Breast Augmentation in Beverly Hills
Dr. Handel is one of the most experienced breast implant surgeons in the United States. His extensive experience helps to ensure that patients will achieve excellent results with minimal risk of any serious side effects or adverse outcomes.
The modern era of breast enlargement (breast augmentation) started in 1962, when silicone breast implants were first were introduced in the United States. Since that time, more than three million American women, as well as millions of other women from around the world, have undergone breast enlargement surgery. Breast augmentation remains one of the most popular types of cosmetic surgery and has an extremely high patient satisfaction rate. Most studies show that 95% or more of the women who have breast implants are “happy” they underwent the operation and would do it again given the opportunity.
Typically, candidates for breast augmentation are women who never had very large breasts to begin with, or women who, as a result of pregnancy and perhaps breastfeeding, have lost breast tissue (involutional changes) resulting in a hollowing of the upper pole of the breast, breast drooping and loss of breast volume. The most effective way to improve the appearance of the breast in these women is by insertion of a breast implant.
All breast implants currently available are made of a silicone rubber envelope (the silicone elastomer shell) that may be filled either with silicone gel or with saline solution (salt water). Both types of implants are available throughout the United States and around the world, but silicone gel filled implants are by far more popular. The major advantages of silicone gel filled implants are that the physical characteristics of silicone gel (the density, compliance, etc.) are very close to breast tissue. Saline implants, on the other hand, are relatively “stiff.” Therefore, in many women, particularly those who have a thin layer of overlying breast tissue, a silicone gel filled implant gives a nicer cosmetic result in terms of the “feel” of the breast. There also tends to be less risk of waviness and rippling of the breast with silicone gel filled implants compared to saline implants. The major drawback of silicone gel filled implants is that they add to the cost of surgery because these devices are more expensive than their saline counterparts.
Breast augmentation is an operation that is routinely performed on an outpatient basis. The procedures are done either at the Plastic Surgery Center in Beverly Hills a fully accredited ambulatory surgery center. The operations are performed under general anesthesia (the patient is completely asleep), and all anesthetics are administered by board certified physician-anesthesiologists. Dr. Handel works only with qualified and experienced anesthesiologists to ensure safety and comfort for his patients. In more than 38 years of performing outpatient procedures under general anesthesia, we have not had a single patient who has experienced any complication related to the anesthetic.
Breast enlargement surgery is performed by creating a pocket or space beneath the breast tissue (and sometimes, beneath the underlying pectoralis major muscle) and inserting the breast implant. The incision to insert the breast implant may be made either in the armpit (the transaxillary approach), around the bottom of the nipple (the periareolar approach) or in the fold beneath the breast (inframammary approach). For women who elect to have a saline filled implant, insertion through an incision in the bellybutton (the transumbilical approach) is another potential option.
Breast implants do not come in “cup sizes” but, rather, are measured in cc’s (cubic centimeters). In addition to coming in different sizes, breast implants come in different profiles. For example, for any given volume implant, it typically comes in a Moderate (flat) Profile, a Moderate Plus (slightly more projecting) Profile or High (most projecting) Profile. Dr. Handel will help you to select the implant profile and volume that best fits your underlying anatomy and your aesthetic goals. The “sizing” process and selection of appropriate implant style and profile are critical to achieve the best possible outcome. We devote considerable time and effort to determining exactly the right implant for each patient. Factors that are taken into account include how much larger a woman wants to be, how “natural” she wishes to look, the thickness of her existing skin and breast tissue, and the dimensions of her breast and chest wall.
In recent years, a new breast implant design has been introduced in the United States. It is known as the “anatomical shaped implant” and is also called the “form stable” breast implant. This implant has a shape that more closely mimics a normal breast. The advantage of the shaped implant is that it gives a more “natural” appearance in many patients. However, most patients do well with either type of implant, and Dr. Handel and his staff will help you decide if you are a candidate for the anatomical shaped breast implant.
When it comes to the technical details of the surgery, there is the option of inserting the implant either just beneath the breast tissue (subglandular position) or beneath the breast tissue and the pectoralis major muscle (submuscular position). The advantage of the submuscular position is that in patients who have a very thin or attenuated layer of breast tissue of the upper pole of the breast and in the breastbone area, additional coverage with the muscle layer may help to “camouflage” the implant and reduce the risk of waviness, rippling, visibility and palpability of the implant edge. However, in patients who have an adequate layer of their own native breast tissue, excellent results are achieved with subglandular positioning. In many ways, subglandular positioning is more “natural” because a woman’s breast tissue is on top of her pectoral muscle and not beneath it! In any event, Dr. Handel and his staff will perform careful measurements and assessments of the thickness of your skin, subcutaneous tissue and breast glandular tissue to will help you make the best decision about whether you would like to have your implants placed in the subglandular or the subpectoral position.
The operation itself takes approximately one and a half to two hours. Afterward, you will recover under the supervision of our licensed recovery room nurses and then be discharged home. Patients are advised not to drive within the first 24 hours after having general anesthesia, and therefore arrangements should be made for someone to drive you home from the surgery center. For out-of-town patients who are coming to Beverly Hills to have their surgery, we can make arrangements at a hotel immediately adjacent to the surgery center for an overnight stay. Patients can be seen then the following morning before they return to their home city.
