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Archive for the ‘breast implants’ Category

Case Study – Large Breast Implant Replacements

Thursday, December 8th, 2016

 

Background: Breast implants are often perceived as one-time lifelong devices. But this is the exception and not the rule. Depending upon the age at which they were placed, breast implants are often replaced at some point in a woman’s life. (and in more rare cases even removed) They are numerous reasons for why breast implants would be replaced including device failure as well as an aesthetic desires for a change in breast size.

The desire to change breast implant size, while often believed to occur early after their initial placement, is usually much later. It often is a decade or more particularly if one has had them placed before children. The breasts will undergo changes from pregnancy and weight loss and this often leads to loss of breast tissue and a real negative change in breast size and shape.

When replacing breast implants for a size increase, it is important to remember the volumetric rule that it takes at least 25% to 33% more volume to see an external change. For example, existing 300cc implants would need to be replaced with 400cc implants to see a visible change. This is usually a 1/2 cup or so. Large increases in breast size will require a 50% or greater volumetric increase. Thus 300cc implants need to be replaced with 450cc implants for a full cup size increase.

Case Study: This 47 year-old female originally had saline breast implants placed fourteen (14) years previously. They were 300cc implants filled to 350ccs. Between her age and loss of some weight she now desired a significant size increase with the desire for a two cup size increase.

large-breast-implants-replacements-front-view-dr-barry-eppley-indianapolisUnder general anesthesia her existing areolar incisions were used to remove her saline implants. The upper and inner capsule was released to accommodate the larger implants. Ultra high profile silicone implants of 700cc size were placed.

large-breast-implants-replacement-results-oblique-view-dr-barry-eppley-indianapolislarge-breast-implants-replacement-results-side-view-dr-barry-eppley-indianapolisThe reason it takes much more implant volume than one would think is due to multiple factors. The stretch of the breast tissue and skin that now exists that was not present initially during the initial procedure is a major reason. There is also the long-standing perception of breast size which initially seemed like a dramatic change but is now well visually accomodated.

As a general rule a moderate breast size increase requires 25% to 33% more volume, a moderate increase requires 50% more volume and a dramatic change requires 100% more volume.

Highlights:

1) Some women over their lifetime may desire to replace their breast implants to a larger size.

2) Secondary breast implant replacements surgery has a much more rapid recovery than their initial placement.

3) To make a visible difference in breast size with implant replacement the volumetric increase is usually greater than one would think.

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 – Large Breast Implant Replacements

Thursday, December 1st, 2016

 

Background: Breast implants are known to have a limited lifespan due to potential disruption of the implant shell. But as long as the implant shell remains intact the volumetric effect of the implants persist. Yet while breast implants remain stable the long-term effect of the appearance of the breast changes many years or decades later.

Whether a woman has an implant in or not, the breast tissue and skin envelope changes. Breast tissue may be lost and the skin will develop some sag. This effect is accentuated with pregnancies and weight gain/loss. The presence of implants may delay or blunt these body-related changes but they almost always occur. Over time the natural breast tissue may slide off of the implant as the tissues weaken and the breasts will look much less perky.

With these breast changes women may seek to exchange their breast implants for larger ones to get a breast rejuvenation effect. The question is what size increase is needed to see a visible change.

Case Study: This 44 year-old female had 350cc saline breast implants placed twelve years ago. She had two subsequent children and then lost some weight as she became much more of a fitness enthusiast. While her saline implants remained intact her breasts had developed some sag and she felt they had lost overall size. She wanted new breast implants that produced a dramatic change in implant size and upper pole fullness.

large-breast-implants-replacements-front-view-dr-barry-eppley-indianapolisUnder general anesthesia through her existing areolar incisions, her saline implants were removed and replaced with 700cc ultra high silicone implants into her existing submuscular pockets.

large-breast-implants-replacement-results-oblique-view-dr-barry-eppley-indianapolislarge-breast-implants-replacement-results-side-view-dr-barry-eppley-indianapolisWhen replacing breast implants for a larger and fuller look, it takes more increased volume than one would think. Of course it depends on what final breast size one wants but anywhere from a 50% to 100% volume increase is needed. That could be anywhere from 150 to 300ccs for most women.

Highlights:

1) As long as breast implants remain intact, they maintain a persistent volume.

2) The tissue around breast implants does change over time through some loss of volume and tissue sag off of the implants.

3) To re-expand saggy breasts with new implants a much larger breast implant size must be chosen than one may think.

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 – 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

The Ideal Implant Update

Sunday, August 7th, 2016

 

Ideal Implant internal structure Dr Barry Eppley IndianapolisThe Ideal implant is the first truly new idea in breast implants that has come along in decades. Its innovative internal baffle and dual chamber design allows a saline-filled implant to act more like a silicone breast implant. It has a fairly natural feel and does not develop rippling but also offers the piece of mind of being saline-filled device for those so concerned about silicone. It also will undergo complete deflation if there should be a disruption in the shell due to its two internal chambers.

