Dr. Donn Hickman

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« on: February 09, 2008, 11:36:27 PM »

         Thank you for your interest in breast augmentation.  As a result of the recent FDA approval of silicone for standard use in breast implants on November 17, 2006,  consumers and physicians  can once again, decide what implant ingredient is most suitable.  While at your present body size and breast volume, you may be pleased with either saline or silicone implants, I   believe the chance of long term softness is far greater with saline-filled implants.  By placing all implants behind the muscle in our experience, overall success is better for each type of implant.  Often if a patient presents with a B cup or larger and desires some filling and lifting with implants, some surgeons may recommend placement of silicone (or even saline) over the muscles since the amount of available breast tissue will properly conceal the edges of the implant shell.  In time, using an over-muscle method, some patients get a higher percentage of firmness and rock-in-a-sock look especially with silicone implants.  When any implant system remains soft and pliable soft over the years, it is this feature that pleases consumers more than anything else.
          When the FDA released its report in 2006 it was clear that the firmness rate of advanced new design silicone gel implants was 11 to 21 % at 4 years, and this is very troubling.  Even the national rate of firmness for saline implants is reported to be 5 % at 4 years.     Our softness rate with saline implants over 15 years is over 99%.  The only patients with some elements of firmness are those with previous surgery and scar tissue, and slender patients who had the high projecting contour anatomic implants which, by design, are a little firmer.   The results with saline implants are usually seen at 3 to 6 weeks, while, in some cases, the silicone implants can smooth out in weeks only to encapsulate on one side in 6 months or sooner.  I am certainly favoring  saline, but do feel comfortable offering silicone gel if the patient would consider the under muscle approach, and use of  drains, and agree to a breast exercise regimen at home to counter the tendency for scarring by silicone gel filler.
         The versatility of saline is as follows:
1.  the implants can be inserted through any incision, even through slender areolar borders.
2.  adjustability at surgery is a plus since many patients can have a portion of a cup difference between one side and another, and it is not uncommon to have a 10 to 30cc difference on the operating table.  Even using implant sizers to check for silicone gel implant symmetry, it is not always possible to get perfect symmetry.  With saline implants it is possible to get a bit closer in balance and harmony.
3. While the implants can deflate signaling the breakage of the device,  the rupture of a silicone implant may go undetected, even on a mammogram or MRI, and can cause consternation down the line.   To be sure, silicone has been shown thus far to cause -------no ill effects-------.  It is the possibility of free silicone migrating to lymph glands undetected, and confusing a patient or doctor examining the breast, and leading to x-rays and surgery, that makes silicone implants a bit more potentially problematic.
         We would recommend insertion of Mentor Style 1600 moderate profile saline implants most likely in your case, at a size of perhaps 300-400cc to obtain a full C or small D configuration, and this would be a behind-the-muscle approach. I would use a periareolar incision approach which is along the border of the areola on each side.  This approach is not likely to cause nipple sensation problems, and in fact there is no one procedure that is better than another in terms of best nipple sensation.   One can occasionally have nerve irritation, but this is truly the exception.  It can be seen in the exceedingly slender consumer who wishes a large augmentation, in one who has already undergone one or more previous surgeries, and in some patients who need a considerable lift to the breasts. The operation takes about an hour or so under general anesthesia as an outpatient. We use Community Hospital of Long Beach where several other plastic surgeons also bring their patients, and for whom there is an experienced Board-Certified Anesthesia Department well versed in plastic surgery patients and outpatient care.   I do place small linguini-size drain tubes in the implant pocket and have been doing so since 1991,  since I believe the removal of operative fluids keeps the scar tissue from forming.  The common approach is to use no drains and wrap the patient tightly.  With a remarkable softness rate to date, I believe it is combination of making a generous pocket, freeing up the muscle properly, use of saline which has a fixed hydrostatic water pressure that resists scarring, and keeping any blood and serum drained away from the foreign body prosthesis.  Recovery is usually a few days for basic activities, getting around, and driving, and return to work.  Some soreness and instability in the implant settling will be present for 4 weeks or so, thus requiring one to limit heavy aerobics and personal activities for that period.
         The costs of surgery can range from  $6000 to $8000 for breast augmentation depending upon the type of implant style and ingredient selected.   Saline implant augmentation is at the lower end of the scale.
         We appreciate the opportunity to provide you with some information to better make an informed choice. Each surgeon will have a passion, philosophy, and experience from which to recommend their approach to Breast Augmentation and other Services.   Our endpoint is an attempt to obtain a happy consumer.   
          Please see our main website  BEFORE AND AFTER  breast augmentation, lift, and reduction,  and our site devoted only to breast procedures, SERVICES, breast augmentation.
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