What is the maximum CC's for silicone implants through an areola incision? (Photo)
Doctor Answers 14
Size is a matter of personal preference
The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.
A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would.
HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.
There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular dual plane. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.
The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant.
The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.
Breast Augmentation: Information
Thank you for your story and questions.
Unfortunately with out nude photos and a exam of your tissues I can can only comment based your story, however I hope you find my comments helpful.
1) depends on the size of your areolae
2)400cc will need a 4.5 cm. incision on a stretched areolae
3)areolar incisions have a slight higher incidence of internal scar formation (capsular contracture) than inframammary.
I recommend that you collect a number of "model" photos of your desired appearance and make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
I wish you my best and success,
R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
Areolar incision breast augmentation
The areolar incision is a perfectly reasonable approach to placement of a breast implant. There is no volume specific volume limit, however, the size of your areola may limit what volume will silicone implant may be able to be placed.
Alternatively, saline implants of any size can easily be placed through this incision.
Some studies have shown that the areolar approach can lead to increased capsular contraction and/or nipple sensation changes, however, this is controversial as other studies have not clearly shown a risk.
I would discuss your concerns with your board certified plastic surgeon.
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What is the maximum CC's for silicone implants through an areola incision?
For most patients it is not my favorite incision, there are a few risks that are increased using this incision as compared to a crease incision. If the patient produces excellent scars it hides very well in either location. If the patient does not, having a poor scar around the focal point of the breast can be worse than the same scar hiding in the crease. There is also an increased risk of capsular contracture, nipple numbness and scar depression leaving an indentation beneath the scar in this location.
The size of the areola is the primary determinant of the size of the implant that can be used, and whether that approach is feasible or not. In certain cases, the diameter is so small that not only would it be very difficult to insert an implant, but simply creating the pocket might be impossible because of the poor view of the surgical space.
Lastly, the risks of malposition, reoperation, and capsular contracture are higher via the periareolar approach. Those risks are not excessive, but definitely something to consider when choosing the incision location. Furthermore, in patients who have what I call a "pouty nipple" - more breast tissue under the areola than typical - a scar placed along that border can lead to a worsening of that tethered appearance.
As always, the best advice will come from an in person examination from a Board Certified Plastic Surgeon. Additionally, I always suggest patients look for membership in the state plastic surgery society. You'll find a list of our Utah Members at the safeplasticsurgeryutah website.
Best of luck!
Given the right conditions, the maximum size implant that is manufactured can be placed through the areola if desired
With regard to the risks of the periareolar approach, the statistics show that there is a measurable increase in the incidence of capsule contrature when implants are placed with a periareolar incision versus under the breast, or inframammary. This doesn't mean that we shouldn't use periareolar incisions at all - I do it all the time - we just need to acknowledge and accept this slight increase in risk. Also I believe that there is perhaps a slight increase in the risk of sensory loss to the nipple with periareolar incisions, and although the studies haven't proved it, I inform my patients who have not yet had their babies that because we have to divide some milk ducts and glands to get to the implant space, we could have some loss or decrease in the ability to breastfeed with periareolar incisions.
Those are the general considerations. What is best in your case will have to be determined with a careful evaluation and assessment of your goals and your breasts. It sounds like you already have a decent amount of breast tissue if you're starting with a B cup, and getting to a full C or small D probably won't take a huge implant. Thus, assuming that your areolae are of average diameter, I would bet that a periareolar approach would be technically feasible for you if you chose to go that route, even if you prefer an implant in the 400 cc or larger range. Again, make sure you discuss all of your preferences with a board certified plastic surgeon who can properly advise you on all of your options and all of the risks. In addition to being certified by the American Board of Plastic Surgery, the organization which certifies plastic surgeons, your surgeon should also participate in the Maintenance of Certification program administered by that board. This program requires that surgeons who participate continue to update their credentials and professional standing regularly, as opposed to practicing on a single lifetime certificate like those plastic surgeons who elect not to participate. To find further information about this program and any surgeons you might consider for your surgery, I suggest visiting these sites: abplsurg.org and abms.org. Good luck.
Breast Implants/ Breast Augmentation/ Anatomic Gummy Bear Implants/ Silicone Implants/ Breast Implant Revision Surgery
The size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve. If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.
Silicone will give you a fullness at the top (upper pole fullness).
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.
Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
Best of luck!