The FDA has recently changed the Ideal Implant name from saline-filled to that of a ‘Structured Breast Implant’. This name change helps make for a clear distinction between that of the traditional saline breast implant. Now there are officially three types of breast implants; saline, structured and silicone gel.

The Ideal Implant or structured breast implant does not come in every size that is available with the more traditional saline and silicone implants…as of yet. But it does come in a fairly wide variety of sizes from 210cc to 635cc. A new 675cc size will be available shortly. Since one can slightly overfill the implant the range of implant sizes is virtually identical to that of silicone breast implants.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Implants and Cleavage

Wednesday, July 6th, 2016

 

cleavageBackground:  Cleavage is defined as the area between the breasts. It usually confers that the inner or medial part of the breast mound encroaches upon the flat sternum which lies between the breasts. While the term defines a certain breast appearance it usually refers to a look that is seen in clothing such as a low cut shirt or blouse, lingerie or swimwear. For Western cultures cleavage is usually viewed as an important element of femininity and sexual attractiveness.

Patients have many expectations from breast augmentation surgery and having cleavage afterwards is often one of them. Having much fuller inner breast mounds that are more prominent and rounder with the breasts fully exposed is often their goal. This is somewhat ironic in that how cleavage is usually perceived is in clothes with a low neckline. Thus surgically enhancing a fully exposed breast that has a cleavage appearance  is a bit unnatural and is asking the breast implant to do what clothing usually creates. This is particularly true in today’s modern positioning of the implant in the submuscular location.

But what defines whether cleavage is the result of placing breast implants or not is the patient’s chest anatomy and the size and positioning of the implant. Breast mound and nipple spacing between both sides is a major factor. Many women simply have very widely spaced breasts and no matter what size breast implant is placed, augmented inner breast fullness is not going to occur.

Case Study: This 42 year-old female presented for breast augmentation. She had small breast with good skin. Her nipples were located on the breast mound at the mid-clavicular level.

Breast Implants and Cleavage result front view Dr Barry Eppley IndianapolisBreast Implants and Cleavage results oblique view Dr Barry Eppley IndianapolisUnder general anesthesia she had smooth round silicone breast implants placed of 375cc through inframammary incisions. Her results show the creation of unsupported fullness in the inner poles of her breasts.

Whether cleavage will result from breast augmentation depends on the spacing of the breast mound and nipples, the location of implant placement (subfascial vs submuscular), the size and projection of the breast implant and the amount of tissue quality that makes up the breast mounds. For most women undergoing breast enhancement prominent cleavage will not be the result. But when several of the natural breast characteristics are just right, some women will indeed develop an inner breast appearance that can appear without clothes to what it may be in clothes.

Highlights:

1) Breast implants rarely create cleavage for most breast augmentation patients.

2) The spacing of the breasts and the width of the sternal gap are the main natural limitations to breast augmentation cleavage.

3) When the distance from the sternum to the nipples is 12 cms or less, and the breast implants are of adequate size, postoperative cleavage can occur.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Teardrop Breast Implants

Wednesday, July 6th, 2016

 

Background: Breast implants have obvious effects on increasing the size of the breasts. While volume of the breast obtained per implant size will vary amongst patients, it is obvious that the larger the implant is the larger the breast becomes.

But when it comes to breast implant shape, the effect on the outer breast is not so straightforward or always completely predictable. In round implants they come in different projections (e.g., medium, medium plus and  high) which makes alterations in the height vs width measurements within the same implant volume. Such changes in implant dimensions, however, are not as significant as that between implant shell shapes.

Teardrop Breast Implants Dr Barry Eppley Indianapolis copySilicone implant shells come in two shapes, round and anatomic. (aka tear drop) The anatomic implant. also called the shaped breast implant, has a defined difference in its upper and lower pole configuration. By making the bottom part of the implant fuller (2/3s of the implant’s volume) it will have the same shape regardless of whether the patient is standing or laying down. Because of having this shape, it is important that the implant does not move around or rotate after surgery. Thus the implant shell has a textured layering on its outer aspect making it thicker than a smooth silicone implant. This means the implant will feel more firm and will not move regardless of the patient’s position.

Case Study: This 35 year-old female wanted a breast augmentation result that was very natural looking. Her definition of that breast look was that it was not too round on the top part of the breast.

Teardrop Breast Implants result results oblique view Dr Barry Eppley IndianapolisUnder general anesthesia she had shaped breast implants placed of 350cc silicone through inframamammary incisions.

Tear drop Breast Implants result side view Dr Barry Eppley IndianapolisHer six week after surgery results show a very natural looking result of modest size with good implant symmetry. This satisfactorily achieved her breast enhancement goals.

Shaped or teardrop breast implants have a role to play in breast augmentation surgery. They give women an option that has a more powerful effect on the final breast result that does implant projection.

Highlights:

1) The design of a breast implant shell has both an initial and long-term impact on the external shape of the breast.

2) Anatomic breast implants allow for less initial upper pole fullness and a quicker attainment of a natural breast shape.

3) Anatomic breast implants are best inserted through an inframammary approach to ensure optimal implant orientation which is critical in these type of breast devices.

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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