Breast implants latest technology has allowed Los Angeles plastic surgeons to deliver results that look and feel natural, and avoid or at least minimize risk of complications.
These are some of the recent advancements in the field of breast augmentation surgery:
- Fat grafts and stem cells. While fat grafting has already been used for decades to add volume to certain areas of the body, recent advances in stem cell technology have allowed surgeons to further achieve consistent and long-lasting results.
The procedures starts with a gentle liposuction of the donor sites to collect fats, which are then sorted, washed, and purified to eliminate biomaterials such as blood. The stem cells from the fat are also separated, concentrated, and then recombined to “supercharge” the grafts.
Stem cells are also referred to as “mother cells” due to their ability to turn into many different cell types.
- Large volume fat grafting. The use of BRAVA, which is a bra-like device that releases negative pressure, can allow surgeons to inject more fat grafts into the breast without worrying about low survival rate.
If BRAVA is used a few weeks prior to fat grafting, it can expand the breast tissue and increase the blood supply. With the device, 250-300 cc of purified fats can be injected in one session, compared to just around 150 cc without such “preparation.”
- Lighter breast implants. B-Lite Implant is currently not available in the US, although in other countries it is gaining popularity due to its perceived benefits.
The implant is about 30 percent lighter than a silicone breast implant of the same size; it uses microsphere technology or “hollowed beads,” which do not leak or separate in case of implant rupture.
Proponents suggest that the reduced gravitational effects allow the breasts to age more “gracefully.” Nevertheless, long-term studies are still needed to demonstrate this perceived benefit.
- New type of saline implants. The standard saline implants fall short in giving natural feel and look (especially in thin and small-breasted women) because they are only filled with sterile salt water. However, they are perceived to be safer than silicone implants in case of rupture because the surrounding tissue will simply absorb the filler material.
But in November 2014, the US Food and Drug Administration approved IDEAL IMPLANT, which is a saline-filled implant with multiple shells and internal structures designed to control movement of the water.
With multiple inner shells, the IDEAL IMPLANT has solved the “splashing” and “swooshing” tendency of standard saline implants.
There are two basic types of breast implant placement: the subglandular in which the device is only below the tissue, and the submuscular wherein it is positioned underneath the chest muscle as well. Meanwhile, these approaches have slight variations to further meet the aesthetic goals of patients.
The way the implants are positioned has a significant effect on the final appearance, or to be more specific, the breast contour, projection or profile, palpability, and skin surface (e.g., rippling and wrinkling).
Renowned breast augmentation surgery expert Dr. Tarick Smaili says the subglandular, also referred to as “overs” because the implants are over the muscle, tends to provide a more globular look and more fullness in the upper poles of the breast. While the result may not appear subtle, he says that some patients nonetheless want this look.
However, overs can still deliver natural-looking results to women with adequate breast tissue who opt for a more conservative augmentation or an implant size that is within the boundaries of their underlying anatomies, explains Dr. Smaili.
Overs tend to stick out more or provide more outward projection than unders or submuscular since the implants are only behind the breast tissue itself, he adds.
Despite the aforementioned benefits of the subglandular, Dr. Smaili says women with little tissue may find themselves with a not-so-natural breast shape with the technique because of the limited amount of coverage. The less than optimal results could be further aggravated, he warns, when small-breasted patients choose larger implants.
For women with little tissue, the renowned Los Angeles plastic surgeon generally recommends the submuscular technique that provides an additional coverage from the chest muscle. With this approach, he says the breast contour of patients with such anatomy can appear natural—i.e., teardrop in which most of the volume is in the lower pole of the breast—assuming that they use implants on the smaller side.
Contrary to popular belief, the submuscular does not mean that the entire implant is covered by the muscle, says Dr. Smaili, adding that its lower half is only supported by the tissue. While this lead to the teardrop shape, which is the quintessence of natural results, rippling at the lower part of the breast might be an issue among thin-skinned patients.
To counteract the rippling effect, which small-breasted and thin-skinned patients are susceptible to, Dr. Smaili recommends the use of silicone breast implants whose filler material has the right amount of cohesiveness that feels like the natural soft tissue.
It is not uncommon for the breasts to appear too high on the chest wall after breast augmentation surgery, although they are supposed to “drop” or “settle” in three to six months, resulting in a more natural appearance.
Take note that it takes time for the breast skin and soft tissue to adjust to the new contour, thus high-riding implants are not uncommon during the initial breast augmentation recovery. Meanwhile, the postop swelling further aggravates the appearance of “excessive” upper cleavage.
While high-riding implants are not uncommon during the initial healing stage, leading Los Angeles plastic surgeon Dr. Tarick Smaili instructs his patients to perform regular massage, or medically referred to as implant displacement exercise, to accelerate the “settling.”
Breast implant massage is also known to maintain the natural softness of the breast tissue and internal scar tissue that forms around the device, explains Dr. Smaili.
Other postop solutions for high-riding breast implants include compression garments and upper pole bands, although Dr. Smaili says time remains the best “treatment.”
Remember that the aforementioned solutions will only accelerate the settling of the implants, and any high-riding appearance that remains “stubborn” after four to six weeks will always need a revision breast augmentation, warns the leading Los Angeles plastic surgeon.
