To view a 3D animation of this procedure click here.
Note about “Gummy Bear” implants
The old silicone gel implants had a silicone shell and within the shell was the "gel", which had a liquid quality to the consistency. This made the gel travel more after the rupture. The new generation of silicone gel implants are called "cohesive" implants. Making the silicone molecules "cohesive" results in more sticker gel, thus preventing the leakage and liquidness of the gel. However, the more "cohesive" the implants are, the firmer the implants are. To preserve the natural feel of the implants, the current implants are moderately cohesive. A highly cohesive implant is firm and called a true "gummy bear" implant, but this highly cohesive implant is still under FDA studies. Both Mentor and Allergan manufacture a high quality cohesive gel implants. Currently their reported rate of rupture is about 1 % in 10 years.Breast Lift (Mastopexy) and Augmentation
Breast lift is a procedure to lift breast. This means lifting the nipples up, and/or breast tissues itself. Incision for this procedure may be around the nipple, around the nipple with vertical extension (lollypop style) or the anchor shape (inverted T shape) to include the scar along the bottom of the breast. These procedures are needed when the breast, particularly the nipples, are too low to make an aesthetic breast.
Often, patients with droopy breast who request to have a breast lift do not have enough breast tissues to make a full, round breast, particularly to create fullness on the upper portion of the breast. In this case, placing an implant will substantially help the overall contour of the breast. Performing both breast lift and augmentation at the same time will provide a lifted, fuller, and larger breast in a single stage operation.
These procedures do not necessarily need to be done at the same time. Some patients who had augmentation in the past may develop droopiness of the breast, and may wish to have a lift. Or some patients who had breast reduction or breast lift in the past may complain of the flatness of the upper portion of the breast, or overall small size of the breast, and they may wish to have an augmentation.
The combination of breast lift and augmentation is the one of most complicated breast procedures and anyone who consider such procedures should find a very experienced surgeon.
What is capsule?
When an implant is placed, whether it is silicone or saline implant, the body consider it a foreign body and creates scar tissues around the implant to conceal it from the rest of the body. This scar tissue is called "capsule" because it is "a bag over a bag". Most patients have very soft capsule, resulting in a flexible, soft feel of the breast. But there are some patients who develop "thicker" and "tougher" scar tissues, and hence "the tighter capsule". When this happens, it is called "scar contracture". The degree of "capsular contracture" varies from mild (a little firmer and less mobile) to severe (feels like a rock). Reported incidence of capsular contracture is about 6% of all breast augmentation. Many of them are mild capsular contractures.
The cause of the capsular contracture is unknown---in other words, we can not predict who gets capsular contracture or not prior to surgery. But we do know some of procedures we do help reduce the chance---they include; placing the implants under the pectoralis muscle, use of smooth surface implants, massaging of the breast after surgery. Also, the use of Accolate (a medicine for asthma) was found to soften the breast after augmentation. Dr Alex Kim can explain more about these post-operative measures to improve the softness of the breast.
Fat Injection for Breast Augmentation
Does fat injection work for breast enhancement? This is a question Dr Kim gets often. The answer is it is possible but in a small degree. Removing fat from unwanted areas of the body and putting it in the breast to increase the size of the breast sounds very good. The catch is, not all fat injected in the breast survive. So everyone who have such procedure need to prepare for possible multiple procedures. Also, putting a large amount of the fat may increase the chance of fat necrosis (scar tissue and lumpiness). Depending upon the availability of fat (usually from the stomach or thigh/hip), 100 cc to 200 cc of fat can be injected safely. That is fairly small, considering the average size of implants is around 350-400 cc. Dr Alex Kim recommends fat injection only for those who wishes to have a modest augmentation, and also he recommends to those who wants to enhance the cleavage by adding fat along the inner side of the breast, or injecting fat over the area of rippling to conceal visible rippling of the implants.
Procedure time: About 1 hour; when combined with breast lift, about 2-3 hours.
Recovery time: 1 week
