Breast Augmentation Hawaii

Breast Augmentation is one of the most popular procedures performed by plastic surgeons. Over 300,000 women undergo breast augmentation in the US each year. It is the most common surgery that Dr. Healy performs. The technique has been highly refined to provide the utmost safety and outstanding long-term results. Like any cosmetic procedure, breast augmentation is very individualized as no two patients are exactly alike.

Dr. Healy’s goal is to customize your surgery for you in order to give you the best results possible. As such there are several decisions that Dr. Healy will discuss with you during your consultation to help you choose the best options for you. He will carefully listen to your goals and expectations, thoroughly examine and measure you and provide a range of recommendations that he thinks will give you the optimal results. He will answer any questions you might have. Dr. Healy will personally spend approximately 30-40 minutes with you during the consultation to educate you. He does not delegate this responsibility to a nurse or other provider. He strongly believes that the doctor-patient relationship is just that…a relationship built on trust between the doctor and the patient.

Factors To Consider

1. Types of Implants

Implants fall into two main categories- silicone or saline. The silicone implants are by far the most popular implants, approximately 95% of our patients choose silicone. Each type of implant has advantages and disadvantages so Dr. Healy likes to discuss both types to fully educate our patients.

Silicone

Advantages- The main advantage is that the silicone gel feels more like natural breast tissue. This is a big selling point especially when comparing silicone and saline side by side. There is also a range of gel cohesivity that the patient can choose from (which affects how firm or soft they feel). Other advantages include: lower leakage rate (approximately 6x less then saline), less chance of rippling or wrinkling and a much better warranty.

Disadvantages- slightly higher cost, slightly larger incisions (approximately 1cm longer than saline), and “recommendations” for MRI exams after surgery.

Saline

Advantages- less expensive, slightly smaller incisions and no recommendations for MRI exams (if they leak they will go flat like a flat tire).

Disadvantages- they do not feel as natural as the silicone gel (more like a water balloon), higher leakage rate (approximately 6x higher than silicone), higher chance of rippling and wrinkling and the warranty is not nearly as good as the silicone implants.

Surface

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)

There are also recent studies that show that the textured implants may be associated with a very rare form of lymphoma (Anaplastic Large Cell Lymphoma). While extremely rare this has only been linked to textured surface implants. This is another reason why Dr. Healy prefers smooth implants.

Shape

Implants come in two basic shapes- round or anatomical (tear drop). 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.

Also studies show that even experienced plastic surgeons cannot accurately pick which implants are round or anatomical when viewing post-operative pictures. The supposed benefit of a more natural look is not valid and the risk of rotation does not warrant choosing anatomical implants in my mind. In addition anatomical implants are always textured which may pose a very small risk of ALCL (see above).

2. Placement of Implants

Implants can be placed either above or below the pectoralis major muscle (dual plane). 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 (scar tissue) 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. Dr. Healy is highly experienced in all three of these incision techniques.

Infra-Mammary Fold (IMF)

This incision is placed in the natural fold between the bottom of the breast and the chest wall. The scar usually heals very nicely and is under the breast so it is hard to see. This incision allows a very direct approach to the muscle with minimal disruption to the actual breast tissue. The IMF incision allows the most direct visualization and precise control of the pocket dissection. This is the most popular incision choice in my practice and across the country.

Trans-axillary

This incision is placed in the armpit (axilla). This incision requires the use of endoscopic equipment to allow visualization of the pocket. The big benefit of this incision is that there is no scar on the breast. This incision may cause a little bit more pain for the first few days because every time you move your arms you will feel the incision. You may also have some temporary numbness in the upper part of the inner arm with this incision. This is the second most popular choice among my patients.

Peri-Aerolar

This incision is placed along the bottom edge of the areola. The incision is placed right in the natural line between the areola and breast skin and the scar usually heals nicely. With this incision there is a slightly higher chance of nerve injury, infection (due to proximity of milk ducts), capsular contracture and difficulty breastfeeding. Some of the milk ducts and breast tissue will be divided with this incision. This is the least popular choice for incision among my patients.

4. Size

This is probably one of the most important decisions you will make. Choosing the right size is very important. We want you to be happy with your decision and to do it right the first time. We will help guide you through this decision process.

Many patients will have a cup size in mind when they are thinking about what size of implants they want to choose. However, the cup size is not a very accurate measurement as the cup size can vary widely depending on the brand and style of bra that you buy.

We encourage our patients to not focus so much on a particular cup size as opposed to the “look” they want to have after breast augmentation.

To achieve the look you want it is helpful to look at women that have already had implants. Dr. Healys photo gallery on this website contains a sample of his work with different body types, ethnicities, breast size, etc. There are many websites such as www.implantinfo.com that have a large number of before and after pictures. Find patients with your similar height, weight and breast size 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.

During your consultation you will also try on different size of implants to see what they look like on you. Again it is all about achieving the look you want. You want to pick a size of implant that will look good for you.

If you pick an implant size that is too big for your body it can lead to complications that are difficult to correct such as stretch marks, thinning out of breast tissue, bottoming out of implants, nerve damage, back pain, etc. We will help you in this decision process so don’t be afraid to ask. Bigger is not always better.

5. Choosing the Right Doctor

This is definitely the most important decision you will make. You should choose a surgeon who is highly trained, board certified in plastic surgery, 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. He is a member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Dr. Healy has performed numerous breast augmentations in patients of various body sizes and shapes. His patients represent all ethnic backgrounds. 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. He also has his own in-office operating room which is fully credentialed and certified. 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.