Revision breast augmentation typically requires techniques similar to those used in reconstructive breast surgery to achieve the most natural contour and highest level of symmetry possible, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
For this reason, breast augmentation reconstruction requires higher level of technical skills (and experience) on the surgeon’s part to achieve good results from the surgery, Dr. Smiley said.
The celebrity plastic surgeon has recently posted a case study on his Snapchat account involving a patient who had breast augmentation 10 years ago and was seeking revision to correct several aesthetic-related problems, which the surgeon has enumerated in the video.
- Enlarged areola
- Visible rippling along the mid cleavage
- Too much cleavage (the breasts were too far apart)
- Excessive lateral bulge
- Sagging or bottomed-out implants
Dr. Smiley first started with the areola reduction in which he used a cookie-cutter device to delineate the new areola and make it smaller. The scar from this technique goes precisely at the dark-light skin junction so it will blend nicely to the background.
To correct the sagging appearance, he made vertical incisions from the areola down to the submammary fold, and another incision pattern that goes parallel to the breast crease. (Basically, this is an anchor breast lift technique due to the shape of its final scar, which is expected to fade into the background about a year postop.)
The anchor breast lift allowed Dr. Smiley to remove some loose skin and tighten and elevate the breast tissue, leading to a perkier appearance.
To further achieve good breast shape and to correct the excessive lateral bulge, he repaired the breast pocket (by making it smaller) and so the implant will not migrate.
Meanwhile, he addressed the visible rippling by replacing the old saline implants, which have a natural deflation rate of 1 percent per year due to evaporation. And since the patient had hers for 10 years, the implants had already lost about 10 percent of their volume, and thus resulting in rippling.
Oftentimes, silicone implants are considered as good replacements if the patient wants to prevent or correct rippling and palpability since they have no deflation rate and they are filled with a cohesive medical-grade silicone gel that resembles that of the breast tissue and fat.
When plastic surgeons mention the term breast implants armpit, they refer to the incision site. This technique results in an inconspicuous fine scar that lies within the natural skin fold, making this ideal for women who want to avoid scars on their breasts.
Despite the appeal of breast implants armpit, as with any technique its success all boils down to several factors such as the patient’s underlying anatomies, cosmetic goals, and implant type. Of course, the surgeon’s skills and experience will also have a large influence on the final results.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says appropriate patient selection is the first step to reap the technique’s full benefits. In general, it favors women whose pre-existing breasts have a “decent” shape—i.e., no drooping or south-pointing nipple, and no contour deformity (e.g., tuberous breasts).
If there is sagging or contour deformity, incisions made directly on the breast skin are always warranted to achieve good results from the surgery.
Furthermore, the patient’s armpit should not be too “narrow” unless she will be having saline implants, which are propelled “empty” towards their pocket before the surgeons inflated them with saline or sterile saltwater solution. Implant manufacturers, meanwhile, always prefill the silicone implants.
Aside from the patient’s anatomy, another important factor is the chosen implants. While silicone implants can be used (despite popular misconception that only saline implants are possible with the armpit incision technique), in the ideal scenario they should not be larger than 350-400 cc lest they require longer incisions and thus defeating the purpose of having well-concealed scars.
However, the use of Keller Funnel device, which resembles a baker’s bag used to propel the silicone implants into their pockets, have made it possible to opt for a larger size range without increasing the risk of longer, more visible scars in the armpit.
Meanwhile, size is less of an issue—at least in terms of scar length and visibility—when saline implants are used. Nonetheless, it remains practical to use implants that are within the chest and breast dimension to avoid a gamut of complications such as implant malposition, rippling, unnatural breast contour, and palpability.
And lastly, the surgeon’s expertise will also determine the results from breast implants armpit, which requires high precision and eye for details, says Dr. Smiley.
Dr. Smiley says a good rule of thumb is to choose a board-certified plastic surgeon who performs breast implants armpit technique on a regular basis, and has impressive collection of before-and-after photos of his actual patients.
The use of breast implants on skinny women has certain challenges that stem from the lack of soft tissue coverage, making them susceptible to rippling, increased palpability, and less natural breast shape that is often described as too “globular.”
However, there are several ways to compensate for the lack of soft tissue coverage, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.
The celebrity plastic surgeon has explained all the things to avoid when breast augmentation involves patients who are naturally thin or have little soft tissue coverage.
Saline implants are filled with sterile saltwater solution once propelled and positioned into their pockets. While women with sufficient soft tissue coverage (they’re wearing B cup bras at the very least) can achieve good results from them, patients with a skinny frame may end up with visible implant edges or a breast shape that is too globular.
Meanwhile, silicone implants are suitable for women who have little soft tissue coverage or low body fat percentage because their filler material closely resembles the breast fat and tissue.
- Avoid over the muscle position (subglandular)
Placing the implants over the muscle that the only thing supporting their weight is the tissue and skin can spell disaster for thin patients. Using saline implants can further aggravate the risk of rippling and palpability.
Under the muscle position, meanwhile, favors breast implants on skinny patients because this strong anatomical layer not just gives additional coverage but also more support that prevents bottoming out or any other type of inadvertent implant displacement.
- Avoid low profile implants
Low profile implants have a wider base dimension that could occupy too much horizontal space when used by thin patients. For this reason, they may end up with unusually flatter and “bubble-shaped” breasts that give them a heavy top look.
In general, thin patients are suitable for moderate profile implants especially if they want just the right amount of lateral bulge and mid cleavage; or high profile implants if they like a fuller upper breast pole (because it offers the most forward projection and has a relatively narrow base, which is the complete opposite of low profile).
To prevent unnatural breast contour and other surgical stigmata, a good rule of thumb is to use implants whose dimension is within the chest and breast measurement.
- Avoid hugely disproportionate implants
Arguably, this is the most influential factor. When implants are too large for the underlying anatomies, they will cause overstretching of the breast tissue and skin, which of course can spell disaster.
Small-framed women who want to achieve natural-looking results are generally advised to stick to 300-400 cc breast implant size range.
The areola breast augmentation technique uses a small incision placed right at the border of the areola, i.e., dark-light skin junction, where the breast pocket is created and the implant is propelled inside, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
On his recent Snapchat video post, Dr. Smiley has demonstrated the technique and its challenges since the patient has a small areolar complex that could make it difficult to hide the scar particularly when prefilled silicone implants are used.
All silicone implants are prefilled by their manufacturers; however, saline implants usually come “empty” and are only inflated with sterile saltwater (saline) by surgeons once positioned in their pocket. In terms of aesthetic superiority, silicone implants are the standard choice because their filler material closely resembles the glandular tissue and fat.
The patient shown in the video has a small areola but nonetheless had chosen the silicone implants, which “traditionally” requires longer incision than saline implants.
Despite the caveat of silicone implants when areola breast augmentation is used, the benefits far outweigh the potential drawbacks because the patient’s lack of soft tissue coverage could mean an increased risk of rippling and palpability when saline implants are utilized.
Because of the anatomical challenge or “dilemma” facing this particular patient, Dr. Smiley has used Keller Funnel that allowed him to use silicone implants without resorting to long incisions.
The Keller Funnel resembles an icing bag that holds the silicone implant. Its narrow tip is positioned into a small incision along the areola’s border so when it is squeezed the implant is propelled into the pocket.
With Keller Funnel, Dr. Smiley says he is able to shorten the incision even when silicone implants are used. Furthermore, the technique significantly minimizes the amount of pressure during the implantation process (compared to the standard finger push method), which in turn preserves the implants stability and reduces surgical trauma, he further explains.
And because there is very minimal trauma around the incision, the scar is further expected to heal and blend well into the background, says the celebrity plastic surgeon.
