. In addition, Dr. Reagan has an array of implants at his surgical center to help ensure that you get the exact 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 the 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 the implant to fall into place through gravity or implant manipulation to achieve the desired results. The positioning will look great immediately! The patient will wear a band for two to four 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 “ptotic” and the condition “breast ptosis.” Other causes of breast ptosis include weight fluctuations following pregnancy and significant weight loss. An important anatomic relationship in evaluating breast ptosis is the location of the nipple-areolar complex to the inframammary fold. When the nipple is “at or below” the inframammary fold, then some degree of ptosis exists. A youthful breast is described as having the breast mound mostly above the inframammary fold with the nipple centered over the mound.
When a small amount of breast ptosis exists and the patient wants larger breasts, a breast augmentation alone can sometimes lead to a satisfactory result. However, in cases with more breast ptosis, a breast lift (mastopexy) will be necessary.
There are three different mastopexy options. The simplest form is a peri-areolar mastopexy. As the name describes, the incision is confined to around the areola. Essentially loose 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 is 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 in cases of severe ptosis and extensive skin redundancy (massive weight loss). The resultant scar will be an “anchor or inverted-T.”
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 perkier breast. The skin is re-draped passively, resulting in better scars with a more predictable and lasting result. With the vertical mastopexy, there will be some redundant skin inferiorly that will contract over four to six 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! Please visit our before-and-after gallery to see Dr. Reagan’s stunning breast lift results.
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!