Breast Implant Position - Part 2

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

Breast Implant Position Part II

by Dr. Michael D. Vennemeyer |

Subglandular Breast Augmentation

Placing the breast implants over the muscle is also called subglandular because the implant is directly beneath the glandular tissue of the breast.  Positioning the implant over the muscle leads to a faster recovery.  There is less pain and swelling.  Also, the shape of the breast can be improved easily because the implant is in direct contact with the breast tissue which is draped over it.  Sometimes surgeons describe this as the implant “molding” the shape of the breast.  This is not entirely accurate.  As we discussed in “The battle for final breast shape” the interaction between the implant and breast tissue results in the final shape.  This change is variable.  However, in most patients this can help improve the shape of the breast.  The improvement results from the increase in volume filling the skin and the shaping effect that the implant has on the breast tissue.  The breast implant can exert this effect best in a subglandular augmentation because it is in direct contact with the breast tissue.  This effect is not as pronounced with the implant positioned under the muscle.

Subglandular Breast Augmentation Disadvantages

The down side of placing the implant over the muscle is that you may see and feel more of the implant than you would like.  Think of it this way.  The more of you (your breast tissue) that covers an implant, the less you feel the implant and the more you feel you.  Your breast will feel more natural and look more natural the more of you that covers the implant.  If there is less breast tissue covering the implant you are more likely to see rippling and you will feel the implant more when you touch your breasts.  Another disadvantage- there is a higher rate of capsular contracture when the implant is placed in a subglandular position.  Finally, there is more interference with mammography when the implant is subglandular.

So who benefits from placing an implant over the muscle?  Classically, it is women with ample breast tissue where there is enough soft tissue coverage to minimize the risk of rippling and implant visibility.  You’re probably thinking, “If I had ample breast tissue I wouldn’t need an augmentation in the first place.”  We completely understand if you feel that way.  Most women seeking breast augmentation don’t have much breast tissue and want another option.  In “Part III:  Under the Muscle” we will tackle that option to see if it works for you.

 

Breast Implant Position Part I

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

Breast Implant Position

Women considering breast augmentation frequently ask, “Should I have my implants placed over or under the muscle?”  Answering this intimidating question is easier than you might think, once you have the right knowledge.  Although this blog will probably give you a good idea what the right choice is for you, the best way to make that decision is during your consultation.   After considering your goals and performing an examination, we can help you discover what implant position will work best for you in the long term.  First, it is important to understand how your breasts get their final shape from a breast augmentation.  Then, you will be able to better understand the advantages and disadvantages of various implant positions, which we will discuss in parts II-IV.

Implant vs. Breast:  The Battle for Your Final Breast Shape

Before we discuss implant position, it is important to understand how you arrive at your final breast shape after an augmentation.  Your breasts have a certain shape to them.  An implant has a certain shape.  They both have variable stretchy characteristics.  They both have variable degrees of softness.

Breast Skin Elasticity

Your breasts are covered with skin that has elasticity.  Usually your skin gets less elastic as time (and pregnancies) go by. The amount of skin and elastic quality of that skin, the amount of breast tissue inside the skin and the distribution of that breast tissue all add up to determine your breast shape.  More skin, less elasticity and less breast tissue filling results in a breast that looks deflated and ptotic (saggy ).  More breast tissue and less, tighter skin result in a perkier breast.

Breast Implant Effects on Breast Shape

The implant is designed to have a particular shape, volume, and projection.  Implants have different levels of softness and change differently with compression, depending on what they are filled with.  (See Breast Blogs Saline vs. Silicone I, II, and III)  There are all sorts of implants that vary in these characteristics.  Implants can have the same volume, but the degree of projection can vary and result in different shaped breasts.  The degree of projection is often referred to as “profile” (for example:  High profile, moderate profile, etc.)

Breast Interacts with Implant

So, now we have your breasts on one side, and the implants on the other.  In the operating room we bring them together and they interact.  The breast pushes on the implant, and the implant pushes on the breast.  All of these characteristics we have discussed intermingle to give your final, unique shape.  The shape that results is not solely determined by the implant or the breast, but somewhere in between.  Perhaps this sounds like complete chaos.  Rest assured.  With training and experience a plastic surgeon knows how to predictably combine these factors to get the result you want.  That’s why we ask about your goals during your consultation, so we can help you make the right decisions.  Now that you understand the interaction between implant and breast, we can discuss how different implant positions affect shape and a few other things.   In the next blog, we will discuss placing the implant over the muscle.



Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

2139 Auburn Avenue, Suite #201
Christ Hospital Medical Office Building,
Cincinnati - Ohio
(513) 793-4000


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Breast Augmentation in Cincinnati Dr Jean Loftus in TV Interview

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center



Dr Jean Loftus Plastic Surgery Cincinnati, author of "The Smart Womens Guide To Plastic Surgery" interviewed on TV show Later Today.

Tips and Traps on Finding a Plastic Surgeon

On How to Find a Plastic Surgeon

Finding a qualified plastic surgeon can be challenging. Do not underestimate the complexity of this important task. Consider the following advice:

Ask a friend:

If a friend was satisfied with the care provided by a plastic surgeon, then chances are that you will be similarly pleased. Unfortunately, not everyone has a friend who has had plastic surgery.

Ask someone in the medical profession, such as your family doctor or a nurse:

Keep in mind, however, that doctors and nurses may only be familiar with the physicians at their own hospitals, and they may refer to plastic surgeons based on personality or friendship rather than ability. They will also tend to refer to “hospital-based” plastic surgeons, who tend to perform mostly reconstructive surgery. Make sure your plastic surgeon spends most of his or her time performing cosmetic surgery – especially the one your seek.

Look for a Plastic Surgeon who is certified by the American Board of Plastic Surgery:

Be aware of made-up boards that sound official and issue official-appearing certificates. These boards may sound impressive, but according to Joyce D. Nash, author of What Your Doctor Can’t Tell You About Cosmetic Surgery, “Certification of competency from such organizations is probably meaningless.” Be certain to ask from which board certification was received. If your plastic surgeon is not certified by The American Board of Plastic Surgery, be suspicious.

You may look in your telephone directory for a plastic surgeon, but beware:

Know that in most metropolitan telephone directories, only about two thirds of the physicians listed under “Plastic and Reconstructive Surgeons” are plastic surgeons who are certified by the American Board of Plastic Surgery (ABPS). Some physicians listed in the plastic surgery section have absolutely no formal training in cosmetic plastic surgery.
Telephone directories in most states do not require physicians to state from which board they received certification.
Therefore, physicians may advertise under “Plastic and Reconstructive Surgeons” and state they are board certified, but not be certified by the American Board of Plastic Surgery.

Look for a Plastic Surgeon who is a member of the American Society of Plastic Surgeons (ASPS).

The ASPS only inducts plastic surgeons who are certified by the American Board of Plastic Surgery. To obtain the names of these plastic surgeons in your area, call the ASPS at 847-228-9900 or visit their web site at http:\\www.plasticsurgery.org.

Summary advice on finding a qualified plastic surgeon:

Finding a qualified plastic surgeon may seem like a daunting task. It can be. Understand that unqualified physicians make great efforts to create the impression that they are plastic surgeons. Be aware that the term “board certified” is meaningless, unless it is associated with the name of the board from which certification was received. Know that, in many states, it is legal for unqualified physicians to perform plastic surgery procedures in which they have not been trained. Realize that you may unknowingly see an unqualified physician, but think he is a qualified plastic surgeon. If you understand these issues, then you are well ahead of the general public. To begin your search, call a reputable plastic surgery organization, such as the American Society of Plastic Surgeons (847-228-9900), ask for the names of plastic surgeons in your area, and carefully evaluate your plastic surgeon during the consultation.

More About Loftus Plastic Surgery Center:

At Loftus Plastic Surgery Center, we offer everything from breast augmentation to facial rejuvenation and body contouring surgery. Our professional staff specializes in cosmetic plastic surgery for women. If you are looking into breast augmentation, we offer both saline and silicone implants. From face lifts and rhinoplasty to tummy tucks (abdominoplasty), our staff look forward to assisting you through the process.

Cosmetic Surgery in Cincinnati

Forehead Lift

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

Brow lift (forehead lift) is a plastic surgery procedure which will raise your eyebrows to a higher and more aesthetic position. It will also improve lateral hoods (which are the droopy flaps of skin that hang over the outside corner of your eyes. Plastic surgery of your forehead will also soften your horizontal forehead wrinkles and the scowl lines between your eyebrows.
A brow lift will NOT improve baggy eyelids, puffy eyes, or crows feet. Consider eyelid surgery or wrinkle treatments for these problems.

Scars from a Brow Lift

May be on top of the head or in front of the hairline, depending on the technique chosen (see Brow Lift Options below).

Brow Lift Options

Brow lift may be performed in several ways. There are three commonly used techniques (Hint: if your surgeon suggests a technique which is not similar to one of these, then go elsewhere). The options are coronal lift, endoscopic lift, and subcutaneous lift.

