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Archive for the ‘breast augmentation’ Category

Anatomic vs Round Silicone Breast Implants

Sunday, January 22nd, 2017

 

Anatomic Breast Implants Dr Barry Eppley IndianapolisAnatomic or tear drop breast implants purportedly offer a more natural breast augmentation result. This seems to make complete sense when one looks at the shape of an anatomic implant where it has a teardrop shape that more closely mimics a natural breast than a round-shaped implant.

In the January 2016 issue of the journal Plastic and Reconstructive Surgery a paper on this topic was published entitled ‘Comparing Round and Anatomically Shaped Implants in Augmentation Mammoplasty: The Experts’ Ability to Differentiate the Type of Implant’. In this paper thirty (30) plastic surgeons and nurses looked at before and after pictures of thirty (30) submuscular silicone breast implants, either round or anatomic shaped) with an average volume of around 300cc (none greater than 340cc) within the first 3 months after surgery. Among the total of 1800 observations done, the observers could only accurately identify the correct implant style 50% of the time.

While previous studies looking at the same breast implant shape issue have shown similar inabilities to identify the type of implant shape used, this is the first one that has done so in a prospective analytical designed fashion. It is well known that the round or convex form of a breast implant will change into an anatomic shape in the standing position due to both the pressure of the overlying pectoral muscle and gravity. It only re-assumes a more rounded shape when laying down just like the implant looks when laying outside the patient on a table.

Anatomic Breast Implants results front view Dr Barry Eppley IndianapolisAnatomic Breast Implants results oblique view Dr Barry Eppley IndianapolisWhile these study results are both solid and I believe accurate, it is important to point out that its relevance is with smaller implant sizes and with them in the subpectoral pocket. Whether similar results would occur in larger breast implant sizes or in the subfascial position is open for debate. It has been my experience that in larger breast implants the effect of an anatomic breast implant is more relevant particularly in the short term. I would also have little doubt that a shaped implant would look more natural in the subfascial location.

When choosing an anatomic breast implant there should be compelling reasons to do so given their higher cost and risk of malrotation and breast shape deformation, a complication that does not exist with round implants.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Fat Injection Breast Augmentation Outcome

Monday, January 16th, 2017

 

Background:  Breast augmentation is the most common as well as recognized body contouring operation. Performed through the placement of an implant, its after surgery volume retention is assured. Its downside is that the use of a gel or saline-filled device makes it susceptible to numerous long-term implant related issues and further surgeries.

Fat injection breast augmentation (FIBA) is an appealing alternative to the use of implants in an elective aesthetic procedure. Since the breasts are composed of fibrofatty tissue, adding fat would be a natural and well accepted augmentation tissue. In addition, some patients do have excess fat they would like to get shed and putting in the breasts at the same time is more than a logical exchange.

But many younger women with small breasts have thin body frames. There can be a correlation between breast size and body habitus in some women. Even in women with some visible fat to harvest, it is important to remember the ‘halving principle’ in injectable fat grafting. This goes as follows…half of the harvested liposuction aspirate is removed by concentration, the concentrated fat is split or halved between the two breasts and half of the injected fat will be resorbed. (or 50% volume retention)

Understanding this principle helps patients to determine if fat injections are a good choice for their breast augmentation as well as to have realistic expectations about the volume increase outcome.

Case Study: This 20 year-old female wanted to have breast augmentation by fat injections. She did have some modest fat to harvest from her abdomen and flanks and was well informed that this approach to her breast augmentation would result in a very modest change at best.

Fat Injection Breast Augmentation Dr Barry Eppley IndianapolisUnder general anesthesia she had 845cc of liposuction aspirate harvested from her abdomen and flanks. The aspirate was concentrated down to 430cc of injectable material which was used to inject 215cc into each breast.

Fat Injection Breast Augmentation result front view Dr Barry Eppley IndianapolisFat Injection Breast Augmentation result obloque view Dr Barry Eppley IndianapolisHer one year after surgery results showed a visible augmentation benefit that was about a 1/2 cup size increase. She eventually decided to get breast implants for a much larger result.

