Breast Augmentation

Patients have a choice of two implant fillers, either silicone or saline (saltwater). Most patients opt for silicone, as it usually feels softer and is less prone to rippling, which can be seen underneath the skin. Saline tends to be less costly, and some patients who are concerned about having silicone in their bodies may opt for this option. The big questions are:

• How likely is it to rupture?

• What happens if my implant ruptures?

The implant industry and the quality of implants are improving all the time. The current generation of implants is very safe. However, ruptures certainly still happen and can be expected eventually in almost all implants.

It is interesting to note that the two different types of implants behave very differently when they rupture. With saline implants, there is absolutely no doubt because the implant goes flat. Silicone, on the other hand, is designed to be a cohesive gel, and so when it ruptures, it doesn’t go anywhere. It just stays in the same spot. Therefore, often there won’t be any obvious changes while looking at the breast, and even an ultrasound can’t always pick up whether the implant is ruptured or not, so an MRI is needed. 

Silicone implants were taken off the market initially because of concerns about what happens when they rupture, and concerns about whether or not they cause other diseases. When they were reintroduced onto the market, there were two FDA warnings. 1. They were deemed unsuitable for women under twenty-two years old. 2. Patients getting silicone implants are technically signing up for a lifetime of checking up on these implants. This is typically done via MRI, and it is recommended that patients have their first check-up three years after implant placement, followed by subsequent check-ups every two years, as this is the only way to determine whether the implant has ruptured.

There are two choices when it comes to implant texture. One is smooth and round, and the other is textured. Why do we have a difference? The textured implants were designed to help address a condition known as capsular contracture. This basically means that if a foreign body is placed inside your body, it will form a wall around that foreign body.

That is not a problem in itself; however, in certain cases, for unknown reasons, the capsule or wall surrounding the implant begins to contract, which is known as capsular contracture. The breast implants become hardened, and as the condition progresses, the implants become deformed. In extreme cases, they may even become painful.

There are several ways to treat this condition, and one approach thought to prevent it is to apply a textured coating to the outside of the implants. With modern techniques, Dr. Gallagher finds capsular contracture is pretty rare and usually recommends smooth implants.

Dr. Gallagher will spend considerable time determining the implant size for each patient before surgery. While this is ultimately up to the patient, there is certainly a sweet spot when it comes to size. Every woman has enough space for the implant size she chooses. If a patient sticks to that size, there will be many benefits. The result will be very natural, will last longer, and because no muscle cutting or stretching is required, recovery will usually be much faster and easier.

Implants are available in either round or teardrop shapes. The vast majority of patients end up choosing a round shape. There are a few good reasons for this. First of all, when Dr Gallagher places an implant, she aims to push forward the patient’s existing natural tissue, using the implant as a platform for the natural breast, so the shape of the implant is not crucial. Secondly, the teardrop-shaped implants are much stiffer and require a much larger incision to position. Finally, when a teardrop implant is inserted, it is possible for the implant to shift, requiring surgery to return it to its correct position.

The implant profile relates to the degree of projection for each device, which can impact your final results with breast augmentation in Miami. There are three available profiles: Low, moderate, and high. High-profile implants are commonly chosen to get the “perkiest” results.

There are a number of options for implant position. Implants can be placed on top of or underneath the muscle, or in a combination of these, where the implant is partially covered by the muscle and partially by the breast tissue. Dr. Gallagher offers all three as part of her tailored approach for patients. Let’s start with the most common position patients choose, which is underneath the muscle.

Underneath the Muscle

Dr. Gallagher will less commonly choose this position, which involves creating a pocket beneath the muscle. This position is advantageous in very slim patients because, at the upper breast, there is a smooth transition, as the upper part of the implant is hidden beneath the muscle, thus avoiding the telltale rounded-out appearance at the top of the implant. This technique involves partially detaching the pectoralis major muscle, so in recent years, Dr. Gallagher has moved away from it in favor of a subfascial technique. 

Underneath the Fascia 

In recent years, many surgeons, including Dr. Gallagher, have moved away from disrupting the muscle and instead placed the implant under the fascia. One instance, in which we would always choose to do this, is in what we call a tuberous breast, where the shape of the breast is not very favorable to begin with, or when the fold is very high, and we don’t have a rounded out bottom to the breast. Often, in that situation, it is best to rely on the implant’s roundness to provide it. To ensure the implant’s roundness is readily visible, we place it beneath the fascia. Compared with sub-muscular techniques, we find that more of the chest anatomy is preserved, recovery is faster, and complications are fewer.

There are three main routes through which a breast implant may be positioned. Incision choice is important because when you have a lovely natural breast augmentation, often the only way to tell a patient has had surgery is the incision. Dr. Gallagher specializes in keeping incisions small and placing them in the best possible position for optimal healing.

Inframammary fold incision – This is normally the choice of the majority of Dr. Gallagher’s patients. This is because the incision can be kept quite small, depending on the size of the implant, and also because it heals extremely well. Therefore, in most patients, it will be almost invisible. When we examine the chest, it is hidden from view in the fold, and the slight discoloration will fade to match the patient’s skin color within about a year. This incision preserves the ability to breastfeed and maintains nipple sensation.

For women who prefer to use natural tissue to enhance the breast size rather than silicone or saline implants, breast augmentation can be performed with fat grafting. Fat cells are extracted via liposuction from an area of abundance, such as the hips, thighs, belly, or flanks. Once they are sterilized and purified, the cells can be injected into the chest region to amplify volume and create more feminine, attractive breast mounds.