Sometimes breast implant surgery needs to be performed in conjunction with other procedures to achieve optimal results and minimize certain risks such as palpability, visible rippling, and implant bottoming out, as suggested by renowned Beverly Hills plastic surgeon Dr. Tarick Smaili.
Fat graft has been one of the most commonly used auxiliary procedures of breast implant surgery. While it has many uses, the technology is particularly helpful in reducing palpability and rippling by “thickening” the soft tissue, common problems of thin and athletic women and post-mastectomy patients.
A recent study published by Plastic and Reconstructive Surgery magazine has suggested that transplantation of a small amount of patient’s own fat can improve the postop result, specifically the appearance of cleavage.
According to the findings, one of the telltale signs of breast implant surgery is the appearance of “separated breasts,” which can be corrected by injecting fat graft to soften the medial transition zone between the implant edges and sternum.
Twenty observers were asked to rate the attractiveness of breasts, which were digitally altered to show a narrower or wider vertical aesthetic line, or the distance between the medial border of the breasts.
Photographs with a narrower VAL were rated as more attractive by 95 percent of participants, according to study.
Another possible way to “thicken” the soft tissue of the breast is to use acellular dermal matrix, which is also helpful in revision and reconstructive breast surgery. Older women, who are believed to be prone to excessive lateral displacement of the implants, could also benefit from this auxiliary procedure.
Acellular dermal matrix is sometimes referred to as internal bra procedure because they strengthen the deeper structures of the breast and/or tighten the implant pocket, thereby minimizing the risk of implant malposition such as bottoming out and lateral displacement.
Breast lift is another surgery commonly partnered with implants. The idea is to correct the saggy appearance and deflated breast mound, especially the upper poles, all at the same time.
While this combo procedure has become a common practice nowadays, Dr. Smaili warns that smaller implants positioned underneath the thick pec muscle are the ideal choice to prevent the acceleration of ongoing breast ptosis (sagging).
Oftentimes, breast implant surgery and lift are performed in one surgical setting to minimize cost and to experience recovery just once. But for patients who need more “lifting,” a staged-surgery is usually a better option to achieve results that are more predictable.
In essence, breast implant surgery involves the placing of artificial prosthetics to increase the bust line or to correct a wide range of breast deformity. Due to skin tissue being displaced and stretched, itching is one of the most common postop symptoms patients have to deal with during the initial healing phase.
Skin itching after breast augmentation surgery, while it is usually a normal part of recovery, can sometimes reach to a point that it leads to a significant amount of inconvenience especially in public, explains leading Los Angeles plastic surgeon Dr. Tarick Smaili.
Dr. Smaili says that itching often occurs about a week after surgery, which may continue for another month or so. But despite the inconvenience, he warns patients from scratching the breast skin to avoid disturbing the incision site and recovering tissue.
The itching could be also associated with the return of normal nerve sensation, which is a good thing despite some of the initial discomfort.
Histamine release, which is related to the healing process, could be another reason for itching after breast augmentation surgery. If this is the underlying cause, some plastic surgeons recommend anti-histamines to their patients.
Some doctors also suggest washing the breast skin with warm water (not hot to avoid aggravating the postop swelling), which can provide some relief from itching, while others recommend icing the area to minimize the sensation.
Icing or cold compress can also control postop swelling in the first few days after breast augmentation surgery, says the renowned Los Angeles plastic surgeon.
Other potential remedies include anti-itching creams, cocoa butter lotions or other types of moisturizers, and cool air from hair dryer. Some patients have also noticed that going braless in the first few weeks following surgery could help with the itching.
While skin itching is often a normal part of recovery, sometimes it is a symptom of allergic reaction from antibiotics and other postop medications. If this is the underlying problem, patients will usually notice skin rashes that are far away from the surgical site.
Itching caused by allergic reaction is usually felt about 30 minutes to an hour after taking a certain drug. To avoid or at least minimize this effect, surgeons can adjust the dosage and/or recommend some alternatives.
Meanwhile, it is important to avoid alcohol during the entire span of breast augmentation recovery because it could lead to poor wound healing, adverse reaction when taken together with prescribed medications, and even itching.
The appearance of scars after breast augmentation surgery is determined by several factors such as the type and size of implant, incision site, surgical techniques, and predisposition to adverse scarring (i.e., ethnic skin is more prone to keloids and hypertrophic scars than fairer skin).
The list below shows the four breast augmentation incision sites and the appearance of their postop scars, as explained by one of the leading LA plastic surgeons Dr. Tarick Smaili.
1. Inframammary fold. The scar is positioned within the natural skin fold so it remains hidden, making this particularly ideal for women whose pre-surgery breast fold is relatively deep.
The IMF incision is the most commonly used technique because of the hidden scars and the preservation of breast functions such as breastfeeding and normal sensation. And to further minimize scarring, some doctors use a cone-shaped device called Keller Funnel that aids in the quick and “no-touch” deliverance of silicone implants.
Another benefit of this breast augmentation incision technique is that it can be used again in future revisions, avoiding the appearance of another scar.
2. Trans-axillary. The scar is situated in the natural skin folds of the armpit, further helping it blend well into the skin. And because the area is not susceptible to keloids, the incision site is believed to be ideal for ethnic patients who might be prone to adverse scarring.
However, the trans-axillary breast augmentation is not ideal for patients who have asymmetry because the surgeon works far away from the breast. Another potential downside is that future revisions will require another incision site.
3. Peri-areolar incision. Also referred to as “through the nipple” technique, it uses a U-shaped incision around the areola’s edge, specifically from 4 o’clock to 8 o’clock. The scar must lie exactly where the dark skin meets the light skin so it will remain undetectable.
But even with a slight migration of scars, it is enough to make them visible. Another possible downside is the higher risk of partial or complete loss of sensation (thus breastfeeding difficulty might be an issue) because the incision site is where most of the vital nerves and milk ducts are located, making this a less popular choice of women who are planning to have children in the future.
4. Trans-umbilical breast augmentation (TUBA). Also referred to as “through the navel” approach, the incisions are placed within the belly button’s rim so there is no scar on the breast skin. For this reason, some beauty clinics call it as scarless breast implant surgery.
Because of the distance between the breasts and incision site, TUBA is not an option for women with breast asymmetry and ptosis (sagging), patients who choose pre-filled silicone implants, and those who need revision surgeries.
Breast implant surgery is an important decision to make, especially if it is used in cosmetic breast augmentation. While it can be removed or replaced through a revision surgery, it always entails additional cost and [potential] risks.
Remember that you should choose your plastic surgeon based primarily on his qualifications and experience, with other factors such as the surgery’s cost only treated as a secondary consideration.
Nevertheless, raising the right questions is critical especially when they involve financial issues to avoid unexpected or sometimes “unnecessary” fees.
Plastic surgery Beverly Hills expert Dr. Tarick Smaili provides a list of financial-related questions that your surgeon must able to answer honestly, and of course in the most accurate manner:
- Do you accept credit cards?
Take note that a lot of plastic surgeons are accepting credit cards, although you have to realize that it has become an industry practice to pass on the usual 5 percent “merchant” fee to their patients. Simply put, this “additional” cost is something you have to consider before tapping this credit line.
- What is included in the surgical cost?
Your plastic surgeon must be able to itemize the cost of your breast augmentation surgery—e.g., anesthesia fee, surgical facility, surgeon’s fee, breast implant, etc.
Of course, you also have to consider the “ancillary” costs such as the medical bra or compression garment, painkillers, and other post-op supplies. Even the cost of potential revisions should not be ruled out.
- What if I would need revisions in the future?
Some doctors are willing to perform minor revisions for free, although in most cases their patients are still expected to pay for the cost of local anesthesia and surgical supplies. Simply put, only the surgeon’s fee is excluded from such deal. Nevertheless, you should ask your doctor about this specific issue.
- What kind of financing or payment do you expect?
Take note that some plastic surgeons are offering different financing options, while others expect deposit or full payment up front. Some doctors also allow the use of regular and health care credit cards.
But when tapping your health care or personal credit cards and other lines of credit, make sure the interest is reasonable and something that you can pay off without causing financial constraint. A good rule of thumb is to read the fine print and be honest about your ability to pay on time, and if you have any doubt, don’t do it.
Breast implant surgery requires the use of incisions to create an implant pocket where the device will be positioned. But any time the skin is cut or injured, a scar always forms as the body’s way of healing itself.
Nevertheless, leading breast enhancement expert Dr. Tarick Smaili says that some surgical techniques are now being used to hide and [possibly] shorten the appearance of breast implant scar.
Saline implants can afford a shorter incision than silicone implants because they are only inflated by surgeons once inside the pocket. Oftentimes, they require an opening just under 1.5 inches, which of course leads to a short scar that usually further shrinks as it matures.
Silicone implants, being always prefilled by their manufacturers, require a longer incision even if they come in smaller sizes.
Smaller silicone implants typically require an incision around 2 inches, while the larger ones of course needed bigger openings. However, they remain the popular choice of breast augmentation patients since their filler material, which is a cohesive gel, behaves just like the natural tissue and fat.
Instead of limiting yourself to saline implants or smallest silicone implants (which may not deliver the look you want to achieve), Dr. Smaili explains your other options if you want to shorten your breast implant scar:
* Keller Funnel
This cone-shaped device, which costs around $125 each, has its narrowest end inserted into the implant pocket through a small skin opening. And with just a few quick squeezes, it can push the silicone implant downward and into its proper position.
With the Keller Funnel breast augmentation technique, silicone implants will only need a short incision the same as the saline implants’.
* Use of small or conservative-sized breast implants
Occasionally, scar migration (e.g., a breast crease scar that inadvertently goes too low or too high) and “unnecessary” scarring are caused by using implants that are too large relative to your underlying anatomies.
Smaller breast implants, meanwhile, only require a shorter incision and are less likely to cause scar migration.
* Proper wound closure
With proper wound closure, the scar can heal and fade well into a barely noticeable white line. Another important thing is to minimize the tension on the skin to prevent the appearance of wide/raised scars.
* Use of scar treatments
A “good” scar is not only short, but it should also appear thin and flat. This is where post-surgical scar treatments come in handy.