A coronal forehead lift involves an incision across the top of your head, from ear to ear. Through this incision, your surgeon can alter the muscles (frontalis, procerus, and corrugators) that cause horizontal forehead wrinkles and scowling.
After doing this, your surgeon will actually remove about a 1-2 cm strip of your scalp and sew the remaining scalp together.

Although this may sound gruesome, it is the oldest and most reliable technique in brow lift surgery. The main disadvantage is that you will be numb on the top of your head for about six months, after which time the sensation usually returns. This technique also raises your hairline, which can be a problem for those with a high forehead who also wear their hair back. The advantages of this technique are that it is lasting (it will not have to be repeated as you age, with very rare exceptions). Also the scars are concealed behind the hairline and are not seen after they heal (unless you are a man with a receding hairline, in which case you should not have this kind of brow lift).

Endoscopic forehead lift involves four to six short (one inch) incisions behind your hairline. Through these small incisions, your plastic surgeon inserts and endoscope which has a tiny camera on the end. This allows her or him to see under your skin without making a long incision across the top of your head. Through this technique, your plastic surgeon will be able to do most of the things that can be accomplished through a coronal lift with a few notable exceptions. Your plastic surgeon will be able to weaken the scowl-causing muscles but will not be able to directly alter the muscle that causes horizontal wrinkles. Also, your plastic surgeon can lift your forehead, but does not remove the excess scalp. She (or he) merely shifts it upward and backward on your skull. To secure your scalp into its new position, your plastic surgeon may drill small hole into your skull and place tiny screws (which later are removed or which are absorbed by your body). Even with these screws, because excess scalp is not removed, there exists greater potential for your forehead and brows to droop
after an endoscopic lift. (Relapse is most common in those with very droopy brows and very deep creases.) Because endo lifts have only been performed since 1995, no one knows exactly how long the results last. Finally, endo lifts, like coronal lifts, raise your hairline, but (unlike coronal lifts) they do not cause temporary numbness on top of your head.

Subcutaneous forehead lifts are the least commonly performed of all brow lifts. In this technique, your plastic surgeon makes an incision across the top of your forehead, where your hairline begins. All of the muscle alterations that are performed through a coronal lift are possible through this operation. Also, your excess skin is removed. Because the incision is in front of the hairline, your hairline will not be moved higher (unlike the other two techniques). Also, you will not have numbness on top of your scalp. The major disadvantage of this technique is that it leaves a scar across the top of your forehead, which can be highly visible (see brow lift photos). To conceal your scar, you will need to wear your hair forward. If you are wearing your hair forward, then it doesn’t matter as much how high your hairline is because your hairline will not be visible. Hence, you could have had a coronal lift or endo lift in the first place. Think about it.

During and After your Brow Lift

Anesthesia: sedation or general.
Location of operation: Office or hospital.
Length of surgery: 30-90 minutes.
Length of stay: Outpatient (home same day).
Discomfort: Mild; anticipate 0-4 days of prescription pain medication.
Swelling and bruising: Improve in 10-14 days. You can reduce swelling through constant head elevation and frequent application of ice. You may develop black eyes temporarily.
Bandages: Removed in 1-3 days.
Stitches: Removed in 7-10 days.
Contact lenses: May be worn in one week.
Make-up: May be worn in 3-5 days.
Presentable in public: 7-14 days, with the help of make-up.
Work: You may feel capable of returning within 3 days, but your appearance will be the limiting factor.
Exercise: May be resumed in 2 weeks.
Final result: Seen in 2-4 weeks.

Ask your surgeon about these possible complications and telltale signs

Forehead paralysis
Brow asymmetry
Permanent loss of hair
Numbness of the forehead
Early relapse
The surprised look
High hairline

Click Here for Average Cost of a Forehead lift

(The above listed fees do not reflect those of Dr. Loftus. For a complete listing, visit Fees at The Loftus Plastic Surgery Center.)



Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

2139 Auburn Avenue, Suite #201
Christ Hospital Medical Office Building,
Cincinnati - Ohio
(513) 793-4000


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Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

Gummy Bear Breast Implants

Written by Dr. Jean Loftus | 18 November 2009

Vs. Non-Gummy Bear Breast Implants and Saline

Gummy Bears are the candy that are soft and pliable but dont lleak when they are cut in half. This is the name chosen for a type of silicone gel breast implant that behaves similarly. Gummy bear implants are more cohesive (thicker) than regular silicone gel breast implants. The whole idea behind them is to guard against leakage of silicone gel if and when the implant shelll ruptures. This may in turn decrease the risk of capsular contracture. Unfortunately, these hopeful advantages have not yet been proven, but studies are underway. We do know that gummy bear implants are much less likely to ripple or wrinkle than saline, and also less likely than regular silicone. So, if you have silicone gel implants that wrinkle, then gummy bear implants may be for you….someday.

FDA Approval

Unfortunately, gummy bear implants are not appproved by the FDA, which is why they are not yet available to the public in the U.S. Projected date for their hoopeful approval is unknown. In the meantime, you can get them in some other countries….but I always recommend waiting until any product receives FDA approval before using it.

Shape and Texture

Gummy Bear breast implants are so thick that they must necessarily be shaped (teardrop) -  so round is not an option. Also, because thye are shaped, they are made textured to prevent rotation after placement. So, if you ever do get gummy bear implants, shaped textured ones are the only options.

Outlook

I can’t wait for the day that Gummy bear breast implants are available in this country – and I AM optimistic that that day will come….I just do not know when. Gummy Bear breat implants will offer women another important option for both breast augmentation and breast reconstruction.
Breast Wishes!
Dr. Loftus
Author and Plastic Surgeon



Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

2139 Auburn Avenue, Suite #201
Christ Hospital Medical Office Building,
Cincinnati - Ohio
(513) 793-4000


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Tips And Traps Of Plastic Surgery

Plastic Surgery Tips and Traps To Avoid

Traps abound in the realm of cosmetic surgery. One way to avoid potential pitfalls is to be aware of them. Print this page and keep it handy. Some of these items might help protect you from an adverse outcome. In addition to the general tips and traps listed here, you will find specific ones along with each procedure on this site.

Questions to Ask when Scheduling an Appointment

When calling to schedule your appointment, ask questions freely. Expect the staff to be courteous, informative, and accommodating. If they are not pleasant before surgery, they certainly will not be afterwards.

• Is the doctor certified by the American Board of Plastic Surgery? Beware of other board certification even if it sounds similar or better.
• What is the surgery fee? Does the cost include the anesthesiologist, the facility, and the implant?
• What is the consultation fee? Is it deducted from the cost of surgery?
• Is the doctor punctual? If so, then expect to be seen promptly.

Checklist for Your Plastic Surgeon:

• Is she certified by the American Board of Plastic Surgery?
• Did he explain procedures, risks, and alternatives in detail and with clarity?
• Did she describe recovery time and postoperative care?
• Did she convey realistic expectations?
• Did he answer questions thoroughly?
• Did he listen to your concerns?
• Did she make you feel comfortable?

Unless the answer to each of these questions is a resounding “yes,” then you should consider seeing another plastic surgeon.

Questions to Ask Your Plastic Surgeon During the Consultation

• Will I be awake or asleep for surgery? Consider general, sedation, and local anesthesia. Note that you may sleep during either general or sedation anesthesia, although the depth of sleep varies.
• How do you avoid the telltale signs of surgery? Bring a list of telltale signs to the doctor’s office (you will
  find them on this site on the page which describes the procedure you seek).
• May I see pictures of others who have had the same procedure? Know that most will show you their best pictures, so this exercise may be of limited help. This is actually most useful if you dislike the results you see, because it tells you that your surgeon’s best results are below your expectations and it is time to see someone else.
• May I speak with others who have had the same procedure? Know that most doctors will refer you only to their satisfied patients. This is not generally a useful activity.
• Do you have privileges to perform this procedure in a hospital? Even if performed in the office, your surgeon should have hospital privileges to perform the procedure as evidence of his or her qualifications.
• Will surgery be performed in the office or hospital? If your surgeon suggests the office, be certain that the office is accredited for your procedure and that the surgeon has hospital privileges to perform the procedure you seek.
• If surgery takes longer than expected, who will pay the extra cost? This is an important question
  when surgery is performed in the hospital because the operating room and anesthesia fees may accrue hourly.
• Do you charge for revision surgery? Know that some procedures have as high as 15-20% revision rate.
  Unless you want to get stuck with another big bill, it is best to establish this ahead of time. You cannot simply assume that you will not need revision surgery.

• Will I be charged for follow-up appointments? Expect at least one year of follow-up appointments at no charge.

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center

Size Matters | Breast Augmentation Cincinnati Ohio

Size Matters

Written by Dr. Jean Loftus | 30 June 2009

Size Issues

Whoever said size isn’t important has never dealt with breast implants. One thing I know for sure, after 15 years and thousands of breast implants, is that size does matter. It matters a lot. If you don’t get the size right, you probably won’t be too happy with the outcome of the procedure. In fact, I advocate that women who choose to have breast augmentation choose the best size implant and then work every other decision around that decision.

