Here is what you need to know about the current state of breast enlargement surgery.
This elective procedure can be one of the most rewarding experiences to which you can treat yourself. But thanks in part to talk-show sensationalism, websites, tabloid rags and half-truths from self-proclaimed experts on social media, there is much incorrect information about breast implants. Take comfort knowing that controlled scientific studies and decades of F.D.A. review panels have exhaustively investigated the safety of breast implants. In fact, in the history of medical science, NO device has been as thoroughly studied or subjected to the intense scrutiny as breast implants. Today both saline and silicone gel breast implants with smooth surface outer shells have been proven safe to the satisfaction of the F.D.A. and come with a manufacturer's warranty. For an accurate and up to date review of the scientific data and position of the F.D.A., the reader is invited to go to Update on the Safety of Silicone Gel-Filled Breast Implants (2011) - Executive Summary for more information.
The surgery generally lasts 1 hour and is performed in the outpatient setting. Dr. Baeke feels you would be most comfortable by having your surgery performed with you completely asleep; therefore, do not worry about the pain of local anesthesia.
Dr. Baeke has performed aesthetic breast surgery on several thousand women over many years; utilizing implants from a dozen different manufacturers. One thing which sets him apart from most other plastic surgeons, is he does NOT tell the patient what to do. It is Dr. Baeke's philosophy that he should adequately present the patient all her options; giving her the advantages/disadvantages of each. Dr. Baeke may make recommendations. However, as it is you the patient, who is paying for the surgery and living with the final results, it should be your desires... not the surgeon's... which direct the course of the operation. Remember you, not the doctor, will be living with these breast implants.
At many plastic surgery consultations, often the new patient spends only a few moments with the surgeon, the bulk of the visit being delegated to some other employee. This is simply not right.
A consultation with Dr. Baeke is not rushed. You should expect a minimum of 1 hour face-to-face with him. You will leave with a wealth of new information on breast enhancement. Feel free to bring a tablet for notes. Do not leave with any questions unanswered.
Topics to be discussed:
First. Breast implants now come in several styles. All implants used by Dr. Baeke are F.D.A. approved. The only similarity shared by all implants is they are manufactured with a tough vulcanized silicone or Silastic™ outer shell. Due to concerns about textured breast implants, Dr. Baeke only uses smooth shell implants.
Implants come in two basic shapes, "round" or "tear drop". Round implants are actually hemispherical shaped. Some are taller; others have a wider diameter.
The other shape are "teardrop" implants; also known by such names as "Contour", "Natural", "Anatomical", "Shaped", etc. These implants are often promoted as providing a more natural shape. If you wish such a device, certainly Dr. Baeke is pleased to provide these. He is not enthusiastic about these implants, and has researched, published, lectured on the national stage and testified on their shortcomings. The primary concern is if a teardrop implant should spin or turn 180º and the thinner portion of the "teardrop" is at the bottom. The woman can be left with an unsightly breast. Round implants have no top or bottom, and (in Dr. Baeke's experience) give better results. You read correctly. Dr. Baeke believes round implants give a more natural result than "Natural" implants. Here is a representation of what abnormal breast shapes might develop should a teardrop or shaped implant flip, spin or turn. Dr. Baeke's published report can be found elsewhere on this site.
Second, let's talk about implant location. Implants are placed either behind the breast, yet in front of the pectoralis muscle; OR behind both the breast and muscle. Many have the erroneous opinion that the pectoralis muscle completely covers the implant, supporting the implant like an internal bra. This is often not true. Study this anatomical drawing, and note even when the implant is placed behind the muscle (retropectoral) the lower portion of the implant is still only covered by just the breast, just as in the woman whose implant is in front of the muscle.
A woman receiving implants behind the muscle should expect a much more uncomfortable and prolonged recovery period than a woman receiving implants in front of the muscle (i.e. higher need for pain Rx). There will be more swelling. Further, there is an increase risk in complications when the implant is placed in the retropectoral position; namely bleeding (hematoma, ~ 5%) and a dropped lung (pneumothorax <1%). Dr. Baeke knows how to deal with any complication.
Typically a recommendation is made to place the implant behind the muscle when the surgeon feels a patient needs the additional soft tissue padding over the implant. Some surgeons also feel implanted breasts will stay softer when implants are positioned behind the muscle. Others feel it makes little difference. Published studies can be cited supporting both positions.
Next, Implants placed behind the muscle will move in an unnatural fashion every time the pectoralis muscle is flexed; termed "animation of the breasts". Want a demonstration? Just go to the gym, and observe such a woman while using the butterfly machine [see video].
It is not true that breasts with implants placed in front of the muscle will fall faster than implants placed behind the muscle. Both female-athletes with highly developed pecs or very thin women with slight-of build chest muscles should carefully discuss the pros/cons of the retro vs pre-pectoral issue with Dr. Baeke.
Finally, women with implants placed behind the muscle often will have wider, boxier cleavage then had their implants been placed in front of the pectoralis muscle. Dr. Baeke believes one of the most beautiful aspects of the feminine form is gorgeous cleavage. Beautiful breasts do not have boxy cleavage. Both breasts should "kiss". A woman is more likely to achieve this look with implants placed in front of the muscle.
Myth: Implants are placed behind the muscle because they are better protected.
Fact: The current generation of implants are very tough. Need proof?
Third. A common concern of women is, "What size will the doctor make me." "Will he make me too big? Many of my friends have said they wish their plastic surgeon had made them bigger". In fact, the #1 complaint of women with breast implants is they are not happy with their cup size. Dr. Baeke believes it is a mistake when plastic surgeons tell their patients that they know what the proper proportions are. Such an attitude from a plastic surgeon... or his staff... is arrogant, if not dangerous. Only you, the patient, knows what looks best on you; not the doctor! You have to live with these puppies, not your doctor. Be wary of any plastic surgeon who does not listen to your desires as to size.
Understand that implants have known dimensions. The implant diameter gets larger as the cup size increases. Be advised that placing an implant of too large a diameter can technically be done, but runs the risk of creating problems such as visible or palpable (i.e. feelable) wrinkles. Rest assured, at PPPS, you will totally control the decision as to what size you will be. We have 200 sample implants of every shape and size. You will be asked to bring with you a bra and tight fitting shirt or sweater to try on many different implants, as you model your new figure. Should it appear that you may have selected an implant size too large, you will be counseled by Dr. Baeke or his nurse. Ultimately, it is your decision. Your total satisfaction is our goal.
FACT: Surveys show 80% of augmented women believe their doctor made them the wrong size.
At PPPS, this rarely if ever happens, as it is the patient who controls this decision. In fact, Dr. Baeke is confident enough to guarantee the results.
Fourth. The implants can be inserted via one of four possible incision locations: #1) in the underarm area; #2) around the lower part of the areola (peri-areolar), which is the pigmented area around the nipple; #3) underneath the breast. #4) through the belly button. Any of these sites should give you minimal scarring.
In expert hands, the peri-areolar incision absolutely provides the least conspicuous scar and does NOT interfere with sensation of the nipple/areola. The only drawback is, in women with smaller areolae larger gel implants may be difficult to insert. Thus, the infra-mammary (near the lower fold of the breast) may be the necessary approach.
Dr. Baeke firmly believes the belly button approach (or trans-umbilical breast augmentation, T.U.B.A., for short.) is a bad procedure. It is too often touted by surgeons as "scarless breast augmentation". Nothing could be further from the truth. There is a scar, only in a place one would not expect, i.e. the belly button. Performing breast augmentation surgery in this fashion is analogous to building a model ship in a bottle. Q: Is it easier to build a ship on your table, or in a bottle? Why make it needlessly difficult? This will only make your results less desirable. Those who tout this as the approach of choice, claim the peri-areolar and other conventional incisions are unsightly. Please study my photos to refute this notion. The T.U.B.A. breast augmentation prevents the surgeon from any ability to use silicone gel implants, as these implants are prefilled, and thus too large to slide through this distant opening. The T.U.B.A. procedure does not allow any digital exploration by the surgeon to confirm proper pocket creation. Without this ability, the patient is at a much higher risk of an odd shaped breast mound and increased risk of post operative bleeding. The T.U.B.A. procedure is not condoned by the F.D.A. and many liability insurance carriers refuse to cover it. Finally, with today’s exposed-midriff fashions, Dr. Baeke is not convinced that women will find that scar acceptable or easy to conceal.
There are currently four manufacturers in the United States supplying either saline or silicone gel breast implants. They are Allergan of Irvine, CA; Mentor (Johnson & Johnson) of Santa Barbara, CA, Ideal of Dallas, TX and Sientra of Santa Barbara, CA. Allergan and Mentor supply both saline and silicone gel implants. Ideal only manufactures saline implants; Sientra only gel.
Saline vs Silicone Gel
For 15 years Dr. Baeke was a clinical investigator of breast implants for the F.D.A. He is equally comfortable placing saline or gel implants. Each has some advantages. During a consultation he will allow you to feel both.
About saline implants:
Curious Fact: Saline breast implants have a higher rupture rate than silicone gel implants.
About gel implants:
Special word about Ideal® breast implants.
These newly designed, F.D.A.-approved implants have been developed to hopefully provide the benefits of both saline and gel. These devices are 100% saline. What makes them unique is inside are a series of baffles which buffers the saline fluid wave. In other words, a saline implant with a somewhat more gel-like feel.
Curious Fact: Silicone gel is actually a lubricant, and today can be found lubricating the inside of all syringes. Thus, every time you receive an injection, you are receiving a small amount of silicone gel into your body. Thus...
Curious Fact: Over the lifespan of an adult insulin-dependent diabetic, she will be exposed to more silicone than a typical woman with silicone gel breast implants?
Curious Fact: Before 1992, breast implants cost around $100 each. What drove the price of silicone implants to more $1,500 each was a combination of junk science and unscrupulous litigation. The actual cost of raw materials and manufacture is minimal.
Expect to be discharged that same day. If you have traveled from elsewhere, you may wish to stay at one of the fine hotels nearby. Dr. Baeke or Suzanne Baeke, RN, MSN will make a house or hotel call on you the day after surgery.
Expect to wear a sports bra (possibly with a bandeau strap) for a short period of time after surgery. You will be given pain medication and written after care instructions. Remember that, as with most operations, there will be a degree of swelling. This will affect the appearance of your breasts. Keep this in mind if you decide to "sneak a peak" at your new assets the day after surgery. In other words, "what you see is not what you get". It generally will take several weeks for all the swelling and soft tissue changes to occur before you will get to enjoy the full benefits of this surgery. Dr. Baeke will give you specific instructions as to any activity restrictions after surgery, but generally they are few. If you are flying in, plan on staying at least 2 days after surgery.
The key to breast surgery being a rewarding experience is having realistic expectations. Keep this in mind. God made no woman with 2 perfect breasts. Even though perfection is Dr. Baeke's goal, that may not be possible.
The risk of complications with breast implantation surgery is fortunately very low. Should bleeding or infection develop, this should become apparent soon after surgery. Don't panic. Dr. Baeke will know how to deal with such an unlikely situation and remedy the problem.
Implant rupture is rare. It takes a significant blow to your chest to harm modern breast implants. So forget about them. Normal activities such as athletics, scuba diving, air travel, sexual foreplay, and even mammography should not harm your implants. To rupture these implants will require a significant blow to the chest, such as a motor vehicle accident. Should a problem occur, Dr. Baeke can be reached 24 hours a day. So don't worry the next time Aunt Hilga gives you a birthday hug.
All breast implant manufacturers have device warranties should your implant rupture. Visit the manufacturer's website for details; or ask Dr. Baeke.
Now a word about breast capsule contracture. Every woman's body reacts the same way to breast implants. With time, the breast develops a layer of fibrous tissue around the implant. This is normal. In most women, this layer of tissue, commonly called a capsule, will remain soft, supple and completely unnoticeable. However, in some, this thin capsule may become thicker and firm around one or both implants. There are all degrees of severity of this condition. In most, it does not distort the profile of the breasts. While in a few, the breasts will appear as if the lady is wearing a push-up bra when she is braless. A few will have discomfort as well. Many of these women will want to have this breast capsule surgically removed and the implants replaced. Occasionally, the surgeon is able to break this scar tissue, by performing an off-label non-surgical maneuver on the breasts. Finally, there is some recent research suggesting that off-label use of an oral asthma medication (zafirlukast), may prevent capsule contracture (read report). Fortunately, the majority of women with implants will not have this situation develop during their lifetime, but if they do, a second surgery should be no riskier than the original.
Dr. Baeke was the innovator of complication insurance for medical devices. This unique insurance called BLIS Care is now commercially available to plastic surgeons throughout the U.S and Canada. You should be pleased to know that as a Dr. Baeke-concierge breast implant patient, this additional protection will likely be provided as part of his usual package for those undergoing routine breast augmentation surgery. What this means is, in the event of an unexpected complication, such as a hematoma or infection, you are protected. During stressful times like that, you needn't worry about medical bills. Dr. Baeke has you covered. It's all part of the Park Place concierge service. (See Park Place Plastic Surgery Guarantee for more details).
If you remember only one thing from this medical education website, this should be it: The proper reason for wanting cosmetic breast augmentation is this:
“Dr. Baeke, I want a fuller bustline. I believe that if I had a more buxomed body, I would be able to better fill out my clothes, have a more feminine figure, and who knows, maybe even walk with a better sense of self-confidence. I know I would feel better about myself.”
This is perfect. However, as your doctor, what I do not want to hear you tell me is:
“And Dr. Baeke, I also expect two breasts which are so absolutely natural, no one will ever wonder if I have breast implants” OR "Dr. Baeke I am getting breast implants because my boyfriend wants me to."
Though I am very proud that many, if not most, of my patients have breasts that not even their family physicians know I have placed implants, I Can Not Guarantee This. If you are the kind of woman who would become emotionally distraught if someday your man were to place his hands on your breasts and say, “those are fake aren’t they?”, then this is not the operation for you. If, on the other hand, you believe, “that would still be better than what I now have”, then this operation may be right for you. Please remember, breast implants are not gifts sent to us from Heaven. They are made by mere mortal men, and can have certain problems. Surveys show most women will never have any problems with their implants and are pleased with their decision. Proceed thoughtfully.
References: Ellenbogen, R., Ceasing Capsular Contracture, Plastic Surgery Products, July, 2002, pp 16-18. Musaffar, A.
Rohrich, R., The Silicone Gel-Filled Breast Implant Controversy: An Update, Plastic & Reconstructive Surgery, v 109, n2, pp 742, 747, 2001.