Breast Procedure Questions
Should I Choose Breast Implants?
Breast enhancement surgery is one of the most commonly performed surgical procedures in the United States, and in Beverly Hills, breast enlargement is also extremely popular. Every year, hundreds of thousands of women choose to enlarge their breasts for a variety of reasons. To decide if breast enhancement surgery is right for you, you have to weigh the risks to the subjective benefits of the surgery. Since breast implant surgery is elective, you will have plenty of time to research the pros and cons of the procedure and arrive at an informed decision. Take your time, ask plenty of questions and become informed. The aim of this section of the website is to clarify some of most important points with breast implant surgery.
Is There an Age Restriction?
While there is no maximum age limit to having breast augmentation, you must be at least 22 years old to have silicone breast implants. To receive saline breast implants, you have to be at least 18 years old.
How Do I Choose a Breast Implant Size?
There is a scientific method for selecting your breast implant size based on the width of your breasts. A full breast measurement is imperative to assuring that you receive the appropriate size. Of course, you can select an implant larger or smaller than your breast measurements, but you would be risking looking unnatural the further away your selected implant is from your ideal size.
Silicone Gel or Saline Implants?
With modern scientific research proving the safety of silicone implants, most women are choosing silicone breast implants over saline. However, each implant type has its benefits and disadvantages. Saline's dominant benefit is that in case of a rupture, your body will simply absorb the salt water. Saline implants are also slightly less expensive than silicone implants. The disadvantage of saline implants is that they do not feel as natural as their silicone counterparts. There is also a greater risk of rippling with saline implants versus silicone breast implants.
The benefit of silicone breast implants lies in their softness. If you have extremely small breasts, silicone implants will feel much softer since all you are able to feel is the breast implant. In women who have moderate sized breasts prior to breast augmentation, the natural breast tissue camouflages the breast implant to a greater extent than in those with pre-operatively small breasts.
The last difference between saline and silicone breast implants is in the size of incision necessary to insert the implants. Since saline implants are inserted in a deflated state, they can be inserted through the smallest incisions (typically 2 cm long). Silicone breast implants are pre-filled and have to be inserted in their usual size. They require a larger incision (3 to 4 cm long).
Textured or Smooth Breast Implants?
The typical breast implant you imagine probably has a smooth silicone shell containing silicone gel or saline inside. There are also textured silicone or saline implants. The shell of these implants has a fine, sandpaper-like texture. Studies suggest that these textured breast implants have a lower incidence of capsular contracture (excess scar formation around the implant). Some surgeons choose textured breast implants when they are placed over the pectoralis muscle. One of the drawbacks of textured breast implants is the higher risk for developing ridges on the breast implant, which can be visible and palpable. Another potential problem with textured implants is that they inherently develop tissue ingrown within the sandpaper like shell. The breast implants subsequently do not move within their pocket. Normally, if you lay down, your breasts move to each side. A textured implant does not move to the side as you lay down and therefore lacks the natural flow of a normal breast. Smooth shelled breast implants are always moving within their loose pocket and as a result do move to the side as you lay down. Most surgeons choose a smooth-shelled breast implant if placed under the pectoralis muscle. If placed under the muscle, there is no longer a significant reduction in capsular contracture in textured breast implants versus smooth-shelled breast implants.
Round or Anatomical Implants?
Another variable to choose is a round breast implant versus tear dropped, or "anatomical," one. Anatomical breast implants are shaped like a teardrop in order to give the breast a natural flow. Anatomic or tear-drop breast implants typically have a textured shell such that they do not accidentally rotate after breast augmentation.
We offer the latest Mentor Memory Shape breast implants. These advanced implants are teardrop-shaped to create a more natural slope to the breasts. They are ideal for women who have little existing breast tissue, since the the upper portion of the breast slopes down to a fuller lower portion of the breast. These textured anatomic breast implants are fixed and do not change shape with changing body positions. So, even if you are lying flat, your breasts with tear-drop implants will stay in the exact position as when you are standing.
Round breast implants appear perfectly circular when placed on a table. When held upright, however, they will assume somewhat of a teardrop shape as gravity pulls the majority of the gel filling downwards. Still, round-shaped implants will create more fullness in the upper chest for a more obvious enhancement that many women do not prefer. We have a wide range of implant options and can discuss these with you during your consultation.
Which Breast Implant Profile Should I Choose?
The last breast implant variable to choose from is the projection of the implant. As you select larger and larger breast implants, at some point the diameter of the breast implant exceeds the diameter of your natural breast. Women with average chest diameters who desire small to moderate breast implants will typically receive a standard "moderate" profile implant.
If your chest diameter is especially small, or if you select a breast implant diameter that is too large, your breast implant will either touch each other at the center of the chest ("synmastia") or extend too far into the underarms, or both. In order to minimize the risk for synmastia or breast implants that extend too far into the underarms, surgeons choose a breast implant with a narrower diameter containing the same volume. For instance, a standard "moderate profile" 425cc breast implant volume has a diameter of 14.2 cm and a forward projection of 4.2 cm. A "moderate plus" 420cc breast implant has a narrower diameter of 12.9 cm and a projection of 4.8 cm. The narrowest 420cc implant, called "high profile," has a diameter of 12.0 cm and a projection of 5.4cm. You are encouraged to discuss your size preference with Dr. Sayah at his office in Beverly Hills before breast enlargement surgery to ensure that he can guide you through the selection process of an ideal breast implant based on your needs and your anatomy.
What Are the Breast Implant Incisions and Sizes?
Dr. Sayah uses several options:
- Areola: A small 2 to 3 cm incision at the areola border is the most common method of inserting breast implants. The transition in skin color between regular breast skin and the darker areola skin color is the perfect place to hide a scar.
- Under the Breast: Another common site to insert breast implants is the fold under the breasts. As the breasts are enlarged, the breast tissue will typically fold over at the bottom, thereby covering any visible scars as you are standing. When lying down, the scars may be visible.
- Underarm: Using modern endoscopic equipment, which involve pencil-thin lenses and camera systems, a newer site to insert breast implants is through the underarms. The scar is well hidden in the natural folds of the underarm creases. The advantage of the underarm approach is the absence of any scars on the breasts. But, if you experience an atypically bad scar, your underarm will likely be more visible than your breasts. Since it is currently not easily possible to revise or re-operate on the breast through the same underarm scars, the disadvantage to this approach is the possible need for another scar on the breast should another surgery be necessary in the future.
- Naval / Belly Button: The least common location for inserting breast implants is the belly button, or naval. This approach is only possible with saline implants. Implant manufacturers do not approve this approach and void their warranty should you have your breast implants inserted through the belly button.
Should My Implants Be Placed Over or Under the Muscle?
Many studies have demonstrated that a breast implant placed under the pectoralis muscle has a lower risk of becoming hard or developing capsular contracture than one placed over the muscle. The extra layer of tissue or muscle covering the breast implant will further camouflage any rippling of the breast implants. The disadvantage is the weakness associated with the cut pectoralis muscle. Another potential problem is what's called "animation deformity." In such cases, the breast implant shape is distorted every time you tighten the pectoralis. Some surgeons argue that the slightly lower risk of tight capsular scarring around the implant when placed under the muscle does not justify the problems faced by this technique.
If you have droopy breasts, a breast implant placed over the muscle is better able to lift the breasts versus one placed under the muscle.
Should I Choose a Breast Reduction?
If you’ve made the decision to move forward with a breast reduction, you probably have a lot of questions. Although many of these will be addressed at your initial consultation with Dr. David Sayah, we encourage all of our patients to learn as much as they can about their procedure ahead of time.
Conditions Improved by a Breast Reduction
There are a few different conditions that may be improved by a breast reduction:
- Macromastia: The medical term for large breast size, living with macromastia can be frustrating, embarrassing and physically and emotionally painful. A breast reduction helps women resolve the physical discomfort associated with large breasts, which in turn helps them feel more positive about their appearance.
- Back, neck, or shoulder pain: Large breasts can cause persistent back, neck and shoulder pain. These may be due to the excess weight from the breasts, or the poor posture that many large-breasted women adopt in an effort to feel more comfortable. Breast reduction alleviates the physical discomfort associated with larger breast size.
- Asymmetry: If one breast is significantly larger than the other, a breast reduction can reshape the larger breast to a more even size and shape with the smaller breast.
- Ptosis: The changes that occur in skin elasticity with age, combined with the forces of gravity, pull breasts downward over time, particularly in women who are well endowed. Ptosis, or droopy breasts, may also be worsened by pregnancy. At our practice in Beverly Hills, breast reduction surgery is often combined with a breast lift to reduce breast size as well as return the breasts to a higher, more youthful placement.
- Large or downward facing nipples: In some women with large breasts, the breasts and areolae face downward rather than forward, and may seem too large for the breast. When nipples and areolae are in this alignment, or if they fall below the natural crease of the breast, a breast reduction can reposition them. The nipple and areolae can be made more proportionate to the new, smaller breast size during breast reduction as well.
- Lack of firmness: More generous breasts typically lack the high, firm look and feel of smaller breasts. During a breast reduction, the existing breast tissue is reshaped to improve texture and appearance.
Can I Combine a Breast Reduction with Breast Lift?
It’s very common to include a breast lift as part of breast reduction. Breast reduction removes excess fatty and glandular tissue, while a breast lift reshapes and lifts the breast for a higher, fuller look than breast reduction alone.
Is There an Age Restriction?
Although there’s no official age limit in Los Angeles for breast reduction, performing the surgery before the breasts have finished growing may necessitate a second reduction surgery later on. Most women have reached their full breast growth by the very late teens or early 20s.
What Are the Breast Reduction Incisions and Sizes?
Dr. Sayah makes every effort to ensure as beautiful a final result as possible. That’s one reason why he offers new techniques during breast reduction surgery, preferring to limit the incisions to either just around the areola, or around the areola and down the center of the breast (sometimes called a “lollipop lift”). If the incisions are extended outward within the natural crease of the breast, this is referred to as an “anchor scar.” Some women may see significant improvement in breast size through liposuction alone; liposuction may also be incorporated as part of more traditional surgery. The specific technique used during surgery depends on the level of correction needed, and whether or not a breast lift will be included as part of the procedure. Dr. Sayah then closes the incisions using multiple layers of internal stitching to minimize the appearance of the scars during healing.
What Is Breast Reconstruction?
Reconstructive breast surgery restores a natural appearance to the breast following a lumpectomy, or rebuilds the breast following a single or double mastectomy. Reconstruction is typically covered by insurance, and is often included as part of a comprehensive approach toward cancer treatment.
Am I a Candidate?
Candidates for breast reconstruction have lost part or all of a breast or both breasts, typically due to cancer treatment. Candidacy may depend on whether future treatments, like chemotherapy or radiation, are still required following a lumpectomy or mastectomy; some women may need to wait until their other treatments are completed before pursuing reconstructive surgery. The best candidates will be in good health mentally and physically, and have realistic expectations about their results.
Will Insurance Cover Breast Reconstruction?
If your insurance company covered your mastectomy, then they are required by federal law to cover your reconstructive surgery as well. This includes not only reconstruction on the affected breast, but also any procedures that are necessary on the opposite breast to create symmetry.
Should I Choose Breast Reconstruction Right Away, or Should I Wait?
This is a personal choice for every woman, and there isn’t one right answer that works for every patient. Some patients prefer to undergo the initial stages of reconstruction at the same time as a mastectomy. Others prefer to wait for personal reasons, or delay reconstruction for medical reasons until after other necessary treatments are completed.
What Options Do I Have for Reconstruction?
Dr. Sayah offers a number of choices for reconstructive surgery. The easiest and most popular option for breast reconstruction is to use breast implants. Form-stable cohesive silicone gel implants (nicknamed gummy bear implants) offer a beautiful choice for reconstruction, delivering results that look and feel very natural. Flap reconstruction is another option offered by Dr. Sayah. During flap reconstruction, tissue is taken from either the back of the shoulder or the abdomen to reshape the breast. This may be combined with implants, or performed on its own.
What Should I Expect During My Procedure?
Each breast reconstruction will vary depending on the level of correction needed, as well as the preferred surgical approach. Reconstructive surgery typically takes more than one appointment, even if the first surgery occurs at the same time as your mastectomy. It’s also common to include additional procedures on the opposite breast to ensure symmetry, like breast reduction or a breast lift. Breast implants may be used on both sides as well. For implant-based reconstruction, adjustable sizers are placed at first to gradually stretch the skin until the desired size is reached. At that time, the sizers are replaced with permanent implants. For patients undergoing flap reconstruction, Dr. Sayah first removes tissue from a donor area, and then uses that foundation to reshape the breast. In some cases, this may be combined with implants as well. Tissue is also used to form a new nipple, which is then tattooed (along with an areola) for natural pigmentation.
What Should I Expect During Recovery?
It’s normal to feel sore and uncomfortable after a breast reconstruction, especially if tissue was taken from a donor area. The skin may feel tight after reconstruction initially, until your body stretches to accommodate your new contours. Cold compresses can be beneficial to reduce swelling and help you feel more comfortable. Over-the-counter medication helps patients feel more comfortable, although Dr. Sayah can recommend something stronger if needed. The majority of patients are able to return to work within a few weeks.
When Will I See Results?
You’ll see a different in your breasts right away after surgery. However, since reconstruction is a very complex surgery, you may not see your final results for several months, depending on the treatment plan that Dr. Sayah recommends.
Am I a Candidate?
Implants don’t have an expiration date as far as how often they should be replaced. However, if your implants have shifted or become hardened, your breast shape has changed since your surgery, or your breasts look uneven, you will likely benefit from breast revision surgery.
What Are the Signs of Implant Rupture?
In the case of saline implants, a rupture is easy to spot because one breast will suddenly become quite a bit smaller than the other in short time frame, usually a few days. Identifying when silicone implants have ruptured is more challenging, particularly for cohesive gel implants. Any change in texture such as hardening may indicate a rupture. There may be other signs as well, such as an unusual amount of pain in the chest during a routine mammogram. Usually, an examination performed by a reconstructive surgeon is required, and an MRI may be necessary as well.
What Is the Surgery Like?
As far as the patient experience, breast revision surgery will seem very similar to your original breast augmentation procedure. The incisions can many times be made in the same place to minimize further scarring. The real difference lies in the procedure itself. During the surgery, the old implants will be removed, and new implants will be inserted. For some patients, this may mean a change from saline to silicone (or vice versa), or an adjustment in how the implants are placed. For example, if implant shifting was one of the issues which led you to seek revision surgery, Dr. Sayah may opt for placement below the muscle to prevent a repeat performance. In some cases, Dr. Sayah will use advanced techniques and materials to create an improved appearance. He uses Strattice™ Reconstructive Tissue Matrix to reinforce weak tissue during the repair of breast conditions such as bottoming out, fold malposition, symmastia, capsular contracture, and wrinkling or rippling.
What About Recovery?
The recovery from surgery may be similar to the original enhancement procedure. For some patients, the recovery period may feel shorter and easier, while for others the recovery may be longer, depending on the complexity of the surgery involved. If hardened scar tissue has built up around the original implants, the removal of the scar tissue can lead to a longer recovery. Some patients may choose to combine procedures, such as including a breast lift along with the revision surgery. This, too, would lead to a more complex surgery and longer recovery period.
What about Insurance?
Health insurance companies commonly entirely or partially cover breast implant revision surgery. While they may not cover insertion of another breast implant, they typically pay at least partially for removal of your problematic breast implants as well as other procedures necessary for your health. In patients with deformity from prior biopsy or breast cancer, health insurance companies are required to cover at least part of your required breast correction surgery. Once your goals have been discussed and a treatment plan determined, our office will verify your insurance coverage for your desired procedures.
Can I Prevent Future Implant Replacement?
One of the key elements to ensuring a positive implant experience is to follow your post-surgical instructions to the letter. Patients should also practice regular breast massage to assist with healing and minimize the chances of developing rigid scar tissue. Women should avoid activities which carry any risk of chest trauma which could lead to a ruptured implant. The surgeon you choose is also an important factor to achieving the best results.
Will I Need to Replace these Implants as Well?
Breast enhancement, no matter how well it is performed, is not a permanent procedure and implants often need to be replaced down the road. Typically, if the implant replacement is performed more quickly after the initial surgery, another implant replacement will be required sooner than women who did not need a rapid replacement.
Male Breast Reduction
What Is Gynecomastia?
Gynecomastia is the development of breasts in men. This can occur at any age, although it is commonly seen as a response to the hormone fluctuations during either adolescence or in older men. In true gynecomastia, the breasts are composed of both glandular tissue and fatty tissue. However, many men may have the appearance of breasts due to fat tissue alone. The majority of gynecomastia cases have no known cause.
What Is Male Breast Reduction?
Male breast reduction is a surgical technique that helps men restore the masculine lines of their chests. Through a combination of surgical excision and liposuction, the excess tissue is removed, and men can enjoy a more muscular appearance again.
Am I a Candidate?
The ideal candidate for male breast reduction will notice the development of breasts on the upper chest, either due to fat deposits or abnormal glandular tissue growth, that have not been resolved through diet or exercise. Candidates should be in good health both mentally and physically, and maintain realistic expectations about the results of their surgery.
Will Insurance Cover My Procedure?
In many cases, male breast reduction is covered by insurance. We are happy to work with your insurance company so that you have coverage for the procedure. If you have any detailed questions about insurance coverage, please do not hesitate to give us a call.
Can I Combine Male Breast Reduction with Other Procedures?
It’s very common to combine male breast reduction with additional procedures that sculpt the chest and abdomen. Liposuction is often incorporated as part of the surgical process, but may be used through other areas of the belly or torso for fine tuning. A male tummy tuck can also help slim the lines of the midsection to complement your chest.
How Do I Choose the Right Surgeon for My Male Breast Reduction?
A board certified plastic surgeon who has extensive training in both cosmetic and reconstructive surgery will deliver the best possible results. You should also choose a surgeon you feel comfortable with, and one whose before and after photos make you feel confident in their work. Some patients choose a surgeon based on recommendations from friends and family who have undergone male breast reduction with good results.
Will My Results Look Natural?
The goal of every male breast reduction is to deliver natural results that leave patients feeling more positive about their bodies, not looking “done”. Choosing a board certified plastic surgeon with extensive experience will go a long way toward ensuring a great outcome.
When Will I See Results?
You should notice a difference in your appearance almost immediately, although any bruising or swelling will initially disguise your improvements. After a month or two, you should have a good idea of your final results, although many patients continue seeing progress even after this time.
Is There Anything Else I Should Know?
Although gynecomastia surgery is a permanent procedure that will improve the appearance your chest, it will not prevent future weight gain in the area. Your chest will continue to change due to age and other factors, although you will notice a significant improvement compared to not having chosen surgery at all.*