Breast Augmentation in New York City, NY

Dr. Aston has written textbook chapters for plastic surgeons on breast augmentation. Breast augmentation is one of the most frequently performed cosmetic surgery procedures around the world. Breast augmentation can give women with small or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of saline or silicone implants under the breast. Dr. Aston knows that every woman is unique in both her body shape and desires, and he takes the time during the pre-operative consultation to learn what each patient hopes to gain from breast augmentation. New York breast augmentation surgeon, Dr. Aston, helps decide which implant type and which implant type and implant placement is best for the individual patient. In this way, every one of our patients enjoys completely customized treatment designed with her specific goals in mind. When patients have drooping of the nipple-areolar complex such that a simple augmentation will not give an aesthetically pleasing result, Dr. Aston will recommend a breast lift operation in conjunction with a breast augmentation.

Breast implants are silicone shells filled with either saline (salt water) or silicone gel. A new implant, recently available, called a Structured Implant, is filled with saline but has more the feel of a silicone implant. All three implant types are very safe and each offers its own advantages. We will help you decide which kind is right for you. During surgery Dr. Aston places the implants behind the pectoral muscle on the chest wall in the vast majority of cases. It is his feeling that only a small percentage of patients are candidates for the implants placed on top of the muscle.

In October 2006, the U.S. Food and Drug Administration (FDA) approved silicone breast implants for breast augmentation surgery. There had been a 14-year-old ban on silicone implants to study whether silicone implants were related to any systemic disease process. After multiple studies and investigations, it was determined that it was safe to offer both silicone gel-filled and saline-filled implants. At the time of your consultation, Dr. Aston will discuss in detail the choice of implants best suited for your and the pros and cons of saline versus silicone.

SALINE BREAST IMPLANTS

Saline implants have always remained a positive choice for patients when deciding what type of implant to use for breast augmentation. Because these implants are filled with a sterile saltwater solution, any potential leakage does not pose a threat as the solution is safely absorbed by the body. Saline implants also cost less than the silicone type. One of the disadvantages of saline implants is that in some cases rippling can appear. This is especially something to consider for women who are thin. Those who opt for this type of implant must be at least 18 years old.

SILICONE BREAST IMPLANTS

Silicone breast implants are the most popular today in Dr. Aston’s patients and are highly recommended by surgeons for patients who are thin and desire a natural look. Since the FDA validated their safety and efficacy, safety concerns surrounding these implants are today almost no different than that of saline. The silicone shell is prefilled with silicone gel and comes in different sizes, shapes, and textures. Unlike saline implants in which leakage is absorbed by the body and implant volume appears visibly flat, it is difficult to tell when a silicone implant ruptures. An MRI is required to detect any rupture. Patients considering silicone implants must be at least 22 years old.

FAT TRANSFER

For patients who desire fuller breasts but do not want an artificial implant to achieve this look, there is also an option known as a fat transfer. In this procedure, the doctor will harvest fat from donor sites of the patient, such as the flanks, abdomen, and thighs via liposuction. The fat collected will undergo a process of refinement and purification, and then gradually reinjected into the breasts with smaller syringes so the shape is evenly distributed.

IDEAL IMPLANTS

Dr. Aston is proud to offer women a new choice for breast implants. The Ideal Implant is a structured implant that looks and feels like silicone, but offers the peace of mind that some patients find with saline-filled implants. The Ideal Implant is only offered through a select number of board-certified plastic surgeons and was found to be safe and produce gorgeous results through almost a decade of clinical trials. The implant has a double-layer inner shell, which holds the inner saline filler, and an outer shell, which holds the outer saline filler. The design and architecture of this implant includes a layer of baffle shells which controls movement of the saline and gives the implant a natural feel similar to a silicone implant. During the initial consultation, Dr. Aston will discuss this new, innovative implant, as well as saline and silicone implants.

Breast augmentation procedures last approximately one and half to two hours and are typically performed with general anesthesia. Local anesthesia with intravenous sedation is possible for some patients. Incisions are made in inconspicuous places to minimize scar visibility. The incisions may be in the armpit (transaxillary), in the crease on the underside of the breast (inframammary), or around the areola, the dark skin around the nipple (periareolar). Dr. Aston does not place breast implants through an incision in the naval. He feels that this technique has many faults and is not in the best interests of his patients.

Most patients feel tired and sore after breast augmentation surgery, but this usually passes in a day or two. Many patients return to work within the week. At the time of surgery Dr. Aston places a saran wrap type bandage over the incision in order that you can get in the shower the same day or the morning following surgery. The stitches are removed in 5 to 6 days after breast augmentation. Any post-operative pain, swelling and sensitivity will usually diminish in two to three weeks. Dr. Aston permits his patients to resume full aerobic activities on the 21st day after augmentation. Scars from breast augmentation incisions will begin to fade in the first few weeks and will continue to fade for several months.

Complications following breast augmentation surgery are uncommon but do occur. While rare, they may include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, and breakage or leakage of the implant (implant rupture) as a result of injury or abnormal compression of the breast. Patients in the appropriate age range can have mammograms after breast augmentation. Regular monitoring of breast implants after breast augmentation is recommended to ensure continuing breast and implant health.

There are several manufacturers approved by the FDA:

• Natrelle by Allergen – silicone- and saline-based implants
• Mentor – silicone- and saline-based implants
• Sientra – silicone-based implants

PROFILE

Breast implants come in a variety of different profiles. The selection is based on how enhanced the breasts’ projection would be, as well as how wide the implant will be on the chest wall in relation to the base width. Since the silicone implants are already pre filled, the standard profiles come in low, moderate, high, and extra high. Saline implants also come in variations in sizes and shapes. Choosing the right profile can sometimes be a difficult decision and it is up to a skilled surgeon to help guide the patient accordingly. High profile breast implants will have greater projection, but less width on each side, whereas a moderate profile, for example, will not have as much projection, but will be broader.

SHAPE

The standard shape of a breast implant can either be rounded or tear-shaped. Each shape serves a different aesthetic function as it pertains to the patient’s goals. Rounded implants produce a shapelier curve on the top portion of the breast. The teardrop implants are shaped to copy the natural appearance of the breast, but are not a good choice for most patients.

TEXTURE

Implants are made with either a smooth or a textured surface. In general, smooth implants cost less and are more common. The textured implants were initially conceived out of the idea that it reduces the chances of capsular contracture (the constriction of scar tissue around the implant) although there is no valid claim to this. The textured type is more common with the teardrop shape as the rough texture adheres to tissues helping the implant stay in place.

IMPLANT PLACEMENT

The two most common placements are on top of the chest muscle or under it. When the implant is placed under the muscle, a pocket is created under the pectoralis major muscle. A pocket is also created if it is placed in front of the muscle, but Dr. Aston prefers the submuscular approach (behind the muscle).

INCISION TYPE

There are several standard incision approaches for breast implants. The most common is known as an inframammary incision, which is an incision near the breast fold. Second, is an incision made under the areola, which is known as a periareolar incision. A third option is to place the incision within the armpit, known as a transaxillary approach. It is up to the patient’s desires and surgeon recommendation as to what approach is best to take.

NATURAL OR ARTIFICIAL?

This depends on the patient’s breast makeup. Those who opt for implants may choose between saline or silicone as each has its own advantages. Generally, patients who have a small amount of breast tissue will benefit from silicone implants.

SILICONE RISK?

Negative notions about silicone started back in the early 90s when there were cases of leakage and complications. With today’s advancements in engineering, the silicone-based shells are made durable and safe, and have been proven so by the FDA. Today, in fact, silicone is more preferred than saline since they last longer and feel more natural. The rates of reported complications have significantly decreased in the last decade.

IMPLANT OR LIFT?

Breast augmentation is a cosmetic procedure designed to enlarge breasts while a breast lift is designed to tighten the loose skin of a droopy breast. Both resolve different breast issues. There are cases that the procedures are simultaneously done when it is agreed that a breast lift with augmentation is necessary.

SILICONE LEAKAGE?

Today’s silicone implants are strong, durable, and safe. Technical advancements have come so far that even if a silicone implant does rupture, the shell of the implant will keep the silicone gel encased and protected from entering the body. In a rare case that a silicone implant does rupture, an MRI will be needed to detect the rupture. This is the main reason why MRI checks are recommended 3 years after surgery and every 2 years succeeding the first MRI.