Fat Injectionk Breast Augmentation result side view Dr Barry Eppley IndianapolisFat injection breast augmentation is a very appealing alternative to implants but patient selection is critical. Until the science of fat grafting is better understood and fat cell survival can be increased, its use in breast augmentation will remain limited to those patients seek very modest breast size increases.

Highlights:

1) The success of fat injection breast augmentation depends on how much fat one has to harvest and how much survives after being injected.

2) Enlarging the breasts by injectable fat grafting usually result in modest change in the range of a 1/2 cup bra size or so.

3) Potential patients need to consider the ‘halving principle’ when considering augmentation by injectable fat grafting.

Dr. Barry Eppley

Indianapolis, Indiana

Congenital Symmastia Correction

Friday, January 13th, 2017

 

One of the rare congenital breast conditions is symmastia. This condition is where the two breasts converge across the sternum eliminating the cleavage area and replacing it with the inner halfs of the breast mounds or a webbing. The name comes from Greek word derivation combining syn (together) and mastos. (breast)

While it is a well known complication from breast augmentation though disruption of the medial edges of the pectoralis muscle, as a congenital deformity it is very rare. Few cases have ever been reported and as a result no standard surgical treatment exists.

In the December 2016 issue of the journal Plastic and Reconstructive Global Open issue a paper was published entitled ‘Congenital Symmastia – A 3 Step Approach.’ In this described technique Liposuction was performed in the presternal area and the web between the breasts but was not extended beyond the lateral border of the sternum. An inframammary fold incision was made just 3 cm lateral to the midline of the sternum. Three quilting sutures were inserted in the intermammary area on each side of the midline between the dermis of the presternal skin and the periosteum at the lateral sternal border. After surgery a compression bolster was applied to the intermammary sulcus for several months on a continuous basis.

This approach to congenital symmastia correction includes three specific surgical manuevers. First excess subcutaneous tissue is removed between the two breasts which is most easily done with liposuction. Secondly the skin of the intermammary sulcus must be fixed down to the underlying periosteum by sutures either at the midline or at the lateral sternal border through the inframammary fold incision. It is almost always easier to place them at the lateral sternal border. The last step is postoperative compression for which there is no exact device/garment made for it. Various bolsters or bra modifications have to be devised.

Dr. Barry Eppley

Indianapolis, Indiana

Supernumerary Nipple in Breast Augmentation

Monday, January 9th, 2017

 

A extra nipple, in either men or women, is not rare. Occurring in up to 5% of the population, it is often mistaken for a mole due to its circular appearance. What separates it from a mole is that it is raised and has a textured and not a smooth appearance. It does not usually grow in size and only gets bigger in proportion to the body as it grows.

milk-linesThe location of a supernumerary nipple is also a giveaway as it will lie along the milk lines. The milk lines are embryonic vertical lines that extend from the armpit to the legs from which arise breast tissue and nipples. They appear early in embryonic life by the end of the second month in utero and well before sexual identity is formed. (hence why men have nipples even though they will never breastfeed) The nipples will form along this line and humans always have two nipples…although more are capable of forming along the milk lines.

In most cases of extra nipples, medically known as polythelia, it will just be a single one and is usually located below the breast or chest. Hence the term third or triple nipple. In more rare cases it will be more than just a nipple and it may develop into an actual breast mound albeit much smaller than a natural breast. (polymastia)

supernumerary-nipple-dr-barry-eppley-indianapolissupernumerary-nipple-next-to-augmented-breast-dr-barry-eppley-indianapolisGiven the relative common occurrence of an accessory nipple, it would not be rare to find it on a prospective breast augmentation. This is an example of a 35 year-old female who came in for breast implants and wanted to have a raised mole removed at the same time. Its appearance was clearly that of a nipple and not a typical mole. When removed at the time of surgery, its appearance can be seen to be similar to a nipple when laid up against the augmented breast.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Transgender Breast Augmentation

Monday, December 5th, 2016

 

Background: Transgender plastic surgery is a large compilation of feminizing face and body procedures. Of all of these procedures breast augmentation has the greatest impact on making a feminization change. It also do so in a rapid and assured manner, creating an instantaneous body shape change as all breast augmentation surgeries do.

