Breast implants for thin skin and little soft tissue coverage can pose challenges since there is a perceived higher risk of implant palpability, rippling, and unnatural breast shape. Nonetheless, Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated some surgical techniques and “core principles” that help him reduce such risks.
In Dr. Smiley’s recent Snapchat video post, he performed breast augmentation on a thin, small-breasted patient.
Dr. Smiley generally prefers the peri-areolar incision technique (i.e., a small scar blends into the dark-light skin junction); however, the patient has small areolas, which could make it difficult to conceal the scar, and thus he recommended the submammary fold instead in which the incision was concealed within the natural skin fold.
The celebrity plastic surgeon said the submammary fold incision measured only 3 cm thanks to the use of Keller Funnel technique; this involved a cone-shaped device that was lubricated profusely so the implant could be propelled inside the pocket in just one squeeze.
Because of the patient’s little soft tissue coverage, Dr. Smiley positioned the breast pocket beneath the chest muscle, which provided additional padding to reduce implant rippling and palpability.
Aside from implant placement (relative to the soft tissue layers), Dr. Smiley said natural results are further guaranteed when the implant’s size and dimension reflect the patient’s underlying anatomy, particularly relating to her chest and breast measurement.
Because the patient has a narrow chest wall, Dr. Smiley used high profile implants—i.e., they have narrower base but offer more vertical height—to ensure natural and proportionate results, which were the specific aesthetic goals of patients.
The high profile implants also suit the patient because she wanted additional projection. Furthermore, it complemented her thin frame.
Dr. Smiley warned that implants with lower profile (they have a wider base and project less) may not suit thin patients, particularly if these come with a base dimension that occupies too much space on the chest wall. Aside from higher risk of rippling along the edges of the breast, they could also result in excessive lateral bulge that looks anything but natural.
After ensuring that both breasts look symmetric, Dr. Smiley closed the incisions; the tissue beneath the skin was closed with absorbable sutures to ensure the best scar possible. The skin, meanwhile, was not picked up and instead “sealed” with a surgical tape to make certain that it would receive no or very little tension.
Breast augmentation recovery tips may vary from surgeon to surgeon. However, they all have similar goals: promote healing and eliminate risk factors that can affect the breast appearance.
Prominent Los Angeles plastic surgeon Dr. Tarick Smiley shares his surprising recovery tips.
Pain threshold and healing may differ from patient to patient, although most people can expect that the first 1-4 days of recovery is the toughest period due soreness, discomfort, and sometimes nausea.
Patients who want the least amount of pain might be a good candidate for Exparel, a numbing medication injected into the muscle whose effects can last up for four days. This relatively new pain control option has allowed people to reduce or even avoid narcotics entirely.
In the first few days after surgery, the implants sit high and tight on the chest wall, resulting in unnatural appearance and excessive upper pole fullness. But over time, the skin and tissue relax and expand a bit, allowing the prostheses to settle into more natural position.
However, breast implant massage, also referred to as implant displacement exercise, can help accelerate the healing process. Dr. Smiley typically recommends this about a week after surgery.
The idea of breast implant massage is to push the prosthesis into the outermost corners of the pocket; hence, it not only promotes softer and more natural results but also minimizes the risk of capsular contracture by encouraging the scar capsule around the implant to remain flexible and thin.
Getting enough rest and sleep is one of the critical points of breast augmentation recovery. Dr. Smiley warns that rushing one’s recovery—i.e., returning too soon to work and doing strenuous house works—may affect healing and even predispose patients to risk of bleeding and edema (fluids collecting beneath the skin).
Some patients are able to return to work within a week, while others need at least a two-week off. It all boils down to variables such as the nature of work (patients who go to office may return sooner than those with physically demanding job) and the individual healing.
Medical garments are designed to keep swelling under control with the right amount of compression and to protect the sensitive tissue. Some resemble standard bras, vests, or wrap-around garments.
Teardrop shaped breast implants have more volume at the bottom, while round implants, which are more commonly used in cosmetic breast augmentation, are like flattened sphere.
In terms of natural breast contour, both teardrop and round implants give similar results. One X-ray study involving breast augmentation patients has shown that on profile view there was no significant difference between them.
Photo credit: Natrelle website
Another study, which involved 75 patients whose one breast had round implant while the other had teardrop, has also shown similar results. Both ordinary observers and experts (i.e., plastic surgeons) who were asked to guess which side had a round or a “shaped” implant could not tell the difference, with about 50 percent accuracy—not better than coin tossing.
Hence, teardrop shaped breast implants offer no real advantage unless the patient ask for gummy bear implants, which are fifth generation silicone implants.
Older silicone implants have liquid silicone gel that can “bleed” in the event of rupture. Gummy bear implants, meanwhile, have semi-solid silicone gel that remain in place even when the shell is cut in half.
Gummy bear implants must always come in teardrop shape because they are unaffected by gravity, i.e., no matter what their configuration is, they always “hold” their shape.
One caveat of teardrop shaped breast implants is the risk of flipping. This is not an issue with round implants, which can rotate inside their pockets without distorting the natural breast contour.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says there are two ways to avoid or at least minimize risk of flipping. First, all teardrop implants have rough or textured outer shell to promote tissue adhesion. Second, they demand highly precise pocket dissection to prevent them from rotating.
Round implants, meanwhile, rotate freely inside their pockets (but not freely lest it would result in bottomed-out or sagging appearance), which can contribute to their more natural look and softer feel.
As of this writing, smooth round implants are the most commonly used design in breast augmentation because they provide more natural results, they do not come with risk of flipping, and they are less likely to cause rippling, a common issue with rough or textured implants particularly in patients with little soft tissue coverage.
