Breast augmentation procedures by Dr. Jeffrey Ptak, M.D., certified plastic surgeon in Scottsdale, AZ, serving Maricopa County and Phoenix, Arizona areas.

Breast Augmentation

Dr. Ptak's personal philosophy and vision for breast augmentation surgery is to achieve a very natural and proportioned result that balances and brings into harmony the features of the feminine body.
Female breasts should be just full enough to entice the imagination but should never be so full that they become disproportioned or unmanageable. Dr. Ptak also believes that the surgical process should be as pain free and risk free as possible and a truly pleasing experience. The result should have the smallest hidden scar possible and be so natural that even your personal physician would be fooled. Many women want to enhance their curves. The curvy body is not balanced without breasts that have a reasonable size/shape in relationship to the waist and hips.
For women whose breasts are smaller than desired, breast augmentation is the best way to get the look they desire and the most proportionate, balanced overall body shape. With breast surgery, the results are completely dependent on the techniques or materials used by a surgeon. The size and shape of the breasts can only be enhanced by augmentation surgery, as exercises, pills or medications often said to enlarge the breast are simply too good to be true. In order for a surgeon to successfully perform a breast augmentation surgery, it is important for patients to manage their expectations and trust the better judgment of their doctor.
Bigger is not necessarily better for every patient, and the healthiest options are the best options.
In addition, it is imperative that a patient understands that this surgery is designed to provide volume and increase the size of the breast. If any asymmetry or malformations of the breast or nipple exist, a patient will have to discuss this with Dr.Ptak during the consultation and there may be other surgical techniques that are necessary to improve these conditions.

What is Breast Augmentation?

Breast augmentation is an elective surgery used to increase the size and improve the shape of the breasts. Through surgical insertion of either silicone, saline or gummy bear implants, Dr. Ptak can assist patients in reaching their aesthetic goals. There are a number of options available for breast augmentation surgery. For one, several implant shapes exist in order to accommodate the large variety of existing breast shapes.

Implant Shapes

implant-shapes

Round

Round implants are very common and come in three different levels of projection. Low profile implants are not used often as they have very little projection and this is generally what a patient is trying to correct. High profile implants are the best choice for women who have flat breasts. Moderate profile implants are the most common choice, and look the most. High profile is necessary for those with flat breasts who would benefit from the most projection.

Contoured

Contoured breast implants, or anatomical implants, are generally used to add more volume to the lower area of the breast. They are less commonly used than round or teardrop shaped implants.

Teardrop

Teardrop implants are meant to mimic the shape and fullness of a natural breast. They slope gently to a full projection at the bottom of the implant, which looks natural but still fuller.

Implant Placement

For each patient, it will be determined where the implant should be placed for the best final result. Implants are inserted into a pocket created in the tissue under the natural breast. It is said that placement under the muscle results in less scar tissue and this is one reason the method is the most common choice.

Below The Muscle

below-musclePlacing the implant below the pec muscle is the most common choice for augmentation patients. This is because it allows for better visibility of the breast tissue during mammograms. It is also said to allow for less rippling due to the additional tissue between the implant and the skin. Another perk is that it offers more volume in the upper area of the breast, since it pushes the pec muscle forward.

Above The Muscle

above-muscleImplant placement above the muscle is usually recommended for patients who have thicker skin and more tissue volume in the breast. It is also helpful for patients who have some sagging in their breasts as it may lift the breast enough to avoid a breast lift surgery. This technique also produces less post surgery pain, as it is less invasive. The downside is that it may make mammogram visibility lower, so this should be taken into consideration by patients with a family history of breast cancer.

Implant Types

Saline Implants

saline-implantThese implants are made with a silicone outer layer and filled with saline after the implant is inserted into the body. The good thing about this implant is that should rupture occur, the leakage is plain salt water and will simply be reabsorbed by the body. These implants may have a more finite lifespan and could deflate or partially deflate over time it would be advisable to be checked every five or 10 years.

Silicone Implants

gel-implantSilicone implants are recommended for patients who are at least 22 years old. they are said to feel more natural than saline implants with less rippling or watery feeling. These implants have been scientifically shown to be quite inert and safe. Silicones are chemicals that exist naturally in sand and rocks and are quite flexible, which may account for their more natural feel.

Cohesive Gel/Form Stable (Gummy Bear) Implants

cohesive-gel-implantThese implants are nicknamed Gummy bear implants because they are made of a new type of cohesive and thicker silicone material that does not deform. They come in varied shapes, sizes, lengths and projections, allowing for maximum customization. There are many advantages to these implants versus older silicon or saline. For one, if they are ruptured, they do not leak into the body. They also maintain their shape over time and don’t show any rippling when a patient bends over. They are better suited for filling areas with volume only where needed. These implants work best for patients with small breast and thinner skin texture.

