1. Types of Implants

There are two companies in the United States that manufacture breast implants- Mentor and Inamed (formerly Mcghan). Both of these companies are approved by the FDA and in my opinion are very comparable in quality of implants, cost of implants and customer service. I use implants from both companies on a regular basis and have been happy with both companies.

Implants fall into two main categories- silicone or saline. In November 2006, the FDA released silicone implants for use in all patients. The silicone implants were taken off the market in 1992 over concerns about their safety. After extensive research and evaluation, the FDA concluded that the silicone implants are safe.

Silicone implants have advantages and disadvantages. The main advantage is that the silicone gel feels more like natural breast tissue. The disadvantages are: higher cost, slightly larger incisions, and more extensive paperwork and follow-up to include recommendations for MRI exams after surgery.

Saline implants have been used extensively over the last 14 years for breast augmentation. The advantages of saline implants are: less expensive, smaller incisions and there are no requirements for extra paperwork and follow-up. The disadvantage of saline implants is that they do not feel as natural as the silicone gel.

Implants have either smooth or textured (rough) surfaces. Some studies have shown that the textured implants have a lower rate of capsular contracture when the implant is placed above the muscle. Smooth implants are thought to have lower rates of rippling (visible indentations in the breast tissue). Since I prefer to place implants under the muscle, I like to use smooth implants. (See below for above or below muscle consideration)

Implants come in two basic shapes- round or anatomical. The anatomical implants are fuller at the bottom and narrower at the top when viewed from the side. This is what the natural breast looks like in profile, so in theory the anatomical implants would seem to be more natural appearing. However, the implants can rotate after placement resulting in the narrow part being at the bottom and the fuller part being at the top. This results in an unnatural appearance. I prefer to use the round shaped implants because if they rotate in the pocket, there is no change in the shape of the breast.

2. Placement of Implants

Implants can be placed either above or below the pectoralis major muscle. I prefer to place the implants below the muscle for several reasons. First- is that the muscle provides more of your natural tissue to cover the implant so there is less chance that you will feel or see the implants. Second- mammography is more accurate if the implant is below the muscle. You have an extra layer of tissue (the muscle) separating the breast tissue from the implant. Third- the muscle gives more support to the implant so there is less chance of developing sagging breasts (ptosis). Fourth- there is a lower incidence of capsular contracture when placing the implants under the muscle.

3. Incision Placement

There are essentially three choices available for the location of the incision. Each incision is possible in most women. It's mainly a matter of personal choice.

Infra-mammary fold- This is below the breast where the breast and chest wall meet. The incision is approximately 4 cm long and is hidden in the natural crease. The advantage is this is the easiest and most direct route to get under the muscle. The disadvantage is there is a scar on the bottom of the breast but it usually is well hidden.

Peri-areaolar- This is around the edge of the areola (usually the bottom edge). This incision follows the natural line between the breast skin and areolar edge. This incision may not be possible if your areola is very small. There may be a slightly higher risk of numbness in the nipple if this incision is used. The scar usually heals very nicely and is difficult to see, but it is located on the center of the breast.

Trans-axillary- This incision is placed in the armpit. Special endoscopic equipment is used for this approach. This incision may need to be changed to one of the previous two incision sites if there is a technical problem with the equipment.
The advantage is that there is no scar on the breast. The disadvantage is that the scar may be visible if you wear sleeveless clothes and raise your arms.

4. Implant Size

This is probably the most important decision to make. I’ve had many patients say they wish they would have gone a little bit bigger. The key is to match your new breast size with your overall body frame. We need to take into account your height, weight, body frame, existing breast tissue and your expectations of what you want to look like.

A method that will give you a good idea of what size of implant to use is the rice sizing method.

1. Buy an inexpensive sports bra of the cup size you think you want to be.
2. Get a nylon stockinette and fill it with uncooked rice. Fold the top of the nylon over and tape it in place. (Don't tie a big knot in the stocking)
3. Place the stocking in your bra and try different clothes on- shirts, dresses, etc. Look at yourself in the mirror and/or have a friend evaluate your new look.
4. Add more rice to the stocking if you want to be bigger or remove some of the rice if you want to be smaller.
5. After finding a good size, wear the sports bra with the rice filled stockings around for a day and perform your normal activities. How does it feel? Does your back or neck hurt? Is everyone staring at your chest?
6. Measure the amount of rice in each side. One cup is equal to about 250 cc. This will give us a good idea of what size of implant you want to have. It should be noted that the exact same size of implant will look a little smaller than the rice in the stocking because the implant is going behind your muscle and breast tissue. For this reason I usually add a little more volume than what you measured with the rice.

Another good idea is to go to a website like implantinfo.com and look at the photo gallery. Find patients with your similar height and weight and look at the size of implants they had placed. This will give you a fairly accurate idea of what you will look like after your surgery.

5. Choosing the right doctor

This is definitely the most important decision to make. You should choose a surgeon who is highly trained, board certified, has experience with the procedure you want and a surgeon whom you feel comfortable with.

Dr. Healy was trained in all aspects of plastic surgery at the world famous Mayo Clinic. This is one of the premier medical institutions in the world. You can visit their website at www.Mayoclinic.org

Dr. Healy is board certified by the American Board of Plastic Surgery, the only specialty board for plastic surgery recognized by the American Board of Medical Specialties. You can visit their website at www.abms.org

Dr. Healy has performed numerous breast augmentations in patients of various body sizes and shapes. His patients encompass nearly every ethnic background. Dr. Healy is proficient at using all of the incision sites described above and ensures that you are well informed of all the options that are available to you.

Dr. Healy is credentialed to perform plastic surgery at several hospitals on Oahu. Your surgery will be performed in an accredited medical facility that meets the highest standards of patient safety. Your anesthesia will be provided by a board- certified anesthesiologist.

Dr. Healy and his staff will do everything possible to make your surgical experience an outstanding one. Our goal is to exceed your expectations in every aspect of the surgical process- from the initial consultation, to scheduling the surgery, to the actual operation and throughout your recovery we will do what it takes to ensure a safe and pleasant experience. We hope to earn your trust and look forward to a long and happy relationship.

Board certified plastic surgeon, Dr Jeff Healy is located in Aiea just outside of Honolulu and serves surrounding cities in Oahu Hawaii.