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Breast augmentation surgery increases the size of the breasts through the insertion of silicone or saline filled implants, usually behind the pectoral major muscle. Breast augmentation is also known as augmentation mammaplasty.​

Did you know that many women return to work in as little as 3 days following breast augmentation? As one of the leading surgeons for breast augmentation, Dr. Jervis believes that the best results can be obtained when the procedure, implant type, location and size are customized to meet a specific patient’s body type, lifestyle and desired look. We offer both saline and silicone filled implants. Patients are given the opportunity to see typical before and after photos, correlated with implant size. I need to know the look they want not just size, but cleavage, how full above, shape, then unless the patient dictates an absolute size I request the client allow me to pick the exact size by the use of sizing implants which are inserted to size up the situation then removed thereby allowing an informed decision of which size to open. saline filled implants allow more versatility as they have a recommended fill range which allows volume adjustment with the recommended range.

Breast Augmentation Consultation

At your consultation, Dr. Jervis will help you choose a shape and size that is natural looking (some clients prefer very large sizes over the “natural” look). He will also explain the pros and cons associated with each type of implant. The goal of the procedure is to enhance confidence and self esteem by enlargement, correcting asymmetries, and/or disguising moderate sagging.

Silicone Gel Breast Implants vs. Saline Filled Breast Implants

Since coming back on the market within the last decade, silicone gel-filled breast implants. Both Allergan and Mentor produce excellent silicone gel and saline inflatable implants. Silicone gel implants are more popular than saline filled and this will probably not change.

Silicone-gel filled implants are more natural than saline to touching or palpation and sometimes visually as well. One advantage of saline filled implants over silicone concerns leakage. If the shell of the saline implants is disrupted, only sterile saline is absorbed and excreted, making the leakage obvious and the saline is harmless.

Gel-filled implants can “bleed” gel through the intact shell (at least in the older implants), and if the shell is disrupted the gel can leak around the implants. However, as long as the scar capsule around the implant remains intact, the gel may be contained within the scar capsule. Gel can get embedded in the scar capsule and in the pectoral muscles, and has been known in some instances to get into the axillary lymph nodes. The current gel implants will hopefully have lower leakage rates, and have more “coherent”? gel, which is less “runny” if the shell is disrupted. Gel-filled implants require larger incisions and are very awkward to place through axillary incision, and are virtually impossible to place through the umbilical incision. If the implants are stressed during placement the shell could be damaged resulting in higher leakage rates.

Silicone gel-filled implants and saline-filled implants have essentially been cleared from the hysteria that they caused various illnesses after the 1992 implant “crisis”. All illnesses have the same incidence in patients with or without implants.

Saline filled implants can be used after age 18 has been attained, but with gel-filled the guideline is that age 22 should be attained before using gel-filled implants. Exceptions are possible due to anatomic considerations.

Breast Implant Placement

One of the major advantages of placing mammary implants behind the pectoral major muscle is that there is far less interference with getting mammograms; also the incidence of hardness or scar contracture is rare. Sensory loss is uncommon behind the muscle. Massage of the implants to counteract scar contracture is important behind the muscle and critical in front of the muscle where the incidence of scar contracture is much greater. Disadvantages of placing the implants behind the muscle are temporary distortion and motion of the implant when doing slow forceful exercise of the arms. Placement behind the muscles also may have more post-operative discomfort.

Loss of nipple/areolar sensitivity is more common with implants placed in front of the muscle, as the sensory nerve supply is more vulnerable.

What is Breast Implant Rippling?

“Rippling” is the visual and palpable presence of waves commonly associated with saline-filled implants, and is more common and more obvious in front of the muscle, particularly in thin and small-breasted women. Leaking implants is not usually due to forcible rupture, but by chronic creasing, which can thin the shell and eventually develop a pinhole. Leakage rates of saline implants are known as they are usually reported back to the manufacturer’s. The rates are approximately one out of 400 per year for smooth shell saline-filled implants. Leakage rates for textured shell saline implants are higher.

Breast Implant Warranty

Breast implant warranties vary with the manufacturer and between saline-filled and silicone gel-filled implants. During consultation, we always recommend taking out the Enhanced Warranty for either product to reduce or eliminate the client’s out–of-pocket expenses for the replacement of the deflated or leaking implant. The partial reimbursement of expenses for the replacement of a leaker with both manufacturers expires 10 years after implantation. Both manufacturers offer free replacements for a deflation or leakage for the client’s lifetime.

Breast Implant Incision Location Information

When using the periareolar incision for breast augmentation it is not necessary to cut through the actual breast tissue as one can easily open the subcutaneous (fatty layer) between the skin and gland, open up in front of the muscle, then spread between the pectoral major fibers to open the space behind the muscle. This is important to reduce the chance of sensory loss of the nipple/areola and also so as not to damage the lactiferous ducts, which could make breastfeeding less successful.

Transaxillary, and particularly transumbilical incisions, offer more difficult visualization and less “easy” access to the internal operative site.