Breast Augmentation Richmond, VA

Choosing the right size breast implant. You can’t come in the office and say, “My friend Mary has 375s, so I want 375s.” We do probably 10 measurements of your chest and torso and nipple position and breast width to really determine what size implant is right for you, and we palpate and feel your soft tissue to feel how much laxity, how much stretch you have in your tissue. You can’t just stick the same size implant in everybody.

So we use these, what we call bio-dimensional profile of each individual to determine what implant best suits their frame. And once we have those measurements taken, what we do is we look at the implants that we have available, whether they’re silicone or saline. Implants come in, we call it, different profiles. So they have different widths and different amounts of projection. So, we can choose something that’s kind of more like a pancake or very flat, and that’s okay for somebody who wants a very, very small breast. Or we can choose something that’s more like a beach ball, that really sticks out and has a lot of prominence. And for some people, that’s exactly what they want. So by choosing the proper profile to what the patient’s desires are, we really can meet everyone’s individual needs.

There are traditionally three different incisions. The most common is the inframammary fold in the breast fold region which is hidden when you stand up. It’s in the shadow of the breast and heals very nicely in most skin types.

The second is what we call the periareolar, which is on the lower typically edge of the pigmented nipple areola skin junction. It’s usually a crescent smiley face incision and that heals very well too.

The third which is one that I really like, I think its great, is called the trans axillary or the armpit incision. And it’s again about one and a half inch incision in the armpit and use a special camera system to make a pocket under lighted magnification. The benefit of that in my hands are that we use a camera system, a bright light and everything is magnified and we use very precise instruments and can create a very nice pocket in a very nice position to implant with no visible scar on the breast.

Some of the concerns about each individual scar are really as follows. The periareolar scar has the highest rate of losing nipple sensation and it has a higher rate of what we call capsular contraction, which is the hardness or firmness of the implant which you really don’t want. Periareolar has a highest risk of that and for that reason it’s low on my list of selected incisions.

The inframammary or the breast fold really is the go to for larger silicone implants or patients that have complex anatomy because it really gives you the best visualization of the pocket and lets you really manipulate the tissue the most. So it’s really the gold standard.

The trans axillary or armpit is not offered by a lot of surgeons because the equipment is more technologically advanced, it’s fairly expensive and it is a more, really a more difficult procedure to perform so most surgeons don’t learn it and don’t offer it. It is something that I’ve done for literally almost 20 years now, so it’s something that when somebody comes to my office and says, “Oh, everyone in town says you can’t have a trans axillary incision.” It’s really because the doctor doesn’t know how to do it, but it really is an excellent, superb procedure for the right patient.

A huge concern patients have is in the post-op period, the bruising, the scarring. We’re going to talk a little about that, because we use some special things to help decrease it. We use medicines called arnica montana. It’s a natural product, helps decrease bruising and swelling. We also use a product called bromelain, which is a pineapple stem extract, and again, that helps decrease bruising and swelling.

When it comes to incisions, I mean, the closure of the incision is not something I take lightly. We do it very precisely. All of your sutures are tucked underneath the skin. In fact, we actually use three to four layers of sutures. So there’s not just one layer, but they’re all underneath the skin. We usually have some special material placed over your incision line, it’s an antibacterial product. You’ll remove that after 24 hours, and then we actually start you on typically a silicone scar gel, which helps improve the quality of your scar in the long run.

We’re going to briefly talk about capsular contracture, or CC. People read about it online and want to know what they can do to help prevent it, and I think the biggest thing to prevention of capsule contracture is having a good surgeon. What you want is a very bloodless technique. The surgery must be performed very, very precisely. You want to select an implant that doesn’t overwhelm your frame, and implant selection is definitely part of it. I think it’s definitely important where you place the implant. Below the muscle, we know, has a tremendously lower rate of caps contracture.

And then we’re going to talk about other ways to place the implant. I am a huge fan of a device called the Keller Funnel. It was developed by Dr. Keller, plastic surgeon, and it’s basically a sterilized single use, slippery… It’s a slip-and-slide for breast implants. You put it in the big end, like a cake icing bag, you put the small end in, squirt it in, so no one touches your implant, the implant has no trauma to it, it doesn’t… It just slides right in. And there are several studies that are good studies showing a decreased risk of capsule contracture with the Keller Funnel.

The other thing is what we irrigate, or what we wash out your breast pocket with, prior to implant insertion. There’s several different formulas. There’s some really new exciting materials that I’m working with that are very safe, and I’m really excited to tell people that caps contracture can really be decreased by using appropriate surgical technique, appropriate implant placement, and then washing the pocket out with specific materials that we know are super safe and work fantastic.

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