This is not to say that bigger is better. In fact it is not. The important thing about breast implant size is to select the best size for each woman. This is where things can get a little tricky, because women are all so different in where they start and where they want to go with breast size. For example, I could have 10 women walk into my office who have identical bodies, and each could choose a different size breast implant, and each could be happy with her selection. This is because a single size is not necessarily appropriate for a given body or breast size. Each plan must be individualized to that woman’s personal goals of how big she chooses to be, taking into account where she begins.

In order to find the size that is best for any given woman, I recommend the following steps:

1. Use silicone sizers. Even if you want saline implants, silicone sizers are the best. I used to recommend rice in baggies, but it just does not conform to the breast the same way. When using sizers, wear a tight-fitting sports bra (preferably 2 tight sports bras). The reason for the tight sports bras is because anything else will allow the sizers to appear larger than they actually are. Hence, a woman wearing looser bras or a cupped bra is very likely to select a size that is smaller than the size she truly desires.

2. Wear several different tops with your breast implant sizers in place to see how you look. Keep in mind that tighter clothes will always make you appear larger, and loose clothes will always make you appear smaller – no matter what size you select.

3. You may end up liking several different sizes. This is common. I recommend that you select the largest of all implant sizes that you like, stopping just short of the first one that is too big. This is soooo important. Here’s why: most of my patients are sitting on a fence with implant size. They want to go large enough so as to make the operation worthwhile, but they do not want to go so large that others notice or that they feel uncomfortable or that they are disproportionate. My strongest recommendation for women who wish to strike this balance is for them to select that very largest size that they like – but not one that is too big. Ever since I began advocating this approach, my rate of revision for change in size has dropped well below 1%, whereas the national average for revisions for change in size is between 10-20%. Of the few patients of mine who have chosen to undergo breast implant revision for change in size, half have chosen a larger size, and half have chosen a smaller size.

4. When you are viewing yourself in the mirror with sizers in place, be aware of the constraints of an established self-image which you might need to overcome. This is especially true for women in their 40s, 50s, and 60s who have become accustomed to looking at their modest sized breasts for decades, but it can also be true for younger women. I recommend that when you view yourself with sizers, you try to imagine that you are looking at the body of another woman rather than yourself. This helps make the decision-making process slightly more objective.

5. Bring your husband, boyfriend, sister, neighbor, cat, etc to help and offer their opinions and support, but be careful to avoid putting the size decision on them. This is especially true of boyfriends and husbands who may feel that if they help you decide, they will be to blame if you do not like the final size. So, my advice is that you should bring them along, but do not press them to give you input if they are hesitant to do so.

6. Ask your plastic surgeon to help you correlate breast diameter with implant size if you wish to be proportionate…but be careful with this, as there are many pitfalls with this approach. This may be the topic for an entire blog of its own.

7. Try to avoid using your desired cup size as a way to select implant size, as cup size is not standardized. The main place that cup size is relevant is with regard to selection of implant profile, but again, that is based on other factors as well…perhaps the topic for yet another blog.

8. If your plastic surgeon does not use sizers or if your plastic surgeon tells you that he or she will select your size, be wary. Most plastic surgeons will choose sizes that most women would be pleased with, but this does not help women who fall outside of the bell curve in their desires to be either larger or smaller than “most” women. Also, some plastic surgeons impose on other women their own perceptions of ideal breast size, which can sometimes be alarmingly large or disappointingly small.

Now, having asserted that size is the most important decision in breast augmentation surgery with regard to satisfaction, here are a few caveats:

* Please do not torture yourself over 30cc. For example, if you like the 360cc implant, you will like the 330cc implant as well as the 390cc implant. If you end up deciding that the 360cc implant was too small, then the 390cc implant would have been too small also. If you end up deciding that the 360cc implant was too big, then the 330cc implant would have been too big, also. Thirty cc is a relatively negligible amount, equivalent to 2 tablespoons. So, once you have decided on your implant size (or range), know that in order to change size in any visible way, you should change by at least 100 cc to be able to see the difference. (By the way, cc=cubic centimeter and ml=milliliter. One cc is the exact same as one ml).

* I view each woman as having a range of sizes that will all work well for her and will give equally satisfying results. So when I say that we need to get the size right, I am talking about a range rather than a specific size. That range may be 50-100 cc in either direction of the size selected – even taking into account that the woman selected the largest size that she liked among all sizers.

* Just getting the size right does not guarantee satisfaction, as other issues exist as well. See the rest of this site for details of all of the other factors that play a role in breast augmentation results.

Breast Wishes!
Jean M. Loftus, MD
PS: sorry for the corny sign-off, but I just couldn’t help myself!

Plastic Surgery Cincinnati from The Loftus Plastic Surgery Center