On average transgender breast augmentation consistently creates good breast mound shapes. This has to do with the genetic male chest which is not exposed to the tissue stresses of pregnancy and weight gain/loss. Even in the male chest that may have some slight sagging the volume expansion effects of a breast implant quickly overcome any loose tissue.

To avoid scarring many transgender breast augmentation are done through an axillary incision. But with larger breast implants or when the use of a textured anatomic shaped implant style is desired, the axillary incision is more problematic. It is far better to switch to an inframammary incision to successully get these types of breast implants into good partial submuscular position.

Case Study: This 21 year-old transgender female desired breast implants. She had been on hormone therapy for several years but had developed little breast tissue or enlargement. She wanted a fairly large breast increase but also wanted a more natural shape and opted for anatomic silicone breast implants.

transgender-breast-augmentation-intraop-result-right-side-dr-barry-eppley-indianapolisUnder general anesthesia and through 4cm long inframammary incisions, 600cc shaped anatomic silicone breast implants were placed in a partial submuscular position.

ar-bam-results-front-viewar-bam-result-oblique-viewWith good overlying breast skin and nipple position, the results of her breast augmentation were satisfying. The tautness of the breast skin and the size of the implants made for rounder breasts than what one would think from using anatomic shaped implants.

Highlights:

1) Breast augmentation is one of the most important of all body contouring procedures for male to female transgender patients.

2) There is nothing unique about the genetic male chest that would not make it amenable to successful breast implant placement.

3) Because of the good quality of the genetic male chest skin, transgender breast augmentation is highly successful with the creation of good breast mound shape.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Implants and Stretch Marks

Saturday, November 12th, 2016

 

Background: Changes to the breasts are common with pregnancy and weight loss. The most common aesthetic breast deformities from these bodily changes include loss of beast tissue, stretch marks and breast sagging. While there are surgical corrections for loss of breast volumes and breast sagging, stretch marks remain resistant to any known treatment.

Many women that present for breast augmentation have stretchmarks on their breasts. Most are fairly minor and are not a major aesthetic distraction to the breasts. But occasionally some women appear that have a large number of stretch marks that are also wide. They appear as long stretch marks that radiate outward onto the breast mound in a circumferential pattern.

For women so afflicted with such stretch marks on their breasts the question is whether breast augmentation surgery will make them look better or worse?

Case Study: This 28 year-old female presented for breast augmentation surgery. Her breast mounds were small due to involution but she had a lot of stretch marks in a radiating pattern from her nipples.

breast-implants-and-stretch-marks-result-front-view-dr-barry-eppley-indianapolisbreast-implants-and-stretch-marks-result-oblique-view-dr-barry-eppley-indianapolisUnder general anesthesia, breast augmentation surgery was performed through an inframammary incisional approach. Gummy bear silicone breast implants of 325cc size were placed in the partial submuscular position. (dual plane pocket) Her postoperative results six weeks after the surgery shows that her stretch marks became ‘bigger’ by being elongated as they were expanded over the enlarged breast mounds. The stretch marks did become elongated by the pressure of the underlying implants although the stretch marks did not technically become worse. (further damage of the skin)

breast-implants-and-stretch-marks-result-side-view-dr-barry-eppley-indianapolisHighlights:

1) Breast implants do not improve the appearance of stretch marks for many women.

2) In the early postoperative period stretch marks may actually look worse after breast augmentation due to their increased redness.

3) Some stretch marks may appear less then before breast implants when their redness fades. But assume there will be no long-term improvement.

