"Breast augmentation is about putting the right volume and shape in the perfect spot."
- Dr. Lisa Cassileth
A breast augmentation is about so much more than just size. At Cassileth Plastic Surgery, we listen to you, to learn how you want to look. Our goal is to give you the most natural-looking breast augmentation results and ensure that you get the look and feel that you want. In planning your augmentation, there are a number of decisions that should be made carefully. These are not just what size you want to be, but also the profile and projection of the implant, the type of implant, and where it is located.
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One very important aspect to getting the best breast augmentation for you is choosing the correct implant size. Breast implant size is primarily a personal decision. There are several important things to remember when choosing an implant size. The size of the implant affects the width of the implant. Larger implants are wider, so if you choose a size wider than your chest can accomodate, your breasts will look unnatural and push out to sides, so that your arms may brush against them. If you want to go larger, and you do not have a wide chest, we usually use higher-profile implants, which give you more outward projection with a smaller implant width.
During your breast augmentation consultation we have two major methods of size determination. First, you will have the opportunity to try on breast implants by inserting them into your bra. This will give you an idea of how the various sizes will look and feel. Next, we will create a three-dimensional representation of your breasts and torso with our Vectra 3D imaging system. Our computer software will project what you will look like with your chosen implants and allows the most accurate selection of your final implant style and size. This is one of the important aspects of your consultation that allows Dr. Killeen, Dr. Min, and Dr. Cassileth to deliver reliable and proportionate results.
To make the most of your breast augmentation consultation:
What is inside the breast implants affects the way the implant looks and feels1. There are three types of material that implants are filled with: saline, standard silicone, and highly cohesive silicone. All are contained within resilient silicone sheeting. Saline implants are filled with salt water. There is a newer, non-rippling, bolstered implant style called the IDEAL implant.
The standard silicone is thick, jelly-like in consistency and soft and amorphous in shape. Although loved by many as the softest type of implant, it also tends to show rippling more, which may be an issue for thinner patient without a lot of natural breast tissue coverage over their implant. Highly cohesive silicone is firmer, like a gummy bear in consistency, and holds its shape, hence the name gummy bear implant. It also is least likely to ripple compared to all other implants. All silicone implants need to be replaced over time as they can leak. Standard silicone, which is more gel-like, can leak outside the implant. Cohesive silicone, which acts more as a soft, single unit, stays within the lining of the implant. With all the advantages of cohesive implants, we usually use only fully or highly cohesive gel implants.
Cohesive (include SCL, SCLP, SCM, SCF, and SCX): these are the most cohesive, or â€śgummy bearâ€ť consistency implants. They are slightly firmer and have the least rippling.
Soft-Touch Cohesive implants (include SSL, SSLP, SSM, SSF, and SSX): these are cohesive implants with slightly less cross-linking than the full cohesive gel so they have a softer feel. They have relatively low rippling.
Responsive Cohesive (include SRL, SRLP, SRM, SRF, and SRX): these are the least cross linked of the cohesive implants and the softest. They have a tendency to ripple more because of the low cohesivity.
The saline implants have some advantages and disadvantages. First, the saline can be filled to an exact size, as opposed the incremental size jumps in the silicone. Next, if the saline implant leaks, it simply leaks sterile salt water, similar to an IV rehydration fluid. The main disadvantage to saline is its tendency to ripple, which is an issue for patient that have thin chests as the natural breast tissue and fat may not provide much coverage over the implant. A newer type of saline implant, the Ideal Implant®, has the safety and adjustability of the saline implant and minimizes rippling. The Ideal Implant has internal bolsters that provide structure for the saline, and give in a more natural look and feel by preventing the "sloshing" of the saline around the implant.
It's important to mention shaped implants as well. Shaped implants are bigger on the bottom and smaller on top, and were an attempt to make the implant look more like a natural breast. The problem with shaped implants is that they are all within textured silicone sheeting, unlike the usual smooth round gel. The texture prevented them from rotating and going sideways or upside down, ruining the whole advantage of the shaped implant. Some textured implants were found to cause a rare localized cancer called Breast Implant Associated ALCL, which did not emerge until after they had been in place for many years, often more than a decade. For that reason, we prefer not to use even shaped implants that are still FDA-approved, as the texture may have negative long term health impact.
|Low||Low Plus||Moderate||Full||Extra Full|
|Typically best for women with broader chests, or those who want a small breast augmentation||Typically best for women needing a bit more projection||Used for most patients; accommodates a standard augmentation size||Best for patients who have a narrow chest, or who want a large breast augmentation||Required for large implants in narrow chests|
Implant placement is essential for a great breast augmentation. Breast implants can be placed in three different layers:
The dual-plane technique is the most common and has well-known benefits. The implant is protected by the muscle, so the top half of the implant is covered by the pectoral muscle. This also protects it from capsular contracture, which is when the scar tissue around the implant feels firm. The primary negative is that the implant is the affected by the muscle. In some patients, the implant may bounce slightly or move when the muscle flexes. This is called pectoral animation deformity, or pec flex deformity. The pec muscle can also push the implant down and to the side. True subpectoral implants are rarely performed, since the muscle is slightly too high and the implant is then placed too high on the chest wall.