In the US, more than 290,000 breast augmentation procedures via implants were performed in 2016 alone, making it the most commonly requested cosmetic surgery, according to data released by the American Society of Plastic Surgeons.
Despite becoming a popular procedure, there are some surprising breast augmentation facts that you may not know about, including the surgery’s cost is now being considered a business expense (according to the United States Tax Court) but only if you’re part of the “adult” entertainment business.
Here are some other surprising breast augmentation facts:
- One woman saved by her breast implants during a stabbing attack.
A 41-year-old woman from Florida was stabbed repeatedly in the chest by a jealous love rival. Lucky for her, the knife pierced through her newly placed breast implant, which served as a shield that protected her heart.
Because of the auspicious event, the woman went further by saying that her “breast implants were the best investment” she made.
- FDA-approved breast implants have serial numbers.
Breast implants nowadays have serial number, date of manufacture, volume, manufacturer name, and other pertinent data. While such information are useful for future surgery, take note that a handful of heinous crimes have been solved because investigators were able to identify the mutilated or decomposing bodies thanks to the implants’ serial numbers.
Meanwhile, some breast implants available outside the US have heat-resistant microchips that can be tracked from outside the body, allowing health authorities to identify serial numbers and other pertinent data of the prostheses.
- Before saline and silicone breast implants, there were glass bottles.
Glass bottles, blood bags, and industrial materials were previously used to enlarge breasts. But in the early sixties, American physician Dr. Frank J. Gerow convinced then 29-year-old Timmie Jean Lindsey to become the world’s first recipient of silicone breast implants.
- High-riding implants are common in the first few weeks postop.
Don’t fret if your implants seem too high on your chest wall, resulting in unnatural fullness at the upper breast pole. As your soft tissue relaxes, they will settle into a more natural position—i.e., centrally behind your nipple-areolar complex. Nonetheless, renowned Beverly Hills plastic surgeon Dr. Tarick Smiley says you can accelerate the healing process by performing breast massage or medically referred to as implant displacement exercise.
And if you’re right-handed, expect that your right implant will “drop” quicker than the other side due to greater muscle development of your dominant side. The same is true for southpaws.
Fat transfer to enlarge breast is a viable alternative to breast implant. This technique requires a concomitant liposuction to collect fats from multiple donor sites; the fats are then washed and sorted before they are injected into the breasts.
Prominent Los Angeles plastic surgeon Dr. Tarick Smiley has recently demonstrated the technique on Snapchat. The surgery involved a female patient with a sufficient volume of “unwanted” fat that made her a good candidate for fat transfer to enlarge breast.
The right breast has more volume and better shape than the left breast, which is yet to receive fat transfer.
After collecting sufficient donor fats, Dr. Smiley purified them, meaning the anesthetic solution, oil, red blood cells, and other tissues were removed so only the healthiest fat cells were injected into the breasts.
Afterwards, Dr. Smiley created a small round incision (on each breast) precisely positioned at the submammary fold where he could insert a blunt cannula (hollowed tube) that injected the purified fat into multiple layers of the tissue. Due to the incision placement and its insignificant size, the scar would fade into the background.
Aside from the “invisible scar,” another notable benefit of fat transfer is the “greater control” over the breast width, cleavage fullness, and overall contour.” However it comes with a caveat: The breast can only be increased by 1-2 cup sizes.
“With fat transfer, we can focus on the area that requires additional volume, allowing us to create more cleavage and upper breast pole fullness. Meanwhile, implants are limited by the width of their base,” says Dr. Smiley in the Snapchat video.
The small incision is positioned at the submammary fold to help camouflage the scar.
During surgery, Dr. Smiley was able to create more symmetric cleavage and contour between the left and right breast. Prior to fat transfer, the patient’s right breast was visibly smaller; the lopsidedness was further aggravated by its cleavage that appeared “flatter” compared to the other side.
Furthermore, he says that fat transfer “eliminates potential risks associated with breast implants such as shifting, capsular contracture or hardening of the breast tissue, and palpability” because it uses the patient’s own fat cells.
“This is not to say that breast implants are bad. In fact, they remain a good option, although patients should realize that fat transfer to enlarge breast is another exciting option,” he says.
Breast augmentation fat transfer precludes the need for implants and thus it avoids risk of capsular contracture (hardening of the breast tissue), implant malposition, rippling, and palpability.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a video on Snapchat demonstrating a patient who requested for breast augmentation fat transfer to achieve more fullness to the upper breast pole and the lateral side.
One of the notable advantages of fat transfer over breast implants is the additional contouring effect.
“The patient needs more volume to her upper breast pole and the lateral side, which fat grafting can help improve. But in breast implants, we are highly reliant on their base. Simply put, using fat allows us to focus more on the area that needs the most correction,” Dr. Smiley says in the video.
But in terms of size, the effects of fat grafting can be limited particularly in patients with low body fat percentage.
“There are many breast implant sizes to choose from. Fat grafting, meanwhile, can only give one to two cup size increase,” says Dr. Smiley.
Dr. Smiley says that breast has fibrous tissue, which does not allow large volume fat transfer due to risk of pressure.
“Pressure is the enemy of high survival rate of fat grafts,” he further explained.
Aside from injecting just a conservative amount of fat, Dr. Smiley says another way to promote high survival rate is to inject fat cells closer to the muscle, which contains more blood supply.
Fat grafts need to integrate with the existing blood vessels, which can provide them the much needed oxygen and other nutrients. Also, their amalgamation with the extracellular matrix, which resembles a mesh that holds the blood vessels and other tissues together, is critical to ensure long-term results.
Meanwhile, Dr. Smiley collected the “unwanted fat” from multiple areas including the abdomen, flanks, and lower back. Prior to its injection, it was washed, sorted, and purified to remove all the biomaterials (blood and oil) and the anesthetic solutions used during surgery.