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.
The “right” breast implants on a bony chest can help improve its appearance. Patients with this “anatomical feature” also typically have wide cleavage gap and little soft tissue coverage, which must be improved as well.
Dr. Tarick Smiley, one of the leading Orange County plastic surgery experts, has recently shown on his Snapchat the effects of “meticulously selected” breast implants that have had improved the bony chest appearance and visible dents of a female patient.
Dr. Smiley used a pair of slightly wider breast implants to “conceal the visible dents” along the sternum and to improve the wide gap between the breasts. Nonetheless, the implants’ base matched the horizontal measurement of the chest otherwise the patient would face a higher risk of scalloping, rippling, and malposition.
To further ensure natural-results—i.e., proportionate to the patient’s body and with no surgical stigmata—the celebrity plastic surgeon used small silicone implants (i.e., 400 cc).
The use of smaller silicone implants particularly suit the patient because of her limited breast tissue coverage and low body fat percentage. These implants were filled with a medical-grade silicone gel designed to simulate the cohesiveness of natural soft tissue.
Saline implants, meanwhile, would not suit the patient because of her little soft tissue coverage that could predispose her to higher risk of rippling and increased palpability. These implants have outer silicone shell filled with salt-water solution; hence, they may lead to firmer results and too globular breast contour when used by thin and small-breasted women.
To further ensure soft and natural contour, Dr. Smiley positioned the implant beneath the patient’s pec muscle, which provided more coverage than the over-the-muscle implant placement.
Even without fat grafting, the right implant design and volume was enough to conceal the patient’s bony indentations of her cleavage.
In general, Dr. Smiley says he reserves fat grafting for patients with “very poor upper-inner breast pole” that an implant-alone approach may not be enough to deliver satisfying results.
Fat grafting that is a part of composite breast augmentation, he says, also suits patients with certain types of deformity.
The use of two different sized breast implants is reserved for patients with at least a “half cup” difference. The goal is to make both sides appear the same in size, shape, and projection, as suggested by leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Recently, the celebrity plastic surgeon performed breast augmentation in a patient whose right breast was noticeably smaller than the other side, thus she entailed the use of two different sized breast implants to help improve the asymmetry.
During surgery, Dr. Smiley placed a 495 cc implant in the right breast, and 470 in the left. Both implants were filled with medical-grade silicone noted for its cohesiveness comparable to soft tissue.
The implants were placed via peri-areolar incision technique, also referred to as “through the nipple.” The incision was precisely made at the dark-light skin junction so it could blend well into the background.
Furthermore, the peri-areolar technique was particularly suitable for the said patient because of the stark color contrast between her areola and its surrounding skin, making it easier to hide the scar.
Aside from a more symmetric look, the patient was also concerned about having natural-looking appearance and “feel,” which silicone implants are known to provide. Saline-filled implants, meanwhile, are more likely to appear globular in shape and are firmer particularly when used in patients with very little soft tissue coverage.
To further ensure natural-looking results and soft feel, Dr. Smiley placed the implants beneath the pec muscle, which provided additional soft tissue coverage. This implant placement is also linked to lower risk of wrinkling, scalloping, and palpability, which are common cosmetic issues among thin or small-breasted patients.
Sometimes, the disparity is not limited to size. For instance, one of the breasts may be more saggy or flatter than the other, or the nipples are of different diameter or position. Hence, Dr. Smiley says that breast augmentation surgery requires a highly customized approach to address specific cosmetic issues and to achieve high patient satisfaction.
Occasionally, breast lift and areolar reduction are performed simultaneously with breast augmentation to further improve symmetry between the two sides, says Dr. Smiley.