Breast augmentation has been the most popular plastic surgery procedure among women for decades. Breast enhancement surgery can improve a woman’s image in clothing, swimwear, and overall figure. Breast augmentation mammoplasty is the surgical procedure to enhance the appearance of the breast with implants. These implants are surgically placed by creating a submuscular pocket for the implant. Dr. Howard does not prefer implant placement in the sub-glandular (on top of the muscle) position due to the un-natural appearance and the increased risk of capsular contracture (hardening of the implants).
Dr. Paul Howard has helped women from ages 18 to 75 improve their overall physical image with cosmetic breast augmentation surgery in Birmingham for over 20 years. The best candidates for breast enhancement surgery will be healthy and a non-smoker. Women should be of legal consenting age to have any surgical procedure. Prospective patients should also not be pregnant and should wait until at least six months following pregnancy to consider any cosmetic surgical procedure. Women considering breast implant surgery should desire the surgery for themselves personally and not at the request of a spouse or boyfriend.
There are a variety of incisions available for this procedure. Dr. Howard pioneered the use of the endoscope for the trans-axillary (arm pit) incision in the early 1990s and has been a world leader in trans-axillary breast augmentation. Dr. Howard prefers the trans-axillary incision due to its decreased visibility, allows for a small incision (approximately 1 1/2 inches) and less invasion to the breast tissue. The armpit incision is completely safe and has a reduced risk of loss of nipple and breast sensation. It is a plastic surgery myth to believe this incision has an increased risk of nerve damage. In the hands of an untrained surgeon, any surgery has increased risks. Dr. Howard has never had a patient with decreased nipple sensation or permanent nerve damage as a result of the trans-axillary incision.
The trans-axillary incision is only available when using saline implants. The FDA requires a larger incision (approximately 5.5cm) for the surgical placement of silicone implants such as the infra-mammary incision (placed in the crease underneath the breast). The peri-areola incision (around the nipple) is also an available option, but has an increased risked of loss of nipple sensation and hyperpigmentation.
Some surgeons only offer breast augmentation using the incision underneath the breast because it is faster to do in the operating room, requires less equipment, and easier to do. Dr. Howard has used the arm-pit incision for over 20 years.
There are currently two different types of breast implants available: silicone and saline.
Saline implants are the most common and popular choice, they can be used for any surgical incision, and have a life expectancy of around 10 years. Some common disadvantages of saline filled breast implants are rippling, loss of volume due to the age of the implants, and deflation. Saline implants are made of a silicone shell and are filled with sterile saline water during the breast augmentation surgical procedure.
Silicone breast implants were re-approved by the FDA in 2006. Silicone gel filled breast implants are gaining popularity due to a more natural feel and longer implant life. The FDA requires a specific incision length for the surgical placement of silicone filled implants. A disadvantage to silicone filled implants is the FDA recommendation the patient has an MRI periodically since silicone implant failure is not always visually detected.
Natrelle® cohesive silicone gel breast implants come in three different levels of cohesivities. These three different levels allow for more aesthetic possibilities to achieve the desired upper pole fullness. How well that upper pole fullness is maintained when held upright depends on the implant's cohesivity.
Dr. Howard and his staff are committed to providing you with the information you need to make an informed and educated decision about your breast implant procedure. During your initial consultation, Dr. Howard will speak with you personally about the surgery, your expectations, and his professional recommendations to achieve the desired result. During your confidential consultation, a complete medical history will be documented including the current medications you may be taking, family medical history will be addressed, photos will be taken for your medical record, and you will be able to view Dr. Howard’s portfolio of breast augmentation photos. Dr. Howard prefers to measure his patients in order to choose the best implant shape and size to acheive your desired goals. Additional information will be provided to you regarding surgical preparation and recovery.
