Ask the Doctor: November 2008

Question: What are the least invasive procedures for breast augmentation?

Answer: Breast augmentation in this day and age should be a minimally invasive surgery. Why would anybody want a large incision on their breast or axilla(armpit)? For the longest time physicians were taught that you needed maximum exposure to all surgeries. The scar was thought of later and the line “it heals pretty well” was always used to tell the patient that the scar was going to be long and obvious.

What patients may not know is that depending on the implant, incisions may be anywhere from about an inch for silicone implants to about one third of an inch for saline implants. Minimally invasive breast augmentation, which is another word for camera-assisted augmentation, is not new. It has been pioneered for about 15 years but what has changed is the relative size of the cameras. They are now down to a quarter of an inch and in fact can go smaller resulting in smaller and smaller incisions. However the limiting step is the actual implants and their respective diameter. The silicone implant can be squeezed through about a one inch incision because they come pre-filled with silicone gel. The saline implant however comes empty and can be squeezed to about one third of an inch and then filled to the desirable volume with saline once inside the breast.

Endoscopic breast augmentation was first used to do the surgery trans-axillary, but it still left about a one to one and a half inch scar. A new procedure called PEBAM uses a miniaturized camera system and surgical tools that allow the trained surgeon to do the surgery with one third of an inch incision. It can also be used to do the surgery through the umbilicus (belly button), placing the implants under the pectoralis muscle.

The less invasive the surgery, the less pain, quicker recovery, and most importantly, the less scarring and visible signs of surgery the patient will experience. These new techniques are usually performed by board certified plastic surgeons who have great experience in the art, form and function of the breast as well being able to handle any complications that may arise.

Typically breast augmentation done with the PEBAM approach allows the patient to resume activities the next day and resume unrestricted activities in a few weeks.

Ayoub Sayeg, MD is a board-certified plastic surgeon currently in private practice in Troy, MI.

If you would like to submit a medical question to Ask the Doctor, please send via email to: askthedoctor@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Silicone is Back

By Anthony Youn, MD

Breast augmentation is one of the most popular plastic surgery procedures today. According to the American Society of Plastic Surgeons, in 2005, 291,000 breast augmentations were performed, up from 187,000 just five years ago. The numbers of women undergoing breast augmentation are expected to rise substantially since the FDA lifted the 14-year ban on silicone gel breast implants in November. Breast augmentation is currently the plastic surgery I perform most often in my practice.

Why were silicone breast implants restricted from use with the general public for so long? The FDA placed a moratorium on these implants after numerous women came forward with what were believed to be arthritis and other diseases from gel implants. Subsequent large scale studies have not proven any connection between silicone gel implants and these “connective tissue diseases.” Because of this, the FDA has now allowed the use of silicone gel breast implants in all healthy, non-pregnant women over the age of 22 who desire these implants either for cosmetic improvement or for breast cancer reconstruction.

What’s the difference between gel implants and saline implants? A lot. Prior to November 17, 2006, the U.S. was the only major industrialized country to ban the use of these implants. Gel implants feel and look much more realistic than saline implants. There is no comparison between the two cosmetically.

Gel implants are softer than saline implants, and therefore feel more like real breast tissue. They are also not as prone to develop visible wrinkling which can occur with saline implants in women with a lack of breast tissue. The newest gel implants, like the MemoryGel implants from the Mentor Corporation, are now considered cohesive. This means that the gel which is inside does not leak out of the implant if there is a tear in the shell. It appears to stay in place.

While this provides the patient with some peace-of-mind, it is important to realize that the FDA recommends an MRI be performed three years after the implantation, and every two years thereafter to make sure there are no tears in the implant’s shell.

While most plastic surgeons and thousands of patients are applauding the FDA’s decision to approve silicone breast implants, many women continue to undergo breast augmentation using saline implants. Although not as realistic as gel implants, saline implants have been used nearly exclusively for the past fourteen years, with overall pleasing results. These implants are less expensive than gel implants (almost half the cost!), have a safety profile second-to-none, and require a smaller incision for placement.

Unlike gel implants, saline implants can be placed via the Transaxillary Endoscopic Breast Augmentation technique for the most hidden scar. Gel implants must be placed through either an incision under the breast or around the areola. In my practice, I’m finding that 2 out of every 3 women who undergo breast augmentation surgery are continuing to choose saline breast implants. Nearly all are extremely happy with their choice.

So where does this leave the patient who is unsure of which implant to use for breast augmentation? The best thing about the availability of gel implants is that women now have a choice on which implants to use. It is important to discuss this choice with your plastic surgeon to determine just which implant is right for you. Make sure to choose a plastic surgeon who is certified by the American Board of Plastic Surgery and has hospital privileges to perform breast augmentation. This way you know your plastic surgeon has been fully trained to perform the surgery you are considering, and hasn’t just completed a weekend course on the procedure. Look at the surgeon’s before-and-after photos, ask questions, and avoid “bargain-basement” cosmetic surgery centers which often hire poorly trained physicians. In plastic surgery as well as life, you often get what you pay for.

Dr. Anthony Youn is a nationally recognized, board-certified plastic surgeon and is a member of the American Society of Plastic Surgeons. He received his medical degree from Michigan State University in 1998 and completed his general surgery and plastic surgery training at the Grand Rapids MERC Plastic Surgery Residency Program. He also completed a fellowship with the Advanced Aesthetic Surgery Fellowship in Beverly Hills, California. He has privileges at William Beaumont Hospital in Troy and Unasource Surgery Center. He’s been featured on E!’s “Dr. 90210”.