While silicone implants can already reduce the risk of rippling, palpability, and other surgical stigmata (which are real concerns because the patient has little soft tissue to begin with), Dr. Smiley positioned them beneath the chest muscle for additional coverage; hence, the patient’s breast is now softer and its contour more natural.
Moderate profile breast implants are perceived to provide the most natural breast shape when viewed from the side (i.e., the contour of attractive breasts that are not surgically enhanced). Unlike high profile implants, they do not result in excessive fullness in the upper breast pole.
Before we delve into the effects of moderate profile breast implants, it is helpful that we describe the other two main profile types.
Image Credit: Natrelle Website
- High profile. It provides the most forward projection and has a narrower base diameter, making it ideal for thin or small-framed women who want additional upper pole fullness.
- Low profile. It provides the least amount of forward projection relative to its base dimension; hence, it creates a flatter, somewhat “bubblier” breast shape. Its design generally suits patients with a wider chest wall.
Moderate profile implants, meanwhile, are “in between” the high and low profile implants. They do not provide the “push up bra look” delivered by high profile, nor the flatter and rounder appearance resulting from low profile.
In the past, moderate profile implants were the only forward projection available to patients seeking breast augmentation and breast reconstruction via artificial prostheses.
Aside from giving a more natural breast shape especially when viewed from the side, moderate profile breast implants may also suit thin patients who want a slight lateral bulge and additional mid cleavage. Nonetheless, it remains critical to measure the pre-existing breast and chest dimension to identify the most ideal implant range in terms of base dimension, size, and forward projection.
By using implants that reflect the patient’s underlying anatomies, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the results will look natural and proportionate. Furthermore, respecting the anatomical boundaries can also prevent most implant-related complications—e.g., inadvertent displacement, rippling, and palpability.
But what if the breast implant profile and base dimension does not reflect the patient’s anatomy?
In patients with a wide chest wall, the use of high profile implants whose base dimension is markedly narrow can result in a “too pointy” breast shape and an unusually wide gap between the breasts.
Breast implant extrusion is a rare complication that occurs when the prosthesis comes through the skin. Typically, the underlying cause is poor wound healing or breast tissue weakness; hence, risk factors must be recognized and eliminated prior to surgery to achieve good results.
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley has explained the fundamental guidelines to prevent or at least minimize risk of breast implant extrusion.
- Respect the patient’s underlying anatomies
Using breast implants that are too big for the patient’s anatomy, particularly relating to chest dimension and soft tissue coverage can lead to increased risk of breast implant extrusion, poor healing, rippling, palpability, and a wide range of problems.
To prevent most known implant-related complications, Dr. Smiley measures the breast and chest width to determine the most ideal breast implant size range, profile, and base dimension.
- Prevent or treat immediately signs of infection
Infection can lead to wound not healing/closing properly that the implant comes through the skin. Fortunately, there are several steps to minimize risk of infection such as irrigation of the breast pocket with antibiotic solutions prior to implantation, use of oral antibiotics a few days postop, and complete cessation of tobacco products and medications with blood thinning properties (aspirin and ibuprofen).
Patients should also know the telltale signs of infection such as increasing pain, persistent swelling, fever, nausea, vomiting, and/or diarrhea.
Radiation therapy has an effect on breast tissue and thus may increase the likelihood of breast implant extrusion. A good rule of thumb is to wait for the body to recover fully from its effects before reconstructing or augmenting the breast with synthetic prostheses.
- Meticulous closure of wound
To further minimize risk of breast implant extrusion, the celebrity surgeon closes the wound in several layers to protect the implants. Additionally, he ensures that the uppermost layer of the skin wound edges are just allowed to kiss each other to promote the best scar possible. Tapes or steri-strips are then used to hold the wound together and to minimize “superficial” tension, further promoting favorable scarring.
- Over-exertion during the initial phase of healing
Heavy lifting and strenuous exercise particularly involving the upper extremities must be avoided for a few months to prevent healing problems and breast implant extrusion.