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Archive for the ‘breast implants’ Category

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

Case Study – Large Breast Implants with Vertical Lift

Friday, June 24th, 2016

 

Background: Breast sagging can be treated by either the use of a lift or an implant. A lift works by removing sagging skin and physically moving the nipple upward. Any lifting effect of an implant comes from tissue expansion with an outward and upward push. In many cases of breast sagging both a lift and implants are used because an implant can not really push the nipple up very much.

Many women understandably try to avoid the need for a breast lift by using a large breast implant. While this would seem to be an effective approach, the reality is that unless the nipple is at or above the level of the inframammary fold a large implant will push the nipple further down. Thus it becomes important to get the nipple moved upward by some form of a breast lift even if it is not a complete one.

Case Study: This 44 year-old female had lost some weight and had breast implants placed years ago. She was never completely happy with their small size and how they did not lift up her breasts. Since she has lost weight her breast sagging had become worse.

Large Breast Implants with Lift result front viewLarge Breast Implants with Lift result oblique viewUnder general anesthesia, vertical breast lifts were performed as well as breast implant exchange. Her existing 450cc saline implants were replaced with 900cc saline implants (700cc base size filled to 900ccs) Given her large and taller body size, this size of breast implant did not look too big.

Large Breast Implants with Lift result side viewEven with a larger breast implant size, a sagging breast may still not be sufficiently lifted. Only a formal lift through tissue excision and nipple-areolar relocation can  a breast be lifted. With larger breast implant sizes the type of breast lift can be affected. With larger breast implant sizes, the need for skin to accommodate that volume may eliminate the possibility of any horizontal skin excision. This leaves the vertical or the lollipop breast lift as the only breast lift of choice.

Highlights:

1) Many women want to lift their sagging breasts by implants alone but this rarely is successful.

2) Even with the use of larger breast implants some actual lifting of the breast is usually needed.

3) The size of the breast implant chosen affects the type of breast lift that can be used. (vertical vs anchor pattern)

Dr. Barry Eppley

Indianapolis, Indiana

Natural Breast Augmentation

Friday, June 17th, 2016

 

One basic preoperative concept of breast augmentation has taken on a contemporary approach of tissue-based planning. Such an approach strives to achieve a ‘natural breast augmentation’ result by not overwhelming the breast tissues with implants that are more than the tissue can accommodate. By having good tissue support for the implant there is a  lower risk of bottoming out, implant malpositions and reoperation rates. To some degree this fundamentally means that smaller breast implant sizes are used.

Based on a study of natural breast beauty the ICE principle has been described. This is an acronym that stands for Implant dimensions, Capacity of the breast and Excess tissue required. This is a simplified approach for calculating the inframammary fold incision placement and to create a 45:55 ratio between the upper and lower poles of the breast. The key element in this approach is the location of the new inframammary fold.

In the June 2016 issue of the journal Plastic and Reconstructive Surgery, a paper was published entitled ‘Design for Natural Breast Augmentation: The ICE Principle’. The paper described a study of 50 women who had primary breast augmentation using the ICE principle. The study looked at both round and anatomical silicone breast implants using the implant meridian relative to the nipple-areolar complex. For an anatomic implant it is 50:50 compared to a round implant of 45:55. The mean upper pole:lower pole ratio changed form 52:48 before surgery to 45:55 after surgery. Mean nipple angulation improved from 11 degrees to 19 degrees upward. The accuracy of the inframammary incision location was 99%.

Asian Female Breast Augmentation result oblique view Dr Barry Eppley IndianapolisThe ICE principle takes into account that in the vast majority of breast augmentations the inframammary fold must be lowered. Much of the work of a breast implant occurs in the lower pole of the breast which must be expanded. If not the upper pole will develop excessive fullness and the position of the implant will cause the breasts to look too high and unnatural. Expansion of the lower breast pole requires extra skin which comes from the abdomen. Knowing where to place the incision in the new inframammary fold location is key. This is not only to avoid a visible incision below the new fold but also to allow a greater amount of the implant to sit below horizontal level of the nipple-areolar complex. Knowing the diameter of the implant allows these measurements to determine the location of the new inframammary fold.

Natural Breast Augmentation Indianapolis Dr Barry EppleyA natural breast augmentation for most women means a breast that has an upper pole that is less full than the lower. Achieving this look does not always require a smaller breast implant to achieve it. The amount of available breast tissue, the natural width of the breast and the elasticity of the tissues may mean a larger breast implant by volume can still allow for a bigger breast augmentation result to still look natural.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Hispanic Breast Augmentation

Wednesday, June 8th, 2016

 

Background: Breast augmentation is a common body contouring procedure. Of the many pictures of breast augmentation results on the internet, the vast majority are of Caucasian type. The main difference with Hispanic or Latin women is their increased propensity to develop dark pigmentation at incision/scar sites. While they almost never develop hypertrophic or keloid scars, the color of the scar may still make it noticeable.

Case Study: This 21 year-old hispanic female never had any breast tissue develop. Her chest was completely flat with a small diameter areola.

Hispanic Breast Augmentation results front view Dr Barry Eppley IndianapolisUnder general anesthesia she underwent the placement of 300cc smooth high profile silicone breast implants through a high axillary incision. (3 cms length) Her implants were placed using a funnel insertion technique.

Hispanic Breast Augmentation results obique view Dr Barry Epley IndianapolisHispanic Breast Augmentation result side view Dr Barry Eppley IndianapolisHer result at six weeks after surgery showed a scarless breast augmentation with tight skin over the implants. With six to none months more time her very round breast augmentation result will soften and they will become more natural and softer.

Young Hispanic breast augmentation patients may want to avoid even the smallest scar at the inframammary fold area. The transaxillary incision offers a scarless approach that is appealing to women of increased pigments. Being placed in the hair bearing skin of the axilla, it heals very well and rarely develops any significant hyperpigmentation.

Highlights:

1) Breast augmentation can make a dramatic change in one’s self image for young women who have no breast tissue. (flat chest)

2) The young juvenile appearing female chest with tight skin will create more of a rounder appearing breast implant result.

3) Hispanic breast augmentation women may prefer a ‘scarless’ method using high axillary skin incisions.

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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