To prevent excessive fullness in the upper breast pole, Dr. Smaili highlights the importance of correct implant pocket dissection. One way to do this is to perform the surgery while the patient is sitting up, a technique that allows any surgeon to correctly assess the breast size, projection, and contour.
To further create natural-looking results, Dr. Smaili says that some patients may require their inframammary crease to be lowered; the idea is to position the implants approximately at the center of the breast mound, behind the nipple area.
Also, the additional distance between the inframammary fold and nipple area might also create some lifting effect, further contributing to the perkier, more youthful appearance.
In addition, using the correct breast implant base diameter (side to side dimension) and size also plays a crucial role in simulating the natural projection and shape. The general rule of thumb is to respect and acknowledge the existing measurement of the breasts.
Meanwhile, an implant whose base and profile goes beyond the existing dimension of the breast can lead to “over-projection” and excessive upper breast pole fullness. Other possible results include palpability, rippling especially along the sides, and globular/unnatural shape.
Some women who want to undergo breast augmentation surgery via breast implants also consider the possibility of breast lift, allowing them to achieve not just a fuller bosom but also a perkier appearance. Depending on the amount of correction they need, the procedures might be performed in one surgical setting or separately.
Despite the convenience of one surgery, Riverside plastic surgery expert Dr. Tarick Smaili says some patients should elect for a staged approach to achieve their cosmetic goals and to minimize risk of complication as well.
In general, staging the procedures is ideal if you have a significant amount of breast ptosis or sagging. Aside from skin and tissue laxity, Dr. Smaili says the viability of your nipple-areola complex, breast implant sizes, tradeoffs you are willing to accept, and desired cosmetic results are also taken into consideration.
The celebrity plastic surgeon says breast lift with implants is technically more challenging than performing the surgeries one at a time, although experienced doctors can do it successfully as long as they conduct proper patient selection.
If you fall under the category of “patients who need more correction,” the general rule of thumb is to start off the procedure with breast augmentation; the idea is to wait at least six months to see how the implants will alter the breast projection and shape, explains Dr. Smaili.
After the implants have settled into place, which could take about six months, then a breast lift can be done. By staging the surgeries, Dr. Smaili says the risk of overcorrection or making too many incisions in an attempt to lift the saggy breasts can be minimized.
It is important to note that breast implants could provide some lifting effect or at least increase the distance between the inframammary fold and nipple-areola complex, leading to a somewhat perkier appearance. In fact patients with pseudo ptosis—i.e., the upper cleavage is deflated but the areola has not yet sagged beyond the breast crease—can benefit from an implant-alone procedure.
Another benefit of staging the procedures, according to Dr. Smaili, is the reduced tension on the skin. In breast lift, the incisions around the areola and the vertical scar between the nipple area and the inframammary fold may receive some “stress” from implants if the two surgeries are performed at the same time.
Nevertheless, a combo procedure—or performing breast lift and augmentation in one surgical setting—remains a viable option if the patient will only need a little amount of lifting, he adds.
The actual breast implants sizes may have little to do with the postop appearance since other variables such as the existing tissue or amount of “coverage,” the chest and breast measurement, the innate shape of the breast, the areola position, and even the torso all have their impact.
Breast augmentation surgery for very small breasts has its challenges, although acknowledging the anatomical limits is one way to achieve impressive results.
First and foremost, small breasts have insufficient coverage that makes them prone to visible rippling and more palpability, as suggested by celebrity Los Angeles plastic surgery expert Dr. Tarick Smaili. To minimize such risks, he says that smaller implants are highly ideal for small-breasted women.
Smaller or conservative-sized implants are less likely to cause scalloping, rippling, and other telltale signs of surgery because the overlying skin and breast tissue is not overstretched, Dr. Smaili adds.
Aside from the actual size of implants, which is determined by cubic centimeter (cc), the leading plastic surgeon says their profile or forward projection, width, and base should also match the preoperative measurement of the breast and chest.
By acknowledging the anatomies and their limitations, Dr. Smaili says it would be easier to achieve natural results from breast augmentation or any type of body contouring surgery.
To further minimize the risk of unfavorable waviness and palpability, he highlights the importance of using submuscular, which is also referred to as subpectoral implant placement. The idea is to increase soft tissue coverage by positioning the upper half of the prosthesis beneath the pec muscle.
The opposite of submuscular is the subglandular in which the implants are placed above the muscle, only covered by the tissue and skin. For patients with sufficient coverage this could provide good results, but for small-breasted women and female body-builders this could spell trouble.
Aside from increasing soft tissue coverage, Dr. Smaili says the submuscular also provides more natural results by making the breasts appear more like a teardrop rather than too round (especially in the upper cleavage), which is a dead giveaway that an implant is underneath the skin.
Women with very small breasts are also generally advised to choose silicone implants whose cohesive filler material can make up for their lack of coverage. Saline implants, meanwhile, could make them susceptible to less natural results, too rounded appearance, more palpability, and rippling, Dr. Smaili warns.
But one downside of using silicone implants is the longer incision than saline implants (2 cm vs. 3.2-4 cm) because they are implanted “intact.” On the other hand, saline implants are only inflated with salt water solution once in position, so the resulting scars are shorter.
Nevertheless, the use of Keller Funnel technique in which a funnel-like device is used to propel silicone implants to their pocket is an effective way to reduce the length of incision by almost half, so the resulting scar is almost like that of a saline implant’s.