The submammary technique is practically antique, and was performed on the first breast augmentations ever in the 1970's and 1980's. It fell out of favor as it was associated with a high capsular contracture rate, and high visibility of the implants. Now it is still occasionally used for the right patient, especially with specific reconstructive issues and sometimes in combination with mesh or dermal matrix.
The newest technique, subfascial plane, corrects some of the problems with the other techniques. It allows the implant to have coverage from the thin fascia so that the implant is less visible and looks more natural. It prevents pectoral motion deformity as the implant does not move with the muscle. Finally, it has some protection against capsule contracture. This technique may work less well for the largest implant, as the pectoral fascia covers the upper portion of the implant only for larger sizes.
During your consultation, you will be able see what your breast augmentation results may look like, using our state-of-the art Vectra 3D Imaging System. The Vectra will create a high-resolution 3D model which we can then use to simulate various implant types, sizes, and positions, to help us finalize your decisions with you.
Breast implant illness is an ill-defined disease, and has become a catch-all term for any type of systemic illness associated with breast implants. Bii has a wide range of possible symptoms, like tiredness, joint aches, brain fog, rashes, food intolerances, and autoimmune symptoms, to name a few. There are many theories as to why breast implants may sometimes cause illness, but good surgical management of implants and implant placement can prevent most problems.
Non-cohesive, silicone breast implants may leak and patients may have free liquid silicone gel. The silicone gel can act as an irritant and stimulate the immune system, and should be removed. For silicone gel spillage, definitive removal of all of the accessible local gel is required. Sometimes, trace amounts of silicone travels to the lymph nodes, which must be left intact. Because of the risk of leakage, we recommend you use cohesive silicone or saline implants.
For all implants, we need to address biofilms. Biofilms are non-infectious bacteria that can sit on the surface of any foreign body. They can populate facial fillers, dental implants, catheters, and pacemakers. And of course, this includes breast implants. Therefore, when using internal devices, special precautions should be taken to avoid biofilm contaminants. Most importantly, the device should never touch anything that could transmit a biofilm. This includes even your own skin, pores, hair, sweat glands, and breast ducts. A protective funnel should always be used when placing the implant, which shields it from contact. The inferior mammary crease incision is preferred, as it provides the least risk of contamination. Before placing the implant, the surgical pocket is bathed with antibiotic solution. Finally, a topical antibacterial hypochlorous solution is infused around the implant after it has been placed, as a final preventative measure. Immaculate closure helps to prevent topical infections which may communicate with the implant space. Biofilm prevention is critical as it does appear that some biofilms cause unnecessary inflammation and may be one of the underlying causes of Bii.
The FDA reported in March, 2017, that a very rare form of cancer, ALCL (anaplastic large cell lymphoma) has been linked to breast implants. ALCL most often occurs with textured implants.
The risk of getting this form of breast implant associated lymphoma is extremely low (occuring between 1 in 2,207 and 1 in 86,029 women undergoing of breast implant procedures)2. ALCL is treated by removal of the capsule (the membrane surrounding the implant). We do not recommend textured implants for augmentation.
Breast cancer, a relatively common form of cancer for women, has not been linked to breast implants. Women with breast implant are not more likely to have cancer, and there is not a delay in diagnosis because of interference with mammogram or ultrasound.
1Mayo Clinic. Breast Augmentation. Available:
https://www.mayoclinic.org/tests-procedures/breast-augmentation/about/pac-20393178. Accessed 2/15/2021.
2American Society of Plastic Surgeons. Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Available:
https://www.plasticsurgery.org/patient-safety/breast-implant-safety/bia-alcl-summary. Accessed 2/15/2021.
After a year of contemplating, researching and having over 5 consults I finally decided to get a breast augmentation last October 2016 with Dr. Killeen. I was very nervous leading up to the day of surgery. Dr. Kileen and her staff has been exceptional. Jade the office manager was attentive and always answered my questions. I have to say I am a very neurotic patient and need a lot of handholding when it comes to surgery. Dr. Kileen is an excellent surgeon and she assured me that would give me natural looking breast with the volume I was looking for. I went from 32b to 32 d. I am 3 months out from surgery and all my friends say I look great. I am glad I finally did it.
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