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Saline-filled breast implants typically have some amount of rippling or wrinkling which is not usually seen with silicone gel breast implants. (although it can still occur) This is particularly evident in women with thin skin and very little breast tissue. Implant wrinkling is felt on the bottom and sides of the breasts and can be seen as patterned set of lines visible through the breast skin. Breast implant wrinkling is usually most visible in certain positions, particularly when one is leaning forward or lying on your back. Wrinkles on a saline breast implant may be only a minor cosmetic issue (if you were informed before surgery) or might be a source of major unhappiness and be the reason to undergo revision surgery.
Rippling occurs as a result of the physical interface between the saline and the elastic silicone polymer shell . The exact reason wrinkling of the breast implant occurs has to do with how well the filler material coats the inside of the implant and bonds to it as well as its own viscosity. Water (or saltwater) flows easily and does not ’stick’ well to the inside wall of the breast implant shell, resulting in implant buckling and folding. This is a normal finding with saline breast implants and its presence is not abnormal or the plastic surgeon’s fault. Placement of saline breast implants above the muscle is also much more likely to lead to visible implant wrinkling in thin individuals as there is little breast tissue to cover the visible ripples and there is no pressure on the implant from the overlying muscle. Textured saline implants are particularly prone to rippling due to their thicker shell (harder for the water to push it out) and due to traction from the implant grabbing the thicker non-stretchable surrounding scar that it creates. The combination of textured saline breast implants above the muscle has the highest incidence of significant wrinkling issues.
Established ways to diminish the amount of wrinkling which can occur are to overfill the breast implant with more saline than the implant base size (increase the internal fluid pressure) and to place the saline breast implants under the muscle. (which puts more pressure on the outside of the implant). Both of these methods do lead to less wrinkling, but neither can completely prevent it. Overfilling a breast implant with too much saline will make it feel more firm than normal breast tissue, although this is generally well accepted by most patients. The best approach for prevention is to use non-textured saline implants placed under the muscle which are then filled 25 to 50cc more than its base size. While all implant wrinkling can not be prevented with saline fills, a significant reduction can be seen in most patients with this approach.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Since silicone gel breast implants have been released back for commercial use in late 2006, nearly 15 years after they were initially pulled from the market, they have rapidly become the breast implant chosen by most women for their breast augmentation. I have seen many women come in for breast augmentation consults that are initially dead set against silicone breast implants and want saline implants, only to change their minds once they have accurate information. In talking to patients over the past two years, here are some of the most common myths surrounding silicone gel breast implants.

1) SILICONE BREAST IMPLANTS CAN CAUSE HEALTH PROBLEMS AND MAKE ME SICK. The extensive human data that has been analysed on hundreds of thouands of women who have had silicone breast implants has failed to ever make the link to any form of autoimmune disease. This potential cause and effect has been thoroughly evaluated and been dispelled. It is the primary reason that silicone breast implants were allowed back on the market by the FDA. Silicone breast implants are one of the most extensively studied medical devices in the history of mankind. Yes it is true that there have been a very small number of women with silicone breast implants that developed autoimmune diseases but the actual rate of this occurrence is no greater than that of women who have never had breast implants. Autoimmune diseases occur in much higher numbers in women and occur mostly in the age ranges where breast augmentation surgery is likely to be performed.(ages 20 -45) So it would not be unexpected that the two will occasionally occur in the same patient. But silicone breast implants do NOT cause autoimmune diseases.

2) SILCONE BREAST IMPLANTS MAKE LEAK OUT AND SPREAD THROUGHOUT MY BODY. Today’s silicone gel implants are much more like jello than any liquid. The silicone particles are gelled together so that they move as  sticky mass, not flowing like a liquid. As a result, if the implant suffered a large tear, the mass of silicone simply sits there. If you squeeze on a silicone implant that has been cut with scissors, you will see that it comes bulging out of the tear only to be retracted back into the implant when the pressure is removed. Checmiaclly, we all have silicone particles throughout our bodies in microscopic amounts due to a lifetime of exposure to that element. But women with silicone breast implants today have not been shown to have substantially higher levels than those who don’t have implants.

3) SILICONE BREAST IMPLANTS BECOME HARD OVER TIME. The phenomenon of ‘hardening of a breast implant’ is known as capsular contracture. It is really the natural scar tissue around the implant which, for reasons not completely understood, may start to thicken and get hard over time. In days gone by with old-style silicone implants, which were placed above the chest muscle, capsular contracture was common. The reasons were that small amounts of silicone leaked (known as implant ‘bleed’) through the implant lining and the body reacted by forming more scar tissue. In today’s breast augmentation surgery, the combination of newer silicone implants which have very negligible amounts of bleeding and the implant being typically placed under the muscle, have reduced the lifelong risk of capsular contracture significantly. While that risk always exists, and it is higher when placed above the chest muscle, the occurrence of capsular contracture is not common. 

