The goal in breast augmentation must always be a soft, natural shaped breast, which is pleasing to ALL the senses!

Andrew Barnett, MD

For more than four decades, breast augmentation has been one of the most popular cosmetic surgery procedures performed. Now a well tested operation, it provides women with the opportunity to safely enlarge and reshape their breasts. While breast surgery should not be taken lightly, in the right patient, modern techniques allow for dramatic results.

Read the article from Details Magazine, written by the boyfriend of one of Dr. Barnett’s patients.

Read additional information about breast augmentation from the U.S. Government FDA.

More information about ALCL and Breast Implants.

How is breast augmentation performed?

Although there are many variations in the procedure, the basics are quite simple. Through a small skin incision, a scientifically designed breast implant in placed behind your own breast tissue to enlarge and reshape your breast. This may be done with local or general anesthesia.

Where is the skin incision located?

The incision can be placed in one of four locations. The medical names for those locations are: Periareolar, Inframammary, Axillary, and Umbilical.

·Periareolar means just at the boundary of the colored area around your nipple, called the areola, and the regular breast skin. This incision tends to heal almost invisibly, but in some patients, a thin line may be seen. The nipple tends to be numb for a period of time, but sensation generally returns.

·lnframammary means under the breast, about at the fold where the breast joins the chest wall. This incision is more visible than the periareolar, but if you heal with minimal scars, it’s a good location. Nipple sensation is usually not affected with this incision.

·Axillary means in the underarm or “armpit”. The advantage with this incision is that there is no “tell tale” scar on the breast at all. While there is a scar in the underarm, this generally becomes barely perceptible with time. Nipple sensation is rarely affected by this approach.

·Umbilical means around the edge of the umbilicus or “belly button”. The advantage with this incision is that there is no “tell tale” scar on the breast. While there is a scar in the umbilicus, this fades and generally becomes imperceptible with time. Nipple sensation is rarely affected by this approach. Only saline filled implants can be used with this approach. This method is also best used when implants are placed on top or in front of the chest wall muscle.

Where is the implant placed?

The implant is placed behind your breast tissue, either on top of or underneath the pectoralis or chest wall muscle. The decision to place it in one location or another depends on your particular breast and chest structure.

What is the implant made of?

Implants are made of a medical grade silicone plastic envelope filled with either salt water (saline) or silicone gel (gel). In the saline implants, there is no silicone gel present, but as the envelope or bag is made of silicone, they are not silicone free. All materials used are generally well tolerated by the body. Allergic reactions to the materials are extremely rare. Implants have either a smooth or textured outer shell. Different implant shapes are available, and implants are available with and without filling valves. All implants are available in my practice.

Both saline and silicone gel implants have been available since the 1960′s, but silicone gel implants were taken off the market in the early 1990′s, except for very limited purposes. There were concerns about the safety of the gel implants. Extensive studies have revealed that the health concerns, specifically the concerns about auto-immune disease, were unfounded. Silicone gel implants were placed back on the market in November 2006, and are now widely available.

Click for Saline Gel comparison sheet.

Alternative fill materials, such as peanut oil and soybean oil, are experimental and not currently available.

Which implant is better, silicone gel or saline?

Neither one is better than the other – they have different pluses and minuses. Gel implants are softer and more “natural” in feel. The incidence of capsular contracture, scarring around the breast resulting in a hard breast, is higher with gel implants. Both implants can and will eventually rupture, and the appearance (not the feel) of the augmented breast is the same with saline and gel. Gel implants are more expensive and require a larger incision for placement than saline implants. All these issues, and more, will be discussed at your consultation. The important thing to remember is that Dr. Barnett has extensive experience, for more than twenty years, with both the saline and gel implants, and both are available through his office.

Click for Saline Gel comparison sheet.

There are so many choices. Which operation do you do?

The operation I do is the one that’s right for you. Just as no one blouse fits or looks good on every woman, so too, no one operation is right for everyone. The surgeon who says “I do it this way” is telling you that he makes the patient fit the operation. I make the operation fit the patient. At your consultation, we’ll discuss the options, and together decide on the procedure that’s right for you.

How large should I be?

Breast size is a matter of taste. Within the range that’s safe, you make the final decision. I’ll help you make that decision, by discussing your general body shape and how the different sizes affect your appearance both in and out of clothing. At your consultation, we will discuss a method whereby you can experience different “sizes” at home. It’s important for you to evaluate different sizes, and see how it impacts your appearance in a tee shirt, blouse, dress, blazer, and sweater. Once you have a rough idea of the cup size you’re comfortable with, we will try actual implants placed in a bra while you’re in the office. Finally, at surgery, different size implants can be tried prior to making the final decision. For assistance, see the Breast Augmentation Sizing Information Sheet.

What are the risks of breast augmentation?

Though breast augmentation is a well established, safe surgical procedure, there are risks of complications. Just as in any operation, bleeding, infection, and scar formation can occur. Asymmetry in size or position, decrease or loss of sensation, and implant rejection are possible. Capsule scar formation which results in firm breasts is the most common complication.

The risk of this occurring can be reduced by massage of the breasts after surgery, but in a small percentage of patients, additional surgery may be required to treat this problem. This information is given not to frighten you, but to help you make an informed decision. Remember, no question or concern is silly or insignificant. At your consultation, I’ll be happy to discuss the full range of potential complications and any questions you might have regarding this procedure.

What about the risk of breast cancer?

That’s an excellent question. Careful scientific studies have been performed, and they show that breast augmentation neither increases nor decreases the chance of getting breast cancer. You still must examine your breasts regularly and be alert for any changes. The implants do not make physical examination more difficult, and mammography can be performed if needed.

How long does it take to recover from breast enlargement?

Recovery time is variable with each patient. You go home the day of surgery, and stitches are removed in a week to ten days. Although many patients return to work in as little as three days, I generally recommend one week off, with limited activity for two to three weeks.

What about the F.D.A. controversy and breast augmentation?

The F.D.A. and the American Society of Plastic Surgeons are working closely together to define precisely the risks of breast augmentation. The information about and status of breast implants is changing on a daily basis. While the media has sensationalized the “controversy”, the actual status of breast augmentation, including the most recent F.D.A. findings, will be discussed at your consultation.

What is the history of the breast implant controversy?

Breast implants were developed by two Texas plastic surgeons in 1962. The basic implant, a silicone plastic bag filled with silicone gel, was produced by Dow Corning Corporation. At the time, medical devices such as implants did not received the same scrutiny as drugs, and only limited testing was required prior to their widespread use. In the late 1970′s, the F.D.A. changed the requirements for medical devices, mandating more comprehensive testing prior to use. Breast implant manufacturers were required to provide research data proving the safety and efficacy of the implants by the late 1980′s. Concerns about implants focused on two areas: known proven risks, (such as capsular contracture – scarring around the breast implant) and unknown unproven risks (such as autoimmune disease).

Three types of implants were commonly available by the late 1980′s, silicone gel filled, saline filled and silicone gel filled with an outer covering of polyurethane. All three have an outer bag made of silicone. In 1991, concerns regarding polyurethane and liver cancer caused the polyurethane implants to be voluntarily removed, leaving silicone gel and saline implants.

In 1992, David Kessler, M.D., head of the F.D.A., decided to remove silicone gel implants from the market for cosmetic enlargement because he felt there were too many unanswered questions. Of interest, the F.D.A. allowed silicone gel implants to be used for women who were undergoing breast reconstruction following mastectomy, for women who needed a lift as well as an enlargement, for women who had previous saline breast implants and had an unsatisfactory result, and for women who currently had silicone implants and had problems such as rupture. All of these “exceptions” resulted in a fairly large number of women with silicone gel implants, and these women were carefully studied.
In November 2006, the F.D.A. finally released silicone gel implants with few restrictions. After 14 years, they once again could be used for regular breast augmentations. Women now, once again, had a choice. The choice was tempered by a greater assurance that the implants, both saline and gel, were safe and effective.

What about autoimmune disease and implants?

While this was a big question in the early 1990’s, excellent studies have been performed which show that there is no relationship between breast implants and autoimmune disease. This has been shown in a number of independent studies, and is acknowledged by the F.D.A., the American Academy of Rheumatology (the doctors that treat autoimmune disease) and by the general medical community.

What about saline implants?

Saline implants have been available since the mid 1960′s and have a very good track record. I’ve been using the saline implants since the late 1970′s, and by the mid 1980′s approximately 80% of the women who came to me for breast augmentation chose to use saline implants rather than gel. Interestingly, in the few years before the silicone gel implants were banned, a textured silicone gel implant was released, with a lower incidence of capsular contracture, and with this improvement, more women began to request gel implants. Shortly thereafter, silicone gel was banned, and women no longer had a choice.

Safety aside, which implants are better, saline or gel?

The safety issue has been carefully studied, and excellent studies have shown that gel is as safe as saline. There are however some significant differences, and I’ve put together a comparison sheet (at the end of this document) that compares the implants point by point. The important thing to keep in mind is that I have extensive experience with both saline and gel, and am comfortable with both, and at your consultation, we’ll spend quite a bit of time on this issue. Click for Saline Gel Comparison sheet.

Can’t saline implants deflate?

Yes. While this occurs infrequently, it is a definite risk, and one which must be considered carefully. Keep in mind that eventually, all implants deflate or rupture. On average, it’s about 14 years, but this can vary. The positive to this is that if deflation occurs, there is no health risk from the saline. Your body simply absorbs the salt water. Your breast however will return to its pre-augmentation size and surgery will be required to replace the implant. Again, a positive point is that the surgery to replace the implant is generally quite simple and requires very little recovery time relative to the actual augmentation operation. The risk of deflation as quoted by the manufacturer is 1% to 2% per year. Various warranty programs are in place to help reduce or eliminate the cost of implant replacement should deflation occur.

Do silicone gel implants deflate?

Because the body does not absorb the gel, the implants don’t deflate, but they do rupture. While the rupture is not associated with significant health risks, when a rupture is diagnosed, the implant should be replaced. Rupture rates are similar to deflation rates, but diagnosis is more difficult. Replacement is also more difficult.

What about a warranty?

Both implant manufacturers, Allerghan and Mentor, offer lifetime warranties on the implants. This warranty is between you and the manufacturer, so if you move, the warranty stays with you. We will discuss this with you at your consultation.
Click for Allerghan Warranty or Mentor Warranty.

What about the “gummy bear” implants?

Cohesive gel implants, nicknamed “gummy bears” are designed to reduce the risk of silicone gel spreading about when the implant ruptures. The gel sticks together the way a gummy bear candy sticks together even when cut in half. The implants are significantly firmer than standard gel implants, require a substantially larger incision for placement. They are an option, which will be discussed at your consultation. An even gummier implant, called the form stable implant, is available in Europe and Asia, but not yet in the United States. It has some applications, but is even firmer than the new cohesive gel implants.

What about the “new” French Saline implants?

They are no longer available. This “new” saline filled implant, from a company called P.I.P., had been available for a number of years. This implant was different because it came pre-filled. McGhan(Allergan) and Mentor, the two American manufacturers, produce an implant with a valve. These implants are filled at the time of surgery through a closed system to prevent contamination. While the valve represents a point of potential leak, this is a small risk, and is balanced by the ability to make adjustments in the size of the implants at the time of surgery and the smaller incision necessary to place the implants. The P.I.P. implant also used a modified silicone bag, which has a different feel. We will discuss all these implants at your consultation. F.D.A. rulings removed P.I.P. implants from the market. As of May 15, 2000, they were not available for use in the U.S..

Are there any new saline implants available?

Saline implants are available in two styles and various shapes and projections. The implants are available with either a smooth or textured outer surface. The textured variety has been available since 1990. The pros and cons of the various options will be discussed at your consultation.

What about fat injections and peanut and soy bean oil implants?

Fat injection for breast augmentation provides only limited enlargement, are unpredictable with regard to long term re-absorption, and can mimic the x-ray findings of breast cancer. They are not recommended. Peanut and soy oil as well as other fill materials for implants are currently being investigated. Even if they prove safe, they will not be available for many years.

What about the suction machine which causes breast enlargement?

This is one of the strangest devices for breast augmentation to ever appear on the market! Suction devices are worn over the breast for 12 to 18 hours a day, for 12 weeks, and the breast actually enlarges! While it does work, the enlargement is extremely modest, less than the smallest implant available, and the result is not permanent.

How does one make a decision regarding breast augmentation?

Breast augmentation is one of my favorite procedures. I’m constantly amazed at how much information patients have before they come to the consultation. Information sources such as the internet, books and magazines provide general information, but a careful examination and consultation provides you with information that is specific to you. At your consultation, we will spend as much time as necessary to provide you with the knowledge base you need to make the decision that is right for you.