Breast Augmentation San Antonio

Breast Augmentation remains the #1 cosmetic procedure in the US! Scores of women have received breast implants going back almost fifty years. Annually over 100,000 women in the U.S. undergo breast augmentation (also known as breast enlargement).

Many women I see for Breast Augmentation are worried about being too big. However, women seeing me for Breast Augmentation by definition want to be bigger! So……

How do you pick the right size breast implant?

Everyone understands volume when it comes to breast implants. And many women have a friend or relative who has had Breast Augmentation and therefore may think that they want the same volume (“She looks great with 450cc and so that is what I want.”)

Volume is only PART of the story. The WIDTH of the breast is also critically important. So a wider breast needs more volume than a narrower breast to achieve the same look. And we want to match the width of the implant to the width of the breast — too narrow and there is too much space between the breasts, and too wide and they extend into the armpit.

Look at this simple graphic. There are cross-sections of two different breast implants. They both PROJECT a similar amount (stick out away from the chest), but the wider implant (orange) will require a LOT more volume than the narrower implant (yellow). So to compare one persons implants to another may be like comparing apples to oranges if they have different breast widths.

Also, consider the Sizing Equation:
Breast (total) = Breast Implant + Native Breast Tissue.

So a woman who brings more native breast tissue may need less implant than a woman with less tissue to achieve a similar look.

For a given width of the breast, a woman generally has three basic choices with respect to the Implant Profile. While they go sometimes by different names, I think of them as low, medium, and high profile.

So for a given width, a woman essentially has three choices. True, a woman’s breast is not exactly one width down to the millimeter, but that is the idea. In saline implants, the same idea applies, but instead of being one volume, there is a volume range that comes with each profile.

I caution against having preconceived notions about the Implant Profile. I think it is a dependent variable–in other words, let’s figure out what size you want to be, and then that tells us what profile we need to use. And sometimes what would be high profile in silicone ends up being medium in saline…so don’t get too worried about the profile.

Ultimately, we try on sample implants on top of the patient’s breast and in a bra to simulate the final look. And while the total shouldn’t change whether the implant is on top of the breast in a bra or under the skin, if anything once they are in patients tell me they feel just a hair smaller.

And when I go to surgery, you and I will both know exactly what implant we are going to put in. In other words, I don’t decide what I think looks good when you are asleep; together we make a plan in the office and then I execute it. My ultimate goal is to help you figure out what you want and then provide it for you.

Saline or Silicone?

Both saline and silicone implants are good products for Breast Augmentation. There are pros and cons to each.

The biggest difference is that silicone feels softer and more breast-like. You might think that saltwater, being very fluid, would be softer, but when it is under a little tension it is typically firmer. As an example, a basketball is filled with air, but is is not soft and billowy.

Now, if you had a large breast and put in a small implant, the way it feels would not be very important. However, you can deduce that large-breasted women do not typically show up to get small implants.

Visually I think they look the same as long as the saline implant is filled to within the manufacturer’s fill range. Saline implants are filled up during surgery, whereas silicone implants are pre-filled from the manufacturer. So if a person has implants that we will loosely term “ridiculous” in size, it is likely a saline implant that has been overfilled.

I do believe that silicone has less “rippling” than saline. I think the higher viscosity of the silicone resists this. I think it is also more common in lower profile implants that are filled higher. If you take something designed to be shaped more like a fat pancake and overfill it, it tries to become a sphere, with the resultant lateral scalloping.

One negative about silicone is the history of the Silicone Controversy. Silicone implants were pulled from the market in 1992, over concerns that ruptured silicone implants were making women sick. Well, how does one know if anything causes anything? As a silly example, a woman may think, “I got silicone implants and my dog died.” Intuitively, those events are unrelated. But if a person got implants and then developed an illness……how do you know if they are related?

The answer is Science. If you compare smokers non-smokers, science tell us that you are more likely to get lung cancer as a smoker. You can still get it as a non-smoker, but it is much more likely as a smoker. So we conclude that there is something about smoking that causes lung cancer.