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Breast augmentation remains one of the most popular plastic surgery procedures overall and one of the most commonly performed plastic surgery procedures for women under the age of 35. Breast augmentation is a fairly ’standard’ procedure in terms of how it is performed and the time it takes to perform it. In my hands, a primary breast augmentation procedure takes one hour to complete, from entering the operating room to being awake headed to the recovery room. Much of the cost of breast augmentation is, therefore, fixed including the cost of the breast implants themselves (silicone gel breast implants cost more to purchase than saline breast implants) and the use of the operating room and the anesthesiologist’s charges.
Because breast augmentation costs are predictable, many plastic surgeons freely publicize their fees to perform the procedure. When seeing a breast augmentation fee stated, make sure the fee you are seeing is all-inclusive. Often times, touted breast augmentation fees only list the surgeon’s fee and you have to read the fine print to see the additional costs of the breast implants, operating room, and anesthesia. If the fee has an asterik (*) by it, you automatically know that the listed fee is only a tease and misleading.
Because breast augmentation is a very predictable operation in terms of costs and execution, unlike most other plastic surgery procedures such as facelift, liposuction, etc., the listing of breast augmentation costs for any practice is not unreasonable. Also, one of the most common questions that patients have about breast augmentation surgery is the cost. It is often the first and only question they may have when making a phone call to your office or an e-mail inquiry to your website. For these reasons I, like many plastic surgery practices, prefer to publicize my fees for breast augmentation. In my practice, the all-inclusive costs for silicone gel breast augmentation is $5,999 and $4,799 for saline breast augmentation.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana

There are two good reasons why patients choose silicone gel breast implants over saline…and one of those is that silicone breast implants have significantly less rippling or wrinkling than saline. This is of great aesthetic importance to those women with very little breast tissue and thin or stretched out skin where the outline of the breast implant can clearly be felt and often even seen. This is most evident in the inferior (lower) and lateral (side) poles of the breast implant where the chest muscle does not provide coverage.
The phenomenon of breast implant rippling is actually present in both saline and silicone filled implants. The exact reason wrinkling of the breast implant occurs has to do with how well the filler material coats the inside of the implant and bonds to it as well as its own viscosity. Water (or saltwater) flows easily and does not ’stick’ well to the inside wall of the breast implant shell, resulting in implant buckling and folding. This is a normal finding with saline breast implants and its presence is not abnormal or the plastic surgeon’s fault. This is why we usually overfill the saline breast implant to generate increased pressure on the inside which lessens the amount of wrinkling that can occur. In the short-term this works but, over time, the plastic bag of the implant stretches a little and relaxes, creating some rebound wrinkling if you will. Silicone gel, a much thicker (viscous) material and with slightly more weight, coats the inside of the implant shell better and is more effective at lessening wrinkling.
The point is….silicone gel breast implants have less wrinkling, usually substantially less, but it may not always be zero. I have had several women who have small amounts of rippling in the lateral (side) pole of the breast. Usually it is only one or two small ripples, which would be less than that which would have been present had they been saline implants instead. I can’t say at this point whether this subtle rippling phenomenon in silicone implants is less evident in high profile (projection) versus medium or low profile style implants. I think it is more reflective of the lack of breast tissue between the overlying skin and the breast implant, an anatomic issue in which no type of breast implant can completely overcome.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

A very frequent request for potential breast augmentation patients is that they would like to see breast augmentation photos/pictures of my results. I find patients reviewing before and after breast augmentation photos to be extremely educational for them and I insist that they do so. I refer to them to either by practice website, http://www.eppleyplasticsurgery.com or Mentor’s excellent website Love Your Look at http://www.loveyourlook.com/doctors/doctor-profile.aspx?id=14771&query=Indianapolis%2c+IN&s=253&tab=10&primary=True&type=augmentation where a sampling of my patient gallery is availble for review. While no patient result seen can be exactly reproduced on another patient, it does give some estimation of breast size and what is possible. It also clearly shows, if the breast augmentation photos are examined carefully, that breast implants do a great job of adding volume and size but are limited in changing other breast variables such as nipple size and position and the amount of spacing between the breasts.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

My approach to selecting a size for one’s breast augmentation is that it is the patient’s choice. It is not for me to judge someone’s taste or desires. Breast size is a very personal issue and it is, to some degree, a bit like art. Beauty (breast size) is in the eye of the beholder. My goal is to make the patient happy. I usually do this by asking the patient to show me pictures of what size they think looks good and then I try and match that size concept in the surgery. The only preoperative measurement that carries much weight to me is the base diameter of the patient’s breast. I have found few women want a breast implant that goes too far to the side and gets in the way of arm movement. Therefore, I keep the breast implant size to no greater than the existing breast base width. If the size is going to exceed the breast base width, that is one good reason to go with a high projecting breast implant so that one’s breast volume comes forward and less to the side.

In the majority of breast augmentation in my practice, I find that most women select sizes that would be viewed as ‘reasonable’. That breast implant size range seems to be between 300cc - 450cc for about 85% of my patients. The remaining 10 - 15% of my patients are anywhere from 450 - 700ccs. For a larger women, in both height and weight, these breast implant sizes are still ‘reasonable’. For smaller women, these breast implant sizes would be considered quite large.

While, on the one hand, it is not my concern when a patient opts for a very large breast implant, I always feel compelled to make them aware that there are some long-term consequences to that choice that they need to be aware of. First and foremost, it is easy to increase the size of the breast but it is difficult to go the other way. Going down in size later may mean the need to do skin reduction and create scarring to maintain a good breast shape.  Secondly, the larger the breast implant, the more loss over time the patient will have of their remaining breast tissue, otherwise known as pressure atrophy. In many large breast implants over time, the patient will only be left with skin and a breast implant with little breast tissue in between. Lastly, the weight of a very large breast implant over time may cause the entire breast to sag, weakening the skin support of the breast under its own weight.

Patients who choose large breast implants also need to appreciate that a woman’s perception and goals of her breasts will change throughout her life. Like that tattoo of ‘Bill’ put on your arm at twenty, you may not even know Bill by the time you are forty.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.eppleybreastaugmentation.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis 

ActiPatch is a non-drug, anti-inflammatory device that has been used for multiple medical conditions from facial surgery recovery to plantar fasciitis. It helps reduce swelling and inflammation through the use of pulsed electromagnetic fields contained in either a patch design or a loop configurations. The patch or loop devices contain a tiny circuit which is operated by a small low-voltage battery. Beneath the geometry of the circuit, a penetrating electromagnetic field or zone is created which penetrates into the tissues under the skin. The frequency of the generated signal works by decreasing intercellular fluid and inflammation in the injured site. As a result, the amount of swelling and associated pain around a surgery site is reduced and recovery is accelerated.

I first starting using ActiPatch for my own back and shoulder pains from years of long hours of surgery. It worked as well as any non-steroidal anti-inflammatory medication and I began to use it on my breast augmentation patients. By positioning a crescent patch over the upper medial pole of the breast (where the raised pectoralis major muscle exists) and another patch over the lateral pole of the breast (4 patches per patient), I have been equally impressed with the results. My past 25 breast augmentation patients have used it with good success. It is now part of my routinue postop breast augmentation protocol and I have each patient wear them around the clock for the first 48 hours after surgery. In most cases, patients are off pain medications within 24 hours. While I aggressively place them on an arm exercise program after surgery (http://www.rapidrecoverybreastaugmentation.com), which makes a big contribution to their recovery as well, the use of the ActiPatch is a simple and easy adjunct to this recovery protocol. Breast augmentation patients are extremely appreciative of any efforts made to decrease any potential pain, which is their biggest fear about breast augmentation surgery. Based on my experience with it in the breast implant patient, I can see no reason why it would not be of benefit for all kinds of breast surgery as well.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Breast augmentation continues to be one of the most popular plastic surgery procedures with over 300,000 women undergoing the procedure last year. With the return of silicone gel breast implants, in addition to existing saline breast implants, women now have two good choices for their breast augmentation procedure. Whether saline or silicone gel breast implants are ‘better’ for any single patient depends on a thorough knowledge of each implant type’s advantages and disadvantages.
Regardless of whether one chooses saline or silicone gel breast implants, every breast augmentation procedure requires a scar to be created somewhere. The choices for the incision location are either the armpit, nipple, under the breast, or the belly button. In my practice, the incision choices narrow down to either the armpit (for saline breast implants) or under the breast (for silicone breast implants). While I have always enjoyed the armpit (axillary) approach for saline breast implants, and I have never had to do a single scar revision with this approach and it certainly is hard to impossible to find later, I have come to really appreciate the scar under the breast (inframammary crease) with silicone gel breast implants. I have observed this is certainly a great place to put the scar, particularly with silicone gel breast implants which require a slightly longer incision. Since the breast usually hangs over the inframmary crease in most patients, it is really difficult to see. My patients are extremely happy with this approach even though the scar will have some potential redness and unevenness in the very beginning, which is normal. Using the nipple incision approach is difficult in many women because there is often quite a mismatch in nipple size and desired size of the breast implant that the patient wants. This makes it virtually impossible to put the proper size of breast implant through such a small incision area. Furthermore, the brown color of the nipple (areolar) margin can make even a well-healed scar look noticeable with its whiter color.
Both armpit and under the breast scars heal well, making them really ‘non-visible scar’ techniques for breast augmentation.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Despite the tremendous popularity of breast augmentation, and the relatively common occurrence of differences in most women’s breasts, there is little public knowledge about what occurs when both are mixed together in a surgical enhancement. All plastic surgeon’s made a good effort to point out a patient’s breast asymmetries beforehand, and that breast asymmetry is likely to continue to exist after surgery, but I have found that most patient’s still have misconceptions in this area.
First and foremost, I have found that many women don’t even know that their breasts are not ‘even’. Many do when the differences are more significant but in small differences it is often not even perceived until it is pointed out. Secondly, breast augmentation may either improve or worsen the breast asymmetry dependent upon what type of asymmetry it is. In my experience, if the asymmetry involves different positions of the nipples before surgery, it is quite possible an enlargement of the breast will make it worse. In this cases, a superior nipple lift may be considered in the more ’southern’ nipple if it is the one not at the right height. If it is a more ‘northern’ nipple, then there is no real solution to that problem short of keeping the implant higher on that side and living with mound asymmetry but with the nipples centered on the breast mound. (either choice is not great). If the nipples are fairly even and the differences are mainly in mound size (amount of skin, level of the inframmary crease), then an implant enhancement may improve the asymmetry by different fill volumes or sizes between the two sides. This is a more desireable situation and , while some asymmetry may still exist, it is likely to be better than dealing with nipple aymmetry.
With all of the options available in breast implants today, saline vs silicone and different projections, it is tempting to get too clever by making changes not only in implant volumes but in styles or projections as well. While this may work in some cases, it is equally possible that you may merely create a different asymmetry problem. I have found it best to usually keep it simple using some differential volumes of implants is some cases but generally not mixing implant projection styles.
In short, if breast asymmetry improves after augmentation that is a bonus but is not assured. It is not possible with any degree of certainty to predict final breast shape outcomes in asymmetry. The goal is improvement in shapes, but not perfection. To use a great quote (to whom I cannot remember to give credit), this is sister surgery, not twin surgery.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Breast Augmentation is the number one cosmetic body procedure performed in plastic surgery, even outdoing liposuction which has the advantage of potentially treating many body areas as opposed to breast augmentation’s one. Because the operation is fairly ’standard’, many potntial patient’s questions and concerns are quite similar I get them on almost every consult that I see. Here are some typical ones of which I will try and provide some general answers. Neither of those questions, however, has a definite answer to any specific patient as there are many variables that control what an implant looks like and how much volume makes a certain cup size. The implant plays a role but the patient’s own anatomy and type and amount of breast tissue and skin play an equally important role.

Will the breast result be better if the implant is above or below the muscle?
The issue of how a breast implant looks above or below the muscle highly depends upon what type of implant that is used, saline vs silicone. They will look somewhat different, silicone will generally be smoother at the edges, saline will likely have some rippling at the bottom and teh sides (eventually). Either way, the shape (due to the weight of its filler content) of the breast will be slightly fuller up top for saline and potentially less full on top with silicone, although the style or projection (low, medium, high) of the braest implant will also play a role. However, how much or how little breast tissue one has and whether the skin is tight or saggy will influence the final appearance as well.
How many implant ccs (volume) does it take to make a full C breast?
The concept of breast size based on cup size and what a certain implant volume may due…..is a little like looking at art. What does a full C look like? What I think it looks like and what you think that looks like may be very different…or similar. Unless we are looking at actual breasts in pictures and asking that same question…one can never know for certain. Even if we agree on what a full C is….every patient’s chest and breast size will require a different volume implant to get there. For example, if you are 5’ 0” tall and weigh 105 lbs, most likely 350 – 375cc will get close to that size….but if you are 5’7” tall and weigh 145 lbs, than 400 – 425cc may be needed to get to that size. Also, how wide your breast is, what we call base diameter, plays a very important role in size and how far to the side the breast implant may go. (which generally is undesired by most patients) We want to choose a breast implant that gets you the size you want but does not go too far to the side. If the size implant chosen for your desired look is too wide, then we need a higher projecting style implant. Sounds confusing, doesn’t it?

These questions are excellent ones and very common. For most patients, these are two of the most important questions (what type of implant, saline vs silicone, is best for you is the most important one) But the answers are not straight forward and each women’s chest and breast size anatomy must be taken into consideration.

Dr Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis