24 Hours To Better Looking Breasts

Gregory A. Buford, MD, FACS
Article by
Denver Plastic Surgeon

Q: What is worse than not liking the appearance of your breasts?

A: Actually having surgery to make them look better and still not liking how they look!

Although the vast majority of women who undergo breast enhancement every year are very pleased with their results, there are those that are not. And the reasons for their disappointment can vary but, for the most part, generally boil down to one of two concerns:

-They are unhappy with their immediate results

-They are unhappy with how those results have aged (and changed) over time

Whatever the reason, the good news is that many of these concerns can be addressed with procedures associated with very little downtime.
 

One common concern is that one breast is higher than the other. If this is the result of surgery, chances are that this can be fixed with a very straightforward procedure. Any time a foreign body (such as a breast implant) is placed within the body, the body walls it off by forming a scar around it. This scar “capsule” effectively protects the body from the implant and remains as long as the implant itself remains. And while most capsules remain soft over time, some tighten and become firm. When they do, they can distort the implant shape and position leading to asymmetry on one side (or both) and produce what is referred to as Capsular Contracture. Just exactly why this contracture occurs can be due to a number of different reasons but the good news is that it can generally be fixed with a relatively simple procedure. Ignoring the more complicated reasons, the most straightforward approach to treating capsular contracture generally involves one or more of the following:

-Exchange of the implant:

Current research suggests that implants may undergo low-grade bacterial colonization over time. When this occurs, bacteria form a “bio-film” protecting them from the immune system. And it is thought to be this bio-film that potentially triggers capsular contracture. As such, it is generally recommended to change the implant on the effected side since there is really no way to remove a bio-film from the implant without removing the implant itself.


-Revision of the capsule:

In very basic cases (e.g.: early contracture with failed settling of the implant), the implant position may be adjusted simply by scoring or making a transverse incision in the capsule to allow it to expand. This incision is generally made at the lower pole of the capsule to enable the implant to drop into its appropriate position.
 

For more complicated cases, some or all of the capsule may need to be removed to allow the implant to be repositioned appropriately within the breast pocket. The decision to perform this type of procedure is based upon a number of variables including (but not limited to) the following:
 

-Degree of capsular contracture


-Thickness of the overlying breast tissue


-Ease of removal (or difficulty) associated with revision of the capsule
 

In a small handful of women, capsular contracture can recur. When it does, a more complex approach may be undertaken such as revision of the pocket (implant is changed from above to below the muscle) or the implant may be effectively wrapped in an acellular dermal matrix (such as Alloderm or Strattice). The good news is that for most women, the initial approach is quite often successful and so more complicated steps usually do not need to be taken.
 

Another quick and easy way to improve the appearance of your augmented breasts is to simply change the type of implants. During the silicone gel moratorium, the vast majority of implants being used in the United States were filled with saline. Now that the silicone gel implants have been shown to be safe, more and more women are opting for gel augmentation. It is estimated that around 60 percent of all augmentations currently use silicone gel implants and that number is rising and is expected to continue.


In the average Plastic Surgery practice, it is very common to see women who have had saline breast implants placed and who are no longer happy with their results. Their major complaints are that their saline breast implants ripple and do not feel as natural as their native breast tissue. For many, the easy answer is to simply exchange saline implants for cohesive gel breast implants. And for a majority of these patients, the results are impressive.


Like any problem, there is rarely one single solution and so these suggestions are merely that…they are suggestions. The best result is achieved in the hands of a well-trained surgeon with significant expertise in the area of not only primary but also revisional breast surgery. Ask to see the surgeon’s results, ask to speak to their former patients, and (most importantly) go with your gut instincts. Whether your implants were placed one year or fifteen years ago, the bottom line is that they should look and feel natural and you should be happy with your results. Life is just too short to not be!