Dr. Barry Eppley

Indianapolis, Indiana

OR Snapshots – Funnel Breast Implant Device

Monday, October 31st, 2016

 

The placement of breast implants is an obvious key ingredient in breast augmentation surgery. While there different incisional locations that can be used, the breast implants must be passed through the incision into the developed tissue pocket regardless of where it is placed. For saline implants, which are inserted deflated and rolled, the location or size of the incision is not an issue. However prefilled devices like silicone breast implants pose insertion challenges particularly in larger implant sizes.

The silicone breast implant placement process can be made easier by having a large incision to easily pass the implant into the pocket. But large incisions create their own aesthetic drawbacks so a limited incisional length is desired. Traditionally the silicone breast implants is passed through an incision that is smaller than its base width by a ‘cram and push’ technique. While effective this is probably not ideal for the implant shell and may create shell indentations and material weaknesses that later may become locations of implant rupture.

funnel-breast-augmentation-technique-dr-barry-eppley-indianapolisA newer breast implant insertion device has been developed over the past few years that has revolutionized this critical step in breast augmentation surgery. Known as the Funnel, this confectionary-looking device allows a breast implant to be placed through a small incision without unduly stressing its shell.. While the implant does get compressed in so doing, it is how it is compressed that makes all the difference. The funnel device allows the compressive forces to be distributed fairly evenly as the implant is pushed from the large end of the funnel through the smaller end which is positioned through the incision into the breast pocket. By so doing there is a much lower risk of creating shell fatigue points.

The other benefit to the Funnel breast implant insertion device is that it allows the implant to go from the box to the pocket without being touched by human hands. This would also lower the risk of potential bacterial contamination.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Puffy Nipple Breast Augmentation

Wednesday, October 19th, 2016

 

Background: Breast implants are intended to enlarge the existing breast mounds. In so doing it is often erroneously believed that other features of the breast may be similarly improved. Unfortunately this is rarely true. Conversely any other deformities or asymmetries of the breast may actually become more noticeable not less.

The most visible feature of the breast mound is the nipple-areolar complex. It has features from size (diameter), nipple projection, to its position on the breast mound. Enlarging the breast will increase the diameter of the areola. Implants will not change nipple projection unless nerve sensation is lost. Uneven horizontal nipple positions between the breast mounds will be greater as the breast gets bigger.

One unique dysmorphic feature of the nipple-areolar complex is that of the ‘puffy nipple’. This is where the entire areola puffs outward due to a collection of breast tissue beneath it. This almost always occurs as part of the spectrum of tuberous breast deformities. In its most minor form, a constricting ring around the base of the areola creates a small herniation of breast tissue through the areola ring creating a puffy nipple appearance.

Case Study: This 22 year-old female presented for breast augmentation due to her natural flat chest. What she did have were larger areolas that stood out due to their puffiness.  The areolas were soft and could easily be pushed in. Her understandable question was whether breast implants would push out the breast mound behind them and make them less puffy.

puffy-nipple-breast-augmentation-results-front-view-dr-barry-eppley-indianapolisUnder general anesthesia, she had 400cc high profile smooth silicone breast implants placed in the dual plane position through inframammary incisions. Her immediate and early postoperative results showed no change in the appearance of her areolar protrusions.

puffy-nipple-braest-augmentation-results-oblique-view-dr-barry-eppley-indianapolispuffy-nipple-breast-augmentation-result-side-view-dr-barry-eppley-indianapolisLonger term followup failed to show any improvement in her puffy nipple concerns. This proves that the push of an implant behind an areolar protrusion does not improve it. This makes sense since anatomically a ‘hernia’ can not be reduced by pushing on the side that the prolapsed tissue emanates.

The puffy nipple must be treated by excision of breast tissue through a partial areolar incision. This can be done at the same time as the breast augmentation or deferred until the patient is convinced breast implants alone are not corrective.

Highlights:

1) Breast implants are well known to magnify the existing features of the breast.

2) The features of a nipple are not changed/improved because the underlying breast volume is enhanced.

