Breast Augmentation

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FDA restricted the use of silicone implants in 1992.

Plastic surgeons experienced a precipitous drop in the number of breast augmentations they performed.

Government’s concern at the time were reports that silicone implants were causing generalized symptoms in some women (Rheumatoid arthritis, lupus and other auto immune diseases).

In the years that followed multiple large studies were performed at leading medical centers yielding consistently favorable data.

The Institute of Medicine independently reviewed this data for the US Congress and found conclusively that there was no evidence that silicone implants were responsible for any major diseases of the body and that these devices did not increase the risk of primary or recurrent breast cancer.

Since then, many other studies have solidified these conclusions reassuring the public that silicone and saline implants are indeed safe.

November 2006 – FDA approved again the use of SILICONE implants.

Breast Augmentation has become one of the most commonly performed cosmetic procedures in the US.

Plastic Surgery News – May 2007

1. 329,000 Breast Augmentation Procedures (Most Popular) in Plastic Surgery.

2. We now perform over 300 breast augmentations yearly.

3. 34% of American women in a study were found to be dissatisfied with the shape and size of their breasts.

Improving breast contours and unevenness may seem trivial and vain at the surface, but the emotional implications are far reaching. The boost in self-confidence that we witness in our patients makes this procedure extremely rewarding.

A significant number feel a lack of femininity and have an altered body image similar to our mastectomy patients before their reconstruction.

Those that are severely underdeveloped avoid bathing suits and instead wear bulky t-shirts to obscure their flat chests. Their gratitude after the surgery is unparalleled and they invariably become an important source of referrals to our growing practice.

1. Silicone vs. saline, SILICONE
2. Round shape vs. contoured, DEPENDS
3. Smooth surface vs. textured, TEXTURED
4. Pre-filled vs. inflatable, PRE-FILLED
5. Under the chest muscle vs. over, UNDER
6. In the hospital vs. the office, HOSPITAL
7. Sedation vs. general anesthesia; SEDATION

Not to mention the different size implants and manufacturers available, as well as which incision to use and whether or not other procedures are required (breast lift and constriction release among others). It can become overwhelming?

Silicone vs. Saline implants

The Institute of Medicine unequivocally ruled out the association between silicone gel implants and systemic diseases.

Saline implants can and do eventually deflate (<1% yearly)

Saline deflations where the patient soon notices a decrease in size and seeks attention, the ruptured silicone implant can go undetected for years until the breast starts hardening and becomes painful

Salt water used to fill them is completely harmless to the body and gets reabsorbed

Saline occasionally report a “less natural feel”

Silicone implants weigh less and have a lower chance of “rippling” (you can see wrinkles in the skin.

Round shape vs. Anatomic shape (tear drop)

Very little difference between the two

Additional cost of the anatomic implant and the possible rotation deformity reported at 14%

That´s why we prefer round.

Smooth vs. Textured (rough) surface

Research in the early 90’s indicated that textured silicone implants hardened less frequently than smooth ones.

That´s why we prefer textured

in patients that are underweight (low BMI),
that have visible ribs
and/or a pinch test on the chest of less than 2 cm.
(just under an inch). In them, smooth is better.

Placing the implant behind the chest muscle or in front

Pectoralis major muscle of the chest.
More surgeons, as I do, feel strongly that behind the muscle is better.

Major advantages

Lower rate of hardening,
better preservation of nipple sensation,
improved breast contour (the edges of the implant are obscured by the muscle)
and improved visualization on mammogram.


More pain after the surgery,
the breasts look fuller at the top the first month
and the implants occasionally “bounce” when the chest muscle is contracted forcefully (as in some body builders).
Despite these inconveniences, behind the muscle is definitely the way to go.

Which incision to use

Under the fold

In a crease of the armpit
Through the areola (nipple)

or the belly button

Most Common in my practice: Through the areola


MENTOR – FDA approved

Eurosilicone – Excellent Quality

Office vs. Hospital

Prevent complications, Reduce Risks
Disadvantage: Increased number of infections (air contamination), in this Hospital we have a special Air Condition System to filter infection.
Facility is accredited (AAAASF or AAASH)

About the complications

No surgery is without risks
but these should be minimal

Possible Complications

Reduce Sensation(95% Recovery in 3 months)
Deflation of implant (Saline),
Hardening requiring surgery
Revisional surgery for implant malposition