Breast Augmentation (Saline Implants) Questions and Answers Archive

Oct
2001

Q&A: Is my plastic surgeon correct in that breast implants would be better located above the breast muscle rather than below?

Question:

I was told by another plactic surgeon that I would need a breast lift because of child bareing days & sagging. And the Dr. told me after studies, the best way to insert the inplant would be above the muscle not behind it. That it would make a more natural look. I would like a different point of view..I was looking for the implant's to be under the muscle not on top..

- Donna

Answer:

 Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Donna, Your doctor was correct. The most natural place for an implant is above the muscle since this allows cleavage to be obtained and this is where breast tissue naturally is. The only reason we place implants under the muscle is if the chest wall tissue is very thin and the implant would be seen if placed just under the skin. This is because currently available implants cannot behave naturally since they are little salt-water filled bags which do not act or look natural.

-- Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Sep
2001

Q&A: Breast Augmentation done 6 or 7 years ago. Getting light colored circles that itch under my nipple. Do I have an infection?

Question:

I had Breast Augmentation done 6 or 7 years ago. I have noticed the last 6 months that my left breast, right under the nipple, somtimes gets these light colored circles that itch. There almost like little sores. They scab up and than go away. I have been extremley tired and just am not myself. Could this be an infection from the implant? Thank You Charlena

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Charlena, I doubt that that would be the only symptom from an implant infection. It may be shingles since you are so tired and that may be from other causes. I would suggest that you visit with a dermatologist or your plastic surgeon in order to see what the problem is and what can be done to correct it.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Sep
2001

Q&A: Can I avoid "capsular contraction" if I have my breast implants replaced?

Question:

I have some questions that I would really appreciate a response to. First, I had breast implants done approximately 16 years ago (silicon) I was 25 years old at the time. I now am faced with "capsular contraction" (I believe that is what it is called, hardening and discomfort of the breasts). I would like to know what the success rate is for successfully replacing the implants and not having the problem reoccur. Is it possible to have the upper and lower eye lids lifted at the same time as this replacement surgery? Also, one question that I am very embarrassed about since I have never heard of this problem before, is there any surgery that would alter the appearance of "extremely" long vaginal lips, I take the word "extremely" from an obstetrition who must have felt that since I was in labor that I would not be sensitive to his remark "she has extremely large vaginal lips". Please answer this question, it has made me very self concious even though my husband says its great!

- DONNA

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Donna, The capsular contracture is a difficult problem and recurrence is common (at least 50% from published studies. It is reduced by the use of textured implants and also by placing the implants under the muscle (a less natural position but one which better "hides" the implant. Eyelid surgery can very safely be performed at the time of explantation, removal of the capsules and replacement surgery. The vaginal lips question is very common. Often women are uneven on the two sides and require evening of the lips. The labia minora (proper term) reduction is commonly performed in my practice (about once or twice per month) with excellent results. Make certain that they are not over reduced, your husband won't appreciate it.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Aug
2001

Q&A: Should I consider the umbilical (naval) incision site for breast augmentation and will the breast be place accurately?

Question:

I am scheduled for a breast augmentation surgery in one week. My surgeon has given me several choices of incision sites--Under the breast, axilla, nipple, or unbilical region. I am very familiar with the under the breast approach, but not so familiar with the navel/umbilical approach. The staff at the surgeon's office really are pushing for the umbilical approach where there will be no scarring in the breast area, but I am hesistant as I know very little about this procedure. Are you familiar with this approach? Do you think that this procedure is easier to rehab from? Do you think that the implants will be put in with the accuracy as they can be with the slit under the breast?

- Christy

Answer 1:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Christy, Not only is it more difficult to make an even pocket for the implant but, the implant manufacturers (last time I checked) will not cover the implants for problems such as leakage if they are placed through the umbilical approach. Most of us prefer a site on or near the breast.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii

Answer 2:

Jonathan Ross Berman, MD - LocateADoc.com

Smaller scars are achieved with a navel operation. Normally, whether I place breast implants in via the inframammary, periareolar, armpit approach, the incision is only about 1.5 inches. I get great exposure and see everything very easily and I am "right there". Is an 1.5 inch incision too big? I do not think so. I see no advantage placing implants in via the umbilicus.

--Jonathan Ross Berman, MD
Boca Raton, Florida



Aug
2001

Q&A: What should I do if my breast augmentation resulted in implants that look and feel rippled?

