Breast augmentation has given women throughout Miami and Florida added confidence in their appearance.
Breast Augmentation is one of the most frequently performed procedures in the United States today. Breast implants enhance the size and shape of the breast by adding firmness and fullness.
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Breast augmentation can be used to enhance body symmetry and self-image primarily or following pregnancy. Breast implants can also be used for correcting asymmetry and for reconstructive purposes. We offer complimentary breast augmentation consultations at our Miami office.
The following is a review of the information you discussed personally with Dr. Sam Gershenbaum regarding possible breast enlargement or augmentation. It is presented to aid you in making a decision regarding this surgery.
There are many details you will want to know and although you discuss them personally with Dr. Sam Gershenbaum, this packet is made available to you so that you may refer to it and review it at your leisure. Please read all the information several times. Discuss any questions or comments with Dr. Sam Gershenbaum prior to making any final decision regarding breast augmentation.
Breast Augmentation is one of the most frequently performed cosmetic surgery procedures in the United States today. Breast implants enhance the size and shape of the breasts adding firmness and fullness while improving body image and self esteem. Breast Augmentation can be performed to make smaller breasts appear larger, balance breasts that are asymmetrical, or restore fullness that has diminished with age or as a result of pregnancy. Breast Implants can also be used for reconstructive purposes.
Types of Breast Implants
Miami cosmetic surgeon Dr. Sam Gershenbaum routinely performs breast augmentations using either saline filled breast implants or the new FDA approved cohesive gel silicone implants. Most plastic surgeons and patients agree that the new cohesive silicone gel implants have a more natural feel. They are also less likely to produce rippling than saline breast implants. The cohesive gel implant will require a slightly larger incision to allow placement of the implant compared to a saline breast implant.
Breast Implants also come in different shapes and profiles. Anatomic or "teardrop" shaped implants were created with a more natural shape in mind and designed to be fuller at the lower half similar to a natural breast. However, this distinct vertical orientation can result in distortion or breast asymmetry if the implant should rotate. A textured surface allowing tissue in-growth helps reduce the chance of rotation however may result in more visible or palpable rippling. For these reasons, anatomic implants are not commonly used.
Dr. Sam Gershenbaum routinely uses the most common, round implant. Since the breast implant is round, it is free to rotate without any adverse consequences. With gravity alone the saline or cohesive silicone gel will gravitate or fill the bottom portion of the implant when sitting or standing erect or fill the breast more uniformly when lying down supine, more closely imitating a natural breast. Unless otherwise indicated, Dr. Sam Gershenbaum will use smooth round implants.
For more Information on breast implants we use, please visit the Mentor's web site www.mentor4me.com or Allergan's web site www.lookingyourbest.com
Breast Implant Location
The breast implant may be placed above the chest muscle (pectoralis muscle) or under the chest muscle. Dr. Gershenbaum generally places the implant under the chest muscle. 
Reasons for submuscular placement include a lower rate of capsular contracture (firmness and hardening of the healing tissues around the implant) and a more natural result due to more soft tissue coverage over the implant. Placement of the implant beneath the muscle may produce some movement and/or distortion of the breast and implant with active movement or exercise of the chest muscle, arms and shoulders.
- Breast Augmentation Consultation
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The initial consultation is extremely important to review the patient’s medical history, goals and expectations as well as build mutual trust and rapport. Numerous before and after photos are reviewed. The procedure is explained and the alternatives discussed. The breasts are examined to ensure that expectations can be met, as well as to review the surgical plan, implant size and incision/scar placement.
An ideal candidate for routine breast augmentation generally will have all the breast tissue above the inframammary crease (the crease under the breast) and the nipple in the middle of the breast. If the breast tissue and/or nipple is at the level of the inframammary crease or lower, additional procedures may be needed.
Appropriate implant size will be determined by taking into account the patient’s request for cup size and physical examination including the width of the breast, distance from the crease under the breast to the areola and the thickness of soft tissue coverage. Dr. Gershenbaum will offer the patient a range of implant sizes that will accommodate the patient’s request for cup size in relation to their physical examination. For those patients who desire the most natural result, the size of the implant used will be determined by their physical examination and available soft tissue coverage. When an implant is placed that is larger than the breast and surrounding tissues can adequately cover, the more there can be rippling that can be felt and visibly seen. For example, a woman with a medium frame and a “B” cup breast can accommodate a larger implant than a petite woman with an “A” cup breast. Breast implants will be more palpable (more easily felt) if there is inadequate soft tissue coverage (skin, breast tissue, muscle) in relation to the size of the implant used. Other causes for a palpable implant may include subglandular placement (over the muscle) and textured implants.
It is also important to understand that breasts are not symmetrical. Often different size implants are used to help improve symmetry. Every effort is made to make the breasts symmetrical and as close as possible to the desired size, however no guarantee as to the exact size, shape or symmetry can be made by any surgeon.
Prospective patients are encouraged to try on various size implants to help with determining size as well as to speak with previous patients about their surgery and results. Dr. Gershenbaum and his staff are always available for questions. Following the initial consultation and after appropriate time for reflection and decision-making, an appointment is scheduled for routine preparation and informed consent. Additional questions and concerns are also addressed. Routine blood analysis and medical clearance is required prior to surgery.
