Is it true that I can get bad results if I choose saline through the pit? And must I quit smoking? (Photo)

I had my 1st consultation yesterday after wanting a ba for years.I cried the entire way home.Everything I wanted the ps shot down.She appeared to hate saline, and called them cheap. She told me silicone was perfectly safe despite what Ive read.She said if I went through the pit my breast would be far apart, my breast need a new fold because of my nipple placement, that my nipples will point out further after ba, and that I must quit smoking to get the procedure :(

Doctor Answers 9

Breasts augmentation

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Dear Amazingly you,
   Thanks for submitting your picture. First off, based on you picture you should get an 'amazing' result. Second, if the surgeon made you cry, you should look for additional consults. I agree with some and disagree with others ideas that were presented to you in the consultation. Creating the pocket through the armpit is not the best approach because it is very difficult to create a nice cleavage since fingers are more efficient in doing so than instruments. Therefore the best incision is under the areola . Saline implants are the best because, for lower cost ( one third ) you get an ' amazing' and natural breasts and it allows a subareola incision aproach that will give you a very nice pocket with beautiful cleavage and good crease position that indeed you will need in order to accomodate the large implants and raise the nipples. As far as smoking, you do not have to stop but it is a good idea so you will have less nausea and vomiting. And finally, yes, the nipples will point further out but will still look very attractive and natural. Always, consult with experienced and well mannered board certified plastic surgeons and check their before and after pictures to make sure that you like their results. Also, make sure that their pictures are numerous and consistent and that they have good reviews.
           Best of luck,
                                Dr Widder


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It might be time to get another consultation if the surgeon made you so uncomfortable. I do agree on some of what was suggested.

Silicone/saline--over 80% of implants sold in the US are silicone. By in large they feel more natural. When ripples occur with saline they are sometimes visible, and in that regard the silicone implants may appear more natural.

Smoking--smoking adds a lot of unacceptable risk in lifting operations--face lift, tummy tuck, breast lift or reduction.  But other that the discomfort of  smoking related coughing, any added risks in smokers for a simple breast enlargement are minimal.

Incision--Different surgeons have different preferences.  The only incisions I ever see outside my office are axillary incisions, usually seen poolside at a hotel swimming pool in LA or Las Vegas. Sometimes the incisions are difficult to see, sometimes not. Incisions in the breast fold are covered in most social settings. But I am sure if you call around you can find  a surgeon willing to use an axillary incision. 

Areolas--Yours are widely spaced, but not at all unattractive or abnormal. Choice of incision should have no bearing on this factor.

Sorry that you left so upset. Don't give up though. Lots of plastic surgeons in New York. Best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Answers to breast augmentation questions

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First, saline is not "cheap".  The implants cost over $1000 less than silicone but that does not make them unviable.  Everyone has their own notion of what they are looking for in an augment and a different comfort level as to silicone v. saline.  In terms of smoking, it is true that smoking should be discontinued as it will affect the scar healing as well as the viability of the closure.  Finally, I am not a fan of the axillary approach for a variety of reasons.  It has higher risks and I do not see its benefit.  In terms of requiring a new breast fold, I do not think that is the case and would advise you to seek consultations with other board certified plastic surgeons.  Best wishes. Dr Kraft

Your surgeon was brutally honest

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as most of what you recall is true... except the part about saline being 'cheap' as they are manufactured to specific standards.  You should use what implant you want and choose the approach but the armpit approach is associated with the greatest risks for contracture.  Smoking... you should quit to minimize your risks because if you have a coughing fit post op or in the recovery room and start bleeding, you will be hit with more costs as you have to return to the OR.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Is it true that I can get bad results if I choose saline through the pit?

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It is true that you may have a bad result through any approach with either silicone or saline implant, but it is also true that you may achieve tremendous results. It is very individualized as to the technique and experience of your surgeon.

I would highly recommend you consult with a surgeon who make you feel comfortable and does not make you cry.

In most cases saline implants feel and act much like silicone implants (unless you are very thin) for a much better price. You can place saline implants through a smaller incision and adjust the volumes without replacing with new implants. If a saline implant leaks, you know it and exchange for a new one is very quick and easy where replacing a ruptured silicone implant may be more difficult.

Currently the FDA recommends that silicone implants should be evaluated by MRI 3 years after placed and every other year after that, but insurance companies are not paying for these. Your surgeon is required to tell you that during your consultation.

Saline implants are safe, less expensive, more adjustable and usually a good alternative.

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 13 reviews

Saline breast augmentation

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Thank you for your question and posting an appropriate picture. I'm sorry you did not have a good experience at your last consultation. Looking at your picture, saline implants may very well be a good option for you. You should have other consultations with expert board certified plastic surgeons who perform saline breast augmentations well and often. Approximately half of the patients in my practice undergo saline breast augmentation using the TUBA procedure.

Kevin Tehrani, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 112 reviews

Is it true that I can get bad results if I choose saline through the pit? And must I quit smoking?

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    You can obtain a good result through any approach.  I perform all of them.

Kenneth Hughes, MD

Los Angeles, CA

Augmentation wish list

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I would suggest meeting with a few other board certified PS in your area.  There are many different ways to perform a breast augmentation.  I also typically shy away from the transaxillary approach for several reasons but implant positioning issues is one of them.  Smoking it typically ok in my book since the augmentation incisions are small, but I like it to be 1/2 pack or less per day.  Good luck!

Transaxillary Breast Augmentation

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Thanks for sharing your question and photos.

The decision on how to perform breast augmentation depends on many factors including the patient anatomy and build, and the surgeon's ability to perform the procedure through a variety of techniques.

You appear to be a good candidate for breast augmentation based on your photos, and I would say that the Transaxillary approach can be used.  The key is to select a surgeon experienced in performing Transaxillary Breast Augmentation.

Multiple approaches for breast augmentation work very well, and I frequently perform both transaxillary augmentations and inframammary augmentations.  

Consult with a board certified plastic surgeon to determine what will work best for you.  If you are not satisfied with your first consult then seek another opinion.

Best of Luck to you

Steven M. Camp, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 120 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.