When they did the science on ruptured silicone breast implants, they determined that there is no evidence that ruptured silicone implants cause any systemic disease in women. It might cause a local problem in the breast, like hardening of the implant capsule, or a lump of silicone, but no systemic issues. So in 2006 the FDA put them back on the market. During the time they were off the market in the US, they were never off the market in South America and Europe. LOTS of women have received silicone implants.

Also, understand that there are different types of silicone, just as there are different types of plastic, or metal. Silicone can be classified as oils, gels, and elastomers. The silicone pre-1992 was runnier (an oil). Now it is gooier (a gel). Even on a saline implant, the shell is made of silicone elastomer. Silicone elastomer is used, by the way, in multiple different types of medical devices, such as catheters, lines, tubes, etc.

A small point worth considering is that when a saline implant fails, the saltwater is absorbed by the body and excreted in the urine. It is not a medical emergency but it may be a cosmetic emergency. Think of a flat tire. If this happens, say, two weeks before your daughter’s wedding….you can see the issue.

Silicone implants are a little bit more expensive than saline implants. Saline implants are FDA-approved for women 18 and older. Silicone implants are FDA-approved for women 22 and older. The FDA recommends MRI’s three years after surgery and then every 2 years after that for silicone implants.

Other Variables

Breast Implant Incision Location:

Options include beneath the breast, around the areola (nipple), or in the armpit. Most of the time, especially for silicone implants, we need to go beneath the breast in the inframammary fold (where the bottom of the breast meets the chest). My experience, especially if the breast has any degree of sag, is that the patient almost never sees this incision.

In the above picture, there is a linear scar just below the pen. (The patient is lying down.) This is five years out from surgery by me. The pen is for scale. The photo is not altered in any way.

Shell:

Implants come smooth and textured. I believe that textured implants fail more than smooth implants. Therefore, I almost always use smooth implants.

Implant Shape:

Implants chome round or shaped. While some women think that a shaped implant will be better, I do not like these for a few reasons. One, they have to be textured to help them not rotate inappropriately after surgery (a problem a round implant does not have). Also, they seem not to give enough fullness to the bottom half of the breast. By contrast, a round implant under the muscle essentially assumes a teardrop shape, but can rotate without causing a problem. I almost always use a round implant.

Pocket:

This is the under-the-muscle versus on-top-of-the-muscle issue. The muscle is the pectoralis major. Even under the muscle there is some areas inferolaterally where the implant is not covered by the pec (think about the pec’s shape). But the muscle helps fill in the upper pole of the breast, and under the muscle helps prevent capsular contracture. I almost always go under the muscle on a first-time breast aug.

Recovery

I use a 24-hour recovery technique. What this means is that usually (but not always), patients feel pretty good pretty quick. Most people feel like they worked out hard at the gym or they feel like their milk came in. I ask people not to work out for two weeks, to prevent bleeding, but they are fine to go to dinner, or the movies, or similar activities that are not strenuous. They can drive when they can work their arms without restriction from pain and when they are off narcotic pain pills.

The implants ride high at first, and they settle a bit over time. I think they are mostly settled by 3 months.

Breast Augmentation Surgery Cost

Unfortunately, there are costs associated with cosmetic surgery and with San Antonio breast augmentation in particular. Saline implants are a little cheaper than silicone implants. Let me be clear-my first goal is to provide quality care and meet your expectations. Fees are an unfortunate byproduct of the process. We treat every patient as an individual. While we might be able to give you an idea of costs over the phone, we really need to see you to give you an exact cost. And when we quote fees we will quote you the entire costs-facility, anesthesia, surgeon, and any other ancillary fees. Usually the only extra costs are prescriptions. See my post entitled Plastic Surgery Cost explained for more information.

Conclusion

I view my job as providing you with education and options. I want to help you determine what is best for you. I have no hidden agenda for silicone versus saline, or large implants versus small implants, or whatever. I just want to help you reach your goals!

Feel free to browse my breast augmentation photo gallery, but realize that the choices other people make may be different than the choices that you make. In other words, someone else may have chosen larger or smaller implants than you personally might like.

Contact us and call the office at 210-495-4100 during business hours for more information. My staff is very helpful and can answer lots of questions. You are welcome to come visit them at no cost and they can show you everything you ever wanted to know about breast augmentation!

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