- Breast Augmentation Operation
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This surgical procedure is performed in our state-of-the-art outpatient facility under general anesthesia and will take approximately one and a half hours to perform. In the holding area prior to surgery, the patient’s “before” pictures are taken and then the breasts marked. After speaking with the anesthetist/anesthesiologist, the patient is brought to the operating room. After asleep, local nerve blocks combined with a medication that shrinks blood vessels and capillaries to reduce any bleeding are instilled. Next, the incisions are made and the “pockets” created – generally under the pectoralis muscle – and the implants are placed. Saline implants are inserted into the “pocket” while empty and then filled after in position.
An antibiotic solution is generally added to the saline which some studies suggest reduces the incidence of capsular contracture (firmness and hardening of the healing tissue around the implant). Cohesive silicone gel implants are prefilled and require a slightly larger incision to be placed. The operating room table back is elevated to place the patient in a sitting position to check implant position and symmetry. Minor adjustments are made to the implant “pocket” as necessary to obtain the best possible results and symmetry.
After the table back is lowered, a long acting anesthetic is placed into the “pockets” which greatly reduces postoperative discomfort. The incisions are closed with sutures predominantly below the surface of the skin to avoid cross-hatching suture marks and optimize the chances for the finest scars. Steri-strips are applied as well as being placed in a post surgical bra.
- Breast Augmentation Recovery
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Following the surgery, patients generally report mild to moderate discomfort which is easily controlled with medication. Varying degrees of swelling, bruising and firmness subside over several weeks to months. Sutures (stitches) are removed after seven days. Patient’s can generally return to work after several days to one week. Light exercise may begin after to four to six weeks. A support bra is generally worn for two to three months following surgery and is encouraged as much as possible thereafter to maintain the contour.
Recovery and healing will vary from patient to patient and depend on the extent of the surgery. Over the weeks and months, the breasts will soften and relax, looking and feeling more natural as swelling subsides and the effects of gravity and tissue relaxation act on the newly implanted breasts. It must be remembered that complete healing takes time and patience, taking up to one year before realizing the final result of the surgery.
- Breast Augmentation Complications
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As with most surgical procedures complications are unlikely when performed by a skilled and competent surgeon. Complications include, but are not limited to anesthesia risks, bleeding, infection, capsular contracture (firmness or hardening of the healing tissues around the implant), deflation, poor healing with prominent or obvious scars, numbness, altered nipple sensation, loss of nipple sensation, asymmetry in breasts and/or areolas, enlarged areolas and need for revisional surgery or implant removal. Also rare, but possible are blood clots or emboli (blood clots which dislodge and travel in the blood stream to distant sites).
At the Aventura Center for Cosmetic Surgery, Venodyne calf compression devices are used for every breast augmentation surgery (as well as other surgeries). Venodynes are pressure cuffs that fit over each lower log from the ankle to the knee circulating every one to two minutes to reduce the pooling of blood in the lower extremities and further reduce the possibility of blood clots or emboli. Smoking seriously decreases blood circulation in the skin which increases the risks of complications and poor healing.
- Breast Augmentation Questions
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Breast Augmentation Frequently Asked Questions
Are connective tissue diseases caused by silicone gel-filled breast implants?
The Institute of Medicine recently concluded that “Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants.”
Do silicone gel-filled breast implants cause cancer?
Published studies indicate that breast cancer is no more common in women with breast implants than in women without breast implants. In its authoritative 1999 report, the Institute of Medicine (IOM) concluded that, “There is no increase in primary or recurrent breast cancer in implanted women.”
What are the effects of silicone gel-filled breast implants on pregnancy and breastfeeding?
Women with breast implants do not risk exposing their breastfed children to excessive amount of silicone. The Institute of Medicine concluded, “No evidence of elevated silicone in breast milk or any other substance that would be deleterious to infants was found in women with silicone gel-filled breast implants.”
Although we have had numerous patients able to breast-feed after breast augmentation, breastfeeding difficulties have been reported following breast surgery including breast augmentation.
How will silicone gel-filled breast implants effect having mammograms?
Current recommendations for getting screening mammograms are no different for women with breast implants that for those without implants. Radiologists experienced in the evaluation of women with breast implants should interpret mammography exams. It is essential that you tell you mammography technologist before the procedure that you have a breast implant. You should request a diagnostic mammogram rather than a screening mammogram because more pictures are taken with diagnostic mammography. The technologist can use special techniques to reduce the possibility of rupture and to get the best possible views of the breast tissue.
Are breast implants permanent?
Breast implants are not considered lifetime devices. You will likely undergo implant removal with or without replacement over the course of your life. Whether undergoing augmentation or reconstruction, be aware that breast implantation is often not a one-time surgery often requiring additional surgery and doctor visits over the course of one’s life.
Is it possible to develop a silicone allergy?
It is possible for anyone to develop an allergy to almost any substance on earth. However, silicone allergies are very rare. We are all exposed to silicone in our environment everyday. It is found in many household items such as polishes, suntan and hand lotion, antiperspirants, soaps, processed foods, waterproof coatings and chewing gum.
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