Candidates

A good candidate for breast augmentation desires a larger, fuller look to their breasts and is realistic about what they can physically achieve through a breast augmentation procedure. They have a healthy body image and seek an improvement in their look and possibly a boost in their self-esteem. Patients with body dismorphia should undergo thorough psychological treatment before they receive any elective surgeries. In addition to this, a patient must be in good physical condition to avoid any unnecessary complications. Full health evaluations will be performed prior to surgery at Dr. Ptak’s suggestion.

What To Expect During The Consultation

During the consultation, Dr. Ptak will examine the breasts and listen to what the patient wants to achieve as a final result. He will discuss the many options available to each patient, although some incisions or implant materials/shapes may not work for certain cases. After the surgical plan is decided, any preparations, health changes and risks will also be discussed. Patients can also ask questions or raise any concerns they may have about the surgery. These steps will allow Dr. Ptak and the patient to reach an understanding of what to expect after surgery. Dr. Ptak will assess each case and will let a patient know if their desired outcomes are realistic. If not, he will suggest alternative treatments until an agreement can be reached with the patient. After this, a price quote will be discussed and Dr. Ptak will explain all the available options for a patient to pay for the procedure. Next, all necessary appointments will be booked and the patient can begin preparing for surgery.

Procedure & Recovery

Breast augmentation surgery takes approximately one to two hours. After the surgery a patient is taken to the recovery room and monitored until the staff determines they are ready for discharge. Recovery varies from patient to patient but any pain and swelling should disappear over time. Patients are instructed to avoid strenuous activities such as heavy lifting or raising of the arms for 4-6 weeks. After some time, any surgical scars will disappear or become barely visible.
The surgery can be performed using one of three incisions.
  • The inframammary is the preferred choice for most women because it allows for breastfeeding in the future should they want to have children. This incision point lies under the breast where the breast skin attaches to the chest. It is barely visible due to the natural hang of the breasts.
  • The periareolar or nipple incision is a bit more risky as it can result in loss of sensation in the nipple. This incision is made around the outer edge of the dark colored skin of the nipple. It is chosen primarily to avoid scarring on the lower breast area.
  • The axillary in the armpit incision is used in the endoscopic Breast Augmentation procedure. Its results may show more asymmetry and often require the surgery to be redone.
After the incision is made, Dr. Ptak lifts the breast tissue to create a pocket under the breast tissue, or under the pectoralis muscle, if he has elected to place the implant under the muscle. The doctor will then insert the implant that has been decided for the patient, depending on their needs and aesthetic desires. There are three implant materials, and their uses vary. One material may suit a patient more than and another based on their needs. Dr.Ptak will determine the implant used for a patient’s surgery during the consultation appointment.

Alternative Treatments

The BRAVA System

This technique involves the transfer of a patient’s own fat into their breasts. It is a painless procedure resulting in an enlarged breast without having surgery. It works by utilizing vacuum pressure to create spaces in the breast tissue. Fat is then suctioned and transferred into these spaces. Usually, one cup size is gained per treatment.

Fat Grafting

This technique requires multiple treatments and some fat deposits are required for the surgery to work. The results of this method vary and often cost a lot more due to the number of sessions needed to achieve the desired breast size. One downside to the technique is that is can create calcifications in the breasts that can be mistaken for breast cancer. This method, however, can be combined with the BRAVA system for much improved results.

Cost

The price for breast augmentation varies significantly depending on the needs of a patient. Some patients may require additional procedures to reach their physical goals. Dr. Ptak will discuss all of these factors in the initial consultation and offers a number of easy payment methods to make sure there is not a financial strain for his patients. It is important to keep in mind that elective surgery is not the time to bargain shop. It carries significant risks and a patient is paying not only for the procedure, but the years of education and experience that the doctor offers. Patients need to make sure they aren’t being overcharged but also that they are not being under charged because this can be a warning flag that something is amiss. Through the doctor’s financing options and payment plans, every budget can be accommodated and all patients can achieve their aesthetic goals.

Frequently Asked Questions

How many women have breast implants?

It is estimated that up to two million women have silicone breast implants. About 25% of these are for breast reconstruction following cancer; 75% for aesthetic (cosmetic) breast enlargement.

How long have breast implants been available?

Modern silicone breast implants were introduced in the US in the early 1960s. Plastic surgeons have had almost thirty years of experience with breast implants and, over that period of time, have observed that the devices have a good overall safety record.

When did the FDA approve the manufacture and sale of breast implants?

The FDA regulates the manufacture and sale of medical devices in accordance with the Medical Devices Amendments passed by Congress in 1976. However, breast implants were available before the passage of these amendments. Therefore, along with many other devices that do not show a significant health risk, they were allowed to remain on the market until they could be classified and reviewed. In June 1988, the FDA did classify breast implants as Class III devices. Under this classification, manufacturers must demonstrate the safety and effectiveness of breast implant devices through scientific studies.

What is the most common problem with breast implants?

Capsular contracture is by far the most common problem associated with breast implants. The body forms a scar envelope, or capsule, around any foreign material (the implant). For reasons that are not well understood, some patients may experience tightening of this scar around the implant severe enough to compress it and cause the breast to feel firm. (It should be noted that it is the membrane around the implant, rather than the implant itself, that hardens). Capsular contracture can occur at any time after your operation, even years later. A recent national survey of women who have undergone breast augmentation shows that only 5% have breast implants that they describe as "hard." Of those women who say that they have any degree of breast firmness, 74% find it "not at all" or "not very" bothersome.

Can the body reject breast implants, pushing them through the skin?

It is unlikely that a properly inserted implant would pop through the skin. However, this can occur in rare cases, especially following breast reconstruction. If the skin covering the implant is too thin and tight, extrusion of the implant is possible. While this occurrence is unfortunate and emotionally painful of those few individuals affected, it should be remembered that this is a very uncommon problem, and most women have a highly satisfactory experience with breast implants. In fact, 80% of women who have undergone breast reconstruction with implants say they would do it again "without a doubt"; 16% say they "probably would"; and only 2% say they "definitely would not" make the same decision.

What happens if an implant breaks?

Does silicone gel "bleed" through the implant's envelope?

Minute quantities of silicone do travel through the implants envelope and are picked up by the body's white blood cells. There is no evidence that this small amount of silicone is harmful. Silicone is the least reactive foreign material known and is used as the US Pharmacopoeia baseline standards for biocompatability. Everyone has tiny amounts of silicone in their body, since it is a major ingredient in many over-the-counter drugs and is present in our food, clothing, furniture, and cosmetics from which it may be absorbed. It is also used to coat every needle and syringe to make injections less painful.

Do implants cause cancer?

There is no evidence of any relationship between breast implants and cancer in humans. Opponents of breast implants often refer to studies which show a form of rare cancer can develop when silicone is implanted in rats. It is well known in the scientific community that any smooth surfaced object implanted in laboratory rodents has initiated tumor growth. In the opinion of an ad hoc advisory group of scientists representing the FDA and the National Institute of Health (NIH), it is unlikely that this finding is relevant to humans.

Do implants interfere with the detection of cancer?

Breast implants do complicate mammography, but research has shown that compensatory measures can be taken. Routine, two-view screening mammography may leave large portions of the breast unvisualized, resulting in an unsatisfactory exam. Studies show that mammographic accuracy can be improved when experienced radiologists use special techniques and extra views designed to maximize visualization of breast tissue ordinarily hidden by the implant. One such method (the Ecklund technique) involves positioning the breast so that the implant is pushed against the chest wall and the glandular tissue is pulled forward. Women who are over 35 years old should have an initial mammogram taken before breast augmentation. This can be valuable as a baseline for comparison of future mammographic x-rays. All women, including those with implants, should engage in breast self-examination monthly and be examined by a physician once a year. They should follow the American Cancer Society's guidelines for periodic mammogram: women with implants should use a skilled radiologist recommended by their plastic surgeon.

Do implants cause connective tissue disease?

Several studies have questioned a possible relationship between breast implants and scleroderma, a relatively rare disease of the connective tissue. None has substantiated any cause-and-effect relationship. Given the very small number of cases of this disease and its unknown causes, it is difficult to draw any statistically valid conclusions at this time. However, it appears that risk, if any existed, to the general population of women with breast implants would be minimal.

Why should breast implants remain available to women?

The decision to have breast implant surgery is one that each woman must make for herself, weighing the risks and benefits with the advice and consultation of a qualified doctor. Breast implants have shown no significant health risk over the 30 years since their introduction. Furthermore, breast implants offer important benefits to women who seek to improve their self-image and self-esteem, with a fuller, better-proportioned breast contour. The overwhelming majority of women who have had breast implant surgery, either for breast enlargement or reconstruction, say that they are satisfied with the results and "without a doubt" would choose to have the surgery again.

Where can a woman get accurate information about breast implants?

Anyone considering breast implant surgery should schedule a consultation with one or more qualified plastic surgeons. Before making an appointment, a prospective patient should check that the surgeon is certified by the American Board of Plastic Surgery or certified in plastic surgery by the Royal College of Physicians and Surgeons of Canada.
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