Breast augmentation surgery is an important part of Dr. Handel’s practice and, in fact, breast surgery comprises the overwhelming majority of surgery he performs. Dr. Handel has personally inserted breast implants in thousands of women in the past 38 years. While patient satisfaction with this operation is extremely high, it is important to realize that there also are potential risks and side effects associated with breast augmentation (just as with any surgical procedure).
Some complications that may be encountered include infections, hematomas, sensory changes of the nipple or breast skin and breast asymmetry. Infections occur in approximately one out of every 200 breast augmentation surgeries. When infection occurs, it manifests within the first week after surgery — usually in the form of redness, tenderness, swelling and pain of the affected breast. In the majority of cases, we can eradicate infections with oral antibiotics. Sometimes the infection is resistant to antibiotics in which case it may be necessary to remove and replace the implant or, in some situations, to remove the implant altogether and wait several months before reinserting it. Hematoma refers to a collection of blood in the pocket around the implant. The usual symptoms of a hematoma are excessive bruising, swelling and pain of the affected breast. Hematomas are most common in the first day or two after surgery. If a hematoma occurs, the patient is taken back to surgery where the incision is reopened, the blood is drained and the implant reinserted. This should not have any adverse effect on the final outcome from the breast enlargement surgery. Sensory changes occur in the breast and nipple as a result of the surgical dissection necessary to create space for the implant. In most patients, there is no significant change in sensation. In patients where there is a decrease in sensation, the feeling usually returns to normal. However, feeling does not return to normal in 100% of cases; there is always a tiny risk of permanent, diminished sensation of the nipple or breast. Breast asymmetry or unevenness can occur and may require revisionary surgery.
Other complications that may occur related to breast implants include capsular contracture and implant rupture. Capsular contracture refers to the phenomenon where a layer of scar tissue (the capsule) forms around the breast implant. This “capsule” forms in all patients — usually within the first six weeks after surgery. In the majority of patients, the scar tissue membrane or lining remains soft and pliable, and the breast has a “natural feel” and moves like a normal unoperated breast. In certain patients, however, the scar tissue capsule begins to shrink and thicken (a condition called capsular contracture or encapsulation). This may be severe enough in some patients to require a revision. The problem can always be repaired but typically requires additional surgery. By the end of ten years, approximately 5-10% percent of patients have developed significant capsular contracture and may require another operation.
Another risk of implants, of course, is a tear of the silicone elastomer shell surrounding the silicone gel or the saline. In the case of a saline implant, this would cause relatively rapid deflation of the implant (as the saline leaks out). This has no effect on a patient’s health but, of course, there would be a noticeable decrease in the volume of the breast, and it would be necessary to replace the implant. Modern gel filled implants contain silicone that is “highly cohesive.” This means that the silicone is not a liquid but rather a gelatinous, semisolid material. In earlier generation implants (particularly those from 1970s and early 1980s), the silicone filler material was very “non-cohesive” and when the implant shell ruptured, the silicone often leaked into adjacent breast tissue and other structures causing nodules and collections of silicone (siliconomas). This problem is not seen with modern breast implants. The implant is now designed so that if the shell sustains a rent or tear, the silicone stays together and is usually confined to the scar tissue capsule that has formed around the implant. Only in rare cases does any silicone escape beyond the confines of the capsule. Most patients with modern implants who have an implant rupture are completely unaware of it (a condition known as “silent rupture”). The rupture typically cannot be felt on physical examination and may not even show on mammography. The most accurate way to diagnose a “silent” rupture is MRI.
The most recent MRI data on breast implants (from studies performed in the US and in Scandinavia) shows that at the end of ten years, approximately 5-7% of modern silicone gel filled implants have a rupture or tear of the shell. If this occurs, Dr. Handel and his staff will discuss with you the recommended treatment. However, it is important to remember that even ruptured silicone implants (including the older style implants where the more liquid silicone gel leaked into adjacent tissues) do not represent a risk to a patient’s health. Silicone implants (intact or leaking) do not increase the risk of breast cancer nor do they increase the risk of any known disease. In fact, recent studies show a statistically significant reduction in the incidence of breast cancer in women with breast implants. While there were concerns in the 1970s and 1980s that ruptured silicone implants might lead to a higher incidence of connective tissue diseases or autoimmune illnesses such as lupus, scleroderma and rheumatoid arthritis, exhaustive studies have shown no link between breast implants and any of these disorders. When the surgery is performed correctly it generally will not interfere with a woman’s ability to nurse.
It is important to remember that because most breast implant recipients are young, and because breast implants are a “man-made device,” it may be necessary for patients to have implant replacement or other types of revision surgery in later years. The idea that breast implants “need to be replaced every ten years” is a “myth.” Many of Dr. Handel’s patients who received implants 25 and 30 years ago have their original set of implants in place and have no problems, in which case there is no need for additional surgery. On the other hand, there are some patients who do require additional surgery, and women considering breast augmentation need to be aware of this before they make a final decision about whether or not to proceed.
For more information on Plastic Surgery procedures and Medical Spa treatments performed by Board Certified Cosmetic Plastic Surgeon, Dr. Neal Handel please call 310-203-0511. Office located in Beverly Hills, CA.