Dr. Howard performs all of his breast surgeries under general anesthesia at a fully accredited surgical facility. Most breast surgeries last approximately one hour unless additional procedures are required to achieve the desired look. Patients are allowed to go home following surgery. Patients will have a surgical bra and dressing placed on them in the operating room. Patients should not remove this bra and dressing until instructed by Dr. Howard. Most patients will have their first post-operative visit with Dr. Howard 2 or 3 days after surgery.
Patients scheduled for breast augmentation surgery should make plans to be off work for approximately one week. Keep in mind that lifting heavy items is not recommended for two weeks following breast implant surgery. Other preparations to consider:
Your recovery after breast implant surgery will include mild to moderate pain and discomfort. This will be easily controlled with the prescriptions given to you by Dr. Howard. Most patients find sleeping in a recliner or elevated using a few pillows allows them to more easily get in and out of bed and reduces swelling of the surgical area. Dr. Howard recommends the patient expect to be off work for one week following surgery and refrain from physical activity for almost 2 weeks following surgery. Patients with small children should get a friend or relative to assist with childcare, due to the inability to lift or carry them. Dr. Howard does allow his patients to walk on a tread-mill one week following surgery. Patients should avoid sun exposure to the surgical incision for six months following surgery. Patients should drink plenty of fluids following surgery and maintain a healthy, low sodium diet.
Breast enhancement is a surgical procedure that involves a general anesthetic. Although complications are infrequent, all surgeries have some degree of risk. All of us at Paul S. Howard, MD will use our expertise and knowledge to avoid complications in so far as we are able. If a complication does occur, we will use those same skills in an attempt to solve the problem quickly. The importance of have a highly qualified medical team and the use of a certified facility cannot be overestimated.
Infection & Inflammation – A superficial infection may require antibiotic ointment. Deeper infections are treated with antibiotics. Development of an abscess usually requires drainage.
Hematoma – Some post-operative bleeding into the pocket containing the breast implant occurs in 2-3% of women. If the bleeding has been minimal, the body will absorb it with time. Marked swelling, however, usually requires surgical removal of the blood.
Capsular Contracture- Capsular contracture is the most common side effect of breast implants. During surgery, a pocket is created for the implant that is somewhat larger than the implant. A fibrous membrane, called a capsule, then forms around the device. Under ideal circumstances, the pocket maintains its original dimensions and the implant “rests” inside, remaining soft and natural. For reasons that appear to relate to the individual characteristics of the patient, the scar capsule shrinks in some women and squeezes the implant, resulting in various degrees of firmness. This contraction usually begins to form within 6 weeks following surgery and can occur in one or both breasts. Many studies have shown tobacco use and heavy alcohol consumption to be linked to capsular contraction. A surgical revision would possibly be advised to re-create the pocket by removing the capsular scar.
Implant Deflation or Rupture – If, for any reason, the valve or implant shell fails, the saline will leak and be excreted by your body. This causes no medical harm, but requires replacement of the implant in a secondary procedure. The rate of saline implant leakage is quoted at about 1-2% over many years. Breast Implants have basic warranties covering implant replacement and financial assistance of up to 10 years.
Rippling and loss of implant volume- In some thin women, the breast implants may present visible wrinkling or rippling. This usually occurs on the outside of the breasts near the arms. This area of thin skin and the lack of breast tissue sometimes exposes the implant surface producing a rippling effect of the skin. This is not a medical condition and can often be corrected by replacing the saline breast implants with silicone gel implants.
Breast Sensation –Small sensory nerves to the skin surface are occasionally cut when the incision is made or interrupted by undermining of the skin during surgery. The sensation in those areas gradually returns – usually within 2 to 3 months as the nerve endings heal spontaneously.
Dr. Howard’s breast implants prices using Natrelle saline filled breast implants is $2500.00 plus the facility fee. The cost for Natrelle silicone gel level 1 breast implants is $3500.00 plus the facility fee. Dr. Howard prefers to hide incisions in the armpit for saline implants and underneath the breast (in the crease) for silicone implants.
With the new silicone implants now approved by the FDA, many women who have saline implants are deciding to exchange their implants. In addition, many women with first generation silicone implants often desire to exchange their implants to either the new silicone or saline implants. The average life of saline breast implants is 10 years. Although Dr. Howard has numerous patients who have saline implants over 10 years of age and still look great, many patients decide to upgrade their breast implants for a variety of reasons.
Dr. Howard's existing patients receive special pricing for breast implant revision surgery such as replacing implants due to age, size, or to exchange type of implant. Call the office for details.
INDICATIONS Natrelle® Silicone-Filled, Natrelle INSPIRA®, and Natrelle® 410 Shaped Gel Breast Implants are indicated for women for the following: Breast augmentation for women at least 22 years old for silicone-filled implants. Breast augmentation includes primary breast augmentation to increase breast size, as well as revision surgery to correct or improve the result of a primary breast augmentation surgery.
IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS Breast implant surgery should not be performed in: Women with active infection anywhere in their body. Women with existing cancer or pre-cancer of their breast who have not received adequate treatment for those conditions. Women who are currently pregnant or nursing.
WARNINGS AVOID DAMAGE DURING SURGERY Care should be taken to avoid the use of excessive force and to minimize handling of the implant during surgical insertion. Care should be taken when using surgical instruments in proximity with the breast implant, including scalpel, sutures, and dissection instrumentation. Do not treat capsular contracture by closed capsulotomy or forceful external compression, which will likely result in implant damage, rupture, folds, and/or hematoma. Use care in subsequent procedures such as open capsulotomy, breast pocket revision, hematoma/seroma aspiration, and biopsy/lumpectomy to avoid damage to the implant. Do not contact the implant with disposable, capacitor-type cautery devices. Do not alter the implants or attempt to repair or insert a damaged prosthesis. Do not immerse the implant in povidone-iodine solution. If povidone-iodine is used in the pocket, ensure that it is rinsed thoroughly so no residual solution remains in the pocket. Do not reuse or resterilize any product that has been previously implanted. Breast implants are intended for single use only. Do not place more than one implant per breast pocket. Do not use the periumbilical approach to place the implant. Do not use microwave diathermy in patients with breast implants. Microwave diathermy has been reported to cause tissue necrosis, skin erosion, and implant extrusion.
PRECAUTIONS Safety and effectiveness have not been established in patients with the following: Autoimmune diseases (e.g., lupus and scleroderma). A compromised immune system (for example, currently receiving immunosuppressive therapy). Planned chemotherapy following breast implant placement. Planned radiation therapy to the breast following breast implant placement. Conditions or medications that interfere with wound healing and blood clotting. Reduced blood supply to breast tissue. Clinical diagnosis of depression or other mental health disorders, including body dysmorphic disorder and eating disorders. Please discuss any history of mental health disorders prior to surgery. Patients with a diagnosis of depression, or other mental health disorders, should wait until resolution or stabilization of these conditions prior to undergoing breast implantation surgery.
ADVERSE EVENTS Key adverse events are reoperation, implant removal with or without replacement, implant rupture, and capsular contracture Baker Grade III/IV.
Other potential adverse events that may occur with breast implant surgery include: asymmetry, breast pain, breast/skin sensation changes, capsular calcification, delayed wound healing, hematoma, hypertrophic scarring/scarring, implant extrusion, implant malposition, implant palpability/visibility, infection, nipple complications, redness, seroma, swelling, tissue/skin necrosis, wrinkling/rippling.
For more information see the full Directions for Use at www.allergan.com/labeling/usa.htm or call the Allergan Product Support line at 1-800-433-8871.
To report a problem with Natrelle® Silicone-Filled, Natrelle INSPIRA®, and Natrelle® 410 Shaped Gel Breast Implants, please call Allergan Product Surveillance at 1-800-624-4261.
Natrelle® Silicone-Filled, Natrelle INSPIRA®, and Natrelle® 410 Shaped Gel Breast Implants are available by prescription only.