3) The puffy nipple or the microform tuberous breast is NOT flattened because a breast implant is placed behind it.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Augmentation and Cleavage

Wednesday, September 28th, 2016

 

Background: One of the well known mottos amongst plastic surgeons regarding breast augmentation is that implants merely take what you have and make it bigger. While simplistic, this statement is largely true. Other than mound enlargement and the potential creation of enhanced cleavage from that effect, many of the other breast features remain the same albeit larger.

There is a difference between younger vs. older breast augmentation patients. Younger women who have not had children have breast mounds that are well shaped with good overlying breast tissue. Older women, or younger women that have had children, often have breast mounds that are not well shaped and have stretched out overlying soft tissues. That difference alone can make a big difference in the aesthetic outcome of breast augmentation surgery.

Case Study: This 3o year-old female presented for breast implants. She had small but wide breast bases with well centered nipples on the mound and well defined inframammary creases at the bottom of the mound. In addition she had breast mound swhere the nipples where pointed directly forward and the breasts were almost too close together. (compared to many other women)

breast-augmentation-with-cleavage-results-front-view-dr-barry-eppley-indianapolisUnder general anesthesia and through 3.5 cm inframammary skin incisions, 450cc round high profile silicone gel breast implants were placed in the partial submuscular position.breast-augmentation-and-cleavage-results-side-view-dr-barry-eppley-indianapolis

breast-augmentation-and-cleavage-results-oblique-view-dr-barry-eppley-indianapolisHer breast augmentation results clearly show how the implants made all features of her natural breasts simply bigger. There was no reason to lower her natural inframammary folds which is actually very uncommon in my experience. She already had a good distance between her nipples and inframammary folds despite her small natural breast volume. The naturally close position of her breasts allowed for actual cleavage to be achieved even without a bra.

Highlights:

1) Breast implants take the breast mounds a patient has and merely makes them bigger.

2) Breast implants make cleavage if the breasts are spaced close together naturally.

3) The east-west nipple position after breast augmentation remains exactly the same as it was before surgery.

Dr. Barry Eppley

Case Study – The Perfect Breast Augmentation

Tuesday, August 30th, 2016

 

Background: With almost a million breast implants placed per year in the U.S. for aesthetic breast augmentation, the results achieved are highly variable even though the implants have the same basic shape. This is due a basic breast augmentation concept….all breast implants do is take what you have and make it look bigger.

Breast implants do not have the capability to fix natural breast asymmetries, sagging breasts, where the breast mound sits on the chest wall or change the position/shape of the nipple-areolar complex. Implants are simple mound enlargers that have no other magical properties to do more. For this reason it is critical that the patient be aware of what breast implants will or will not do before surgery so their postoperative expectations are realistic.

While most women will achieve satisfying results from their breast implant surgery, few women ever achieve a perfect result by either patient or surgeon assessment. This is for the simple reason that few breasts are ever perfect initially and that the placement of paired synthetic implants into the body can create different responses in healing.

Case Study: This 20 year-old female presented for breast augmentation desiring a full round breast look result. She opted for high profile silicone implants.

Perfect Breast Augmentation results front view Dr Barry Eppley IndianapolisUnder general anesthesia she had 350cc high profile silicone implants placed trough 3.5 cm long inframammary incisions in the partial submuscular dual plane position. (it required her nipple piercings to be removed right before surgery)

Perfect Breast Augmentation results oblique view Dr Barry Eppley IndianapolisPerfect Breast Augmentation result side view Dr Barry Eppley IndianapolisHer breast augmentation result is as good one as one can get. This is judged by the symmetry of the breasts and their rounded shape which she desired. While good placement and surgical technique was needed, it was aided by the good symmetric shape of her breasts before surgery.

Highlights:

1) The best breast augmentation results occur in those women who have the best breast tissue/shape before surgery.

2) A high profile silicone breast implant produces a fuller looking breast mound with good upper pole fullness.

3) Symmetry is an important element of a good breast augmentation result.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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