Question:

I had breast augmentation 2/01. It was planned that I would receive textured implants. After the surgery my Dr. advised me I had too thin of skin for textured. I requested my original breast size of 36D (after babies & weight loss I was a 36B). I am 40 years old. My main concern is that the implants look and feel rippled (all the way around), as though they are too large for the size I requested. It is as though there is too much material for the fluid amount. Is this possible?

- Teresa

Answer 1:

Jonathan Ross Berman, MD - LocateADoc.com

Be fair to your plastic surgeon and ask him/her what they think they can do to help you. I believe that the doctor acted in your best interest to give the best operation for you. Your questions are reasonable. Ask your doctor! We here have not examined you and it is easy to render an opinion as a "monday morning quaterback."

--Jonathan Ross Berman, MD
Boca Raton, Florida

Answer 2:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Teresa, Although it is possible it is unlikely. Breast implants are filled within the requirements set forth by the implant companies and sometimes even more so. If your surgery was performed by a competent plastic surgeon with many implants to choose from, it is unlikely that he/she would underfill the implant. I am not certain why you did not receive a textured implant since this is possible to be placed even in very thin individuals and texturing seems to reduce the incidence of capsular contracture down the road. Rippling is an inherent problem with any implant that is filled with saline - as they all are in this country at the present time.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii

Answer 3:

Josh Korman, M.D., F.A.C.S. - LocateADoc.com

Dear Teresa, You could have more saline put in, but that would probably give you the same problem. Since you have already had saline implants placed and your skin is thin, you would be eligible for silicon gel implants under a special study which many plastic surgeons participate in. Check with your plastic surgeon about this.

--Josh Korman, M.D., F.A.C.S.
Mountain View, California



Aug
2001

Q&A: Am I more likely to have nerve damage from breast augmentation via a nipple site incision versus other sites?

Question:

I am scheduled for breast augmentation in two weeks, but have some reservations about the incision site (the nipple). Is this site more likely to result in nerve damage? I cannot seem to get a concrete answer from my doctor or anyone else. What is the collective opinion? Thanks.

- Katharyn

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Katharyn, No, this site is not more prone to nerve damage or loss of sensation. The sensory nerves come in from deep along the 4th thoracic vertebrae. You are more likely to suffer damage to nipple sensation the larger the implant that is placed since then the dissection to place the implant may affect that nerve. The route that the skin is incised is least likely to affect the sensation.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Aug
2001

Q&A: Do breast implants obstruct the ability to identify breast cancer lumps?

Question:

My wife may be interested in breast implants. Her major concern is that her family has a history of breast cancer. Do the implants "get in the way" when detecting a lump?

- Scott

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Scott, Many studies have been done on this subject, most of which showed no delay in detection of breast cancer with implants. Special views are needed by mammogram or, better, MRI in detecting early breast cancer. Depending upon the type of breast cancer and its inheritable characteristics, a better determination can be made of the risk involved. I would suggest that you and your wife visit with a qualified plastic surgeon in your area to determine if the risks are warranted.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Aug
2001

Q&A: How expensive are the "tear-drop" type of breast implant and are they less dangerous?

Question:

Can you tell me more about the "tear-drop" type breast implants? And how much do they typically cost? Are they less dangerous? Thanks.

- Sheila

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Sheila, Anatomical implants are meant to give a more contoured look to the woman when she is in upright posture. They have largely been overated and can give a strange look to the supine (lying down) chest. They are no safer and are still filled with salt water which will always have problems with looking and feeling natural. They cost more than standard implants and thus the cost of surgery is more as well.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Aug
2001

Q&A: How do I find the best surgeon for breast augmentation given I have a curved spine and cost is not a concern?

Question:

I have just moved to Ft. Lauderdale Florida and I am interested in breast augmentation. However, I have a curve in my spine and it has given me in general terms...a (pigeon breast). My chest is uneven and I am extremely embarassed of this. I have a small B cup breast and I want to enlarge them enough to have cleavage and to help make the uneven breast bone less noticeable. I need a plastic surgeon that is an expert on something like this.. Can this be done? How can I locate someone in the top of this field? I want someone that a celebrity would choose. I am not concerned about the cost. I just want the best surgeon that I can find. Please help! Sincerely, Brandee Toledo

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Brandee, I have seen a number of patients with your chest wall condition who have had severe problems after simple breast augmentation with the implants essentially joining in the middle. I would suggest that the chest wall deformity be evaluated first and, if correction is needed, that this occur with the implant procedure. I would suggest that you visit with a center of excellence such as the Mayo or Cleveland Clinics for this evaluation prior to visiting with a cosmetic surgeon for the implantation procedure.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii