Breast Augmentation in Boston - Breast Implants Wellesley
For a woman who, for personal reasons, feels her breast size is too small, too large or not contoured enough, cosmetic breast surgery can be the answer. At
Accurate Aesthetics Plastic Surgery we perform Breast Augment
(Breast Enlargement), Breast Lift and
Breast Reduction. We will help you choose the operation that is right for you. We encourage you to bring photographs of the shapes of breasts that you think are most pleasing. Although we can never give you someone else’s breast, we can use this as a starting point for what will look best on you. Privacy is of utmost concern with
breast surgery. Please remember that most breast operations may be performed within our private operating suite without the need for hospitalization.
Breast Augmentation (Breast Implant)
In a breast augmentation, Dr. LoVerme inserts an implant to improve the contour and increase the size of the breast. He performs this operation customized to the patient. Factors to be considered before surgery are positioning of the implant, size, shape and height (profile) of implant, whether to use a textured implant, and where the incision will be placed.
In order to understand the reasons for many of these factors, you must first understand a bit of the history of breast implants. Breast implants have been used since the mid 1960’s. Initially these were mostly
liquid silicone implants. Surgeons noticed that there was a large incidence of capsular contracture around the implant. This is a firming of the scar capsule that always forms around any foreign body. We had patients start to massage their implants and helped decrease the rate of hardening. In the early 1980’s we decided that if massage is good, perhaps if the implants were placed under the pectoralis (chest) muscle it would massage the implant every time the arm was moved. Indeed, this did help with the rate of capsular contracture. In the early 1990’s the FDA removed the
liquid silicone implants from the market for standard breast augmentation because of the concerns of breast implants causing autoimmune disease. It has since been well proven that silicone does not cause these diseases. It appears that the
old liquid silicone implants caused capsular contracture by a very slow leeching of the silicone through the plastic shell of the implant.
Plastic surgeons started using the saline filled implants as the only alternative. Within a few years we noticed that saline implants did not get capsular contracture nearly as often as the old silicone implants. Therefore, the saline implants would not need to
be placed beneath the muscle on the basis of capsular contracture.
Silicone versus saline implants
- Feel: Silicone is much more natural
- Appearance: Silicone has less chance to ripple
- Cost: Silicone is more expensive
- Scar: Needs to be slightly longer with silicone
Before and After Photos: Breast Augmentation (Breast Implant)
5’8″, 163 lbs., 300 cc implant subglandular
We could now choose the positioning of the implant based on the best appearance for the patient. For a patient with some sagging (ptosis) of the breast an implant in front of the muscle would certainly be better unless a breast lift were performed with subsequently more scars on the breast. The patient must decide which appearance is preferable. (During your consultation you may be showed photographs of each in order to help make your decision.) For patients with smaller breasts, the implants sometimes gave a round appearance at the top of the breast. In recent years this, too, has been limited by the newest technique of subfascial breast augmentation. In this technique the lining of the muscle on the chest is lifted up and the breast implant is placed beneath it. This lining is a firm structure which helps limit some of the roundness at the top of the breast and gives the most natural appearance. There is no abnormal movement of the implant with flexing of the muscle as sometimes happens in the submuscular breast augmentation. At Accurate Aesthetics we place the implants most often in the subfascial position but also use the submuscular approach for selected patients (most often in the smallest breasted women or for patient request).
Size of the implant will be determined by going through a series of photographs to help determine what you desire. We will ask what cup size you would like but this can never be guaranteed as each bra manufacturer sizes their bras differently. Your chest cage will be measured to determine an appropriate diameter of implant. Implants can be high profile or low profile depending on the patient’s desired look. The doctor will determine what he deems to be the correct size to fulfill your needs and you will then be asked to go home and try on an appropriate amount of rice. Breast implants are measured in cc’s. 1 ounce of dry rice equals approximately 30 cc. A 300 cc implant equals 10 ounces. You will be told how much dry rice (by volume, measured in a measuring cup) to try on. This should be done in a 1 quart zip lock bag. This gives the rice enough room to spread out evenly over the breast. You should use a loose sports bra or halter top so that the entire breast covered, not a small revealing bra because the rice will come out over the top of the bra. If you decide this amount is too large or too small, please try on other amounts but vary by at least two ounces at a time.
5’3″, 112 lbs., 275 cc implant subglandular
Shape of implant will be determined by your desires for the proper appearance. The most frequent shape used at Accurate Aesthetics is a round implant. For most women this gives the most natural appearance. Anatomic shaped or teardrop implants are also available. These implants have a larger volume on the bottom than the top. It is our opinion that in a standing position the round implants tend to fill more on the bottom just by gravity. Mammograms of each are available for review at time of consultation so that you can see this has proven. Texturing of the implants (making the outer surface more of a velvety appearance rather than smooth) was first used to decrease capsular contracture. With saline implants and with the newest silicone implants this is not necessary as there is lower incidence of hardening around the implant. Anatomic implants are always textured because they increase friction within the body. This prevents the implants from flipping over within the body and having the larger portion of the implant on top which would look extremely unnatural. This texturing in our opinion also causes the implants to stay “stuck” to the chest wall and not move like a natural breast. This outweighs most of the benefits of a textured implant for most women and therefore the most common implant used at Accurate Aesthetics is a smooth round. Of course, for specific women with individual problems any type of implant may be used.
5’4″, 135 lbs., 415 cc implant subglandular
The smooth round implants come in different projections or profile. Consider a 12 ounce glass of water. This can be a very tall thin glass or a wider and shorter glass. The height of the glass is similar to the projection of the implant. A lower profile implant will be wider on the chest wall and give more roundness at the side of the chest. A higher profile implant will give more projection to the front. There are two main manufacturers of breast implants in the United States, Mentor and Inamed. These companies each size their implants differently. A low profile Inamed is similar to a moderate profile Mentor. Because there are so many possibilities of implant size, shape, texture and projection which vary among companies, please allow our experts to help choose the best one for you. At Accurate Aesthetics your chest cage size will be measured and your desires for appearance will be taken into consideration in order to determine the best implant type that will give you the look you want.
Incisions are made below the breast or around the areola. For the incision below the breast, it is actually on the breast at the lowermost portion. If you look closely at women with suntans, the tan line is almost always on the breast and not really in the crease. This is because the top pulls up when the arms are raised. An incision placed exactly in the crease will show if you wear a small bikini or bra when you raise your arms. In women with smaller breasts and large enough areolas, the incision may be placed in this area. It is called a periareolar incision. We try to give you the incision that will be most hidden in your case. At Accurate Aesthetics we do not prefer the axillary (armpit) incision although it is sometimes used. The transumbilical or TUBA technique (belly button incision) is never used in our practice.
5’4″, 132 lbs., 300 cc implant subglandular