Your Questions
Your Questions
Q: Dr. Eppley, I would like to know your experience with breast augmentation revisions. Is this something that you have done often? I am considering revision from saline to silicone and believe I’d like to go smaller. My previous surgical site for the augmentation was axillary and can this be done again with a revision? Any information you can provide would be greatly appreciated.
A:Any plastic surgeon that performs a substantial number of breast augmentations will perform secondary breast implant surgery, given desires of changes in size later in life, change in breast shape due to pregnancy and weight loss and the eventual failure of most breast implants over a patient’s lifetime. So yes I have done many breast implant exchanges and revisional surgery.
I believe you are asking if your existing saline implants could be replaced with smaller silicone implants through your already present axillary scars. The answer to that question is maybe…and it depends on what size silicone implant needs to be inserted through such a small incision. In days past, I would say it would not be adviseable unless the silicone implants are fairly small (under 350ccs). But with today’s funnel insertion technique, much bigger silicone breasts implants can now be placed through much smaller incisions.
Dr. Barry Eppley
Indianapolis, Indiana
Breast augmentation continues to be one of the most popular and successful body contouring procedures in plastic surgery. While it may seem hard to make the association of breast enhancement with confections and desserts, they are more closely related than one would think. This is because of two recent technological advances in the type of breast implants that are available and how they are implanted at the time of surgery.
One important, but often overlooked, aspect of the surgical implantation of breast devices is getting them placed into the breast pocket. When only saline implants were available this was never a concern as they were inflated after they were placed. This meant that very small incisions could be used for their introduction that were not even on the breast. Rolled up like a burrito, a saline implant is inserted through a one inch incision and then inflated to the desired size. With the re-introduction of silicone breast implants in 2006, larger incisions are needed as they are pre-filled and must be inserted as such.
This makes the issue of larger scars with silicone breast implants a concern for some patients. Plastic surgeons will frequently push and cram the breast implant through a small incision because of this concern. Needless to say, this technique is not good for the implant and undoubtably weakens its shell and leads to premature rupture and the early need for replacement. That has all changed with the introduction of an improved delivery method.
Known as the funnel, and looking exactly like what is used to decorate a cake, the breast implant is now easily propeled into the implant pocket….all without ever touching the implant or squeezing it too hard in one place. This incredibly simple but highly effective delivery method now makes it possible to use very small incisions again and even do silicone gel breast augmentation from a remote armpit incision.
As silicone gel has returned as an implant option to saline, it has again become a sought after breast implant material. With no risk of ever spontaneously deflating like a saline implant can (and eventually will), its more natural feel makes it a very popular choice. While the health concerns from the early 1990s with silicone has long been dispelled, the concern about rupture and what happens to the material persist. This has lead to the development of advanced silicone materials that hold together more like a solid, resulting in what is known as the gummy bear breast implant.
The gummy bear breast implant is more than just a cute nickname. It is a reflection how the silicone filling looks and feels…soft and spongy. And just like those cute little red, green and yellow bears, you can push and pull on it and even cut the material and it won’t lose its shape. The physical similarity between this new implant and the candy are striking and it is no wonder how it got tagged with this name.
Breast augmentation continues to get better and more safe as the materials and techniques to deliver them improve. This gives women more options to choose what they feel best fits their bodies.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in breast augmentation and want silicone implants. But I am Hispanic and am very worried about any scars on my breasts. I have been to several plastic surgeons and they all have said that silicone implants need to be put in through an incision on the bottom of my breasts. They say only saline implants can be put through an armpit incision which is what I want. I have had numerous cuts on my body since I was a child and the scars all get dark and don’t go away. So even though the doctors say the scar under my breast will heal and look good, I know better based on my own body’s experience. Is there any way silicone implants can be put in through my armpit?
A: While once very difficult to get any size silicone implant in through the small armpit incision, that problem has now been solved. A brand new insertion or delivery device is now available for silicone breast augmentation. Known as the Keller Funnel, this funnel-shaped wrap allows the implant to be gently squirted into the breast through very small incisions, including the armpit one. Looking like a pastry chef applying icing to a cake, the breast implant is placed into the funnel and then squeezed out of its smaller end. This means not only can even large silicone breast implants be put in through smaller lower breast crease and nipple incisions, but they can now routinuely be inserted through an armpit incision as well. This will be of great interest to non-Caucasian breast augmentation patients, particularly those of Hispanic ethnicity who tend to get scar hyperpigmentation. The other great benefit of Funnel Breast Augmentation is that the implant is not touched from the product packaging to the breast pocket